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More Multicultural: Handling Post-inflammatory Hyperpigmentation

By: Christine Heathman
Posted: January 4, 2013, from the March 2013 issue of GCI Magazine.

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One of the most common pigmentation disorders of those with darker skin is PIH, which is one type of pigmentation morbidity. PIH can be considered the default pathophysiologic response to cutaneous injury of darker global skin of colors. This response is the belief predicated on the labile response of melanocytes to irritation or inflammation. The common link to any pigmentation disorder is inflammation. Darker skin differs from Caucasian skin in its reactivity and clinical presentation. Although ongoing research continues to unveil aggravating factors, significant prudence in understanding this problem still remains to be practiced in the area of ethnic skin disorders to properly manage them.

The basis of pigmentation morbidity can occur as the result of cumulative exposure to UV light, making it a major culprit in melasma, solar lentigines and ephelides. Many medications, cosmetics and inflammatory skin diseases, in addition to adverse reactions to chemical peels, ingredients, pesticides, chemicals, detergents, heat, laser resurfacing, laser-assisted hair removal and skin injuries can also be a source of pigmentation disorders.

PIH is caused by one of two mechanisms that result in either epidermal melanosis or dermal melanosis. These constituents of inflammation alter the activity of both immune cells and melanocytes. Specifically, these inflammatory components stimulate epidermal melanocytes, causing them to increase the synthesis of melanin and subsequently to increase the transfer of pigment to surrounding keratinocytes. This increased stimulation and transfer of melanin granules results in epidermal hypermelanosis.

Dermal melanosis occurs when inflammation disrupts the basal cell layer, causing melanin pigment to be released and subsequently trapped by macrophages in the papillary dermis, also known as pigmentary incontinence.

Accept the Challenge

PIH is a universal response of the skin and can occur in lighter global skin categories, but is more common in the darker global skin types. This condition can occur at any age and takes place in both females and males. Inflammation is the trip wire to hyperpigmentation, and skin can have many levels of damage that require assessment to determine how to manage pigmentation disorders.

Are you prepared to accept the challenges of working with skin of color? Beautiful skin, sex appeal, sophistication and good looks have always been a desire of all cultures.

Christine Heathman is a licensed master esthetician, massage therapist and burn specialist with more than two decades of clinical practice and research at institutions such as Stanford University in Palo Alto, California, and the University of Utah in Salt Lake City. Honored in 2003 as an industry legend by the American Association for Esthetics, she believes the future of skin care is now.

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