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clear. Also, her sibling had recently commented that the appearance of her skin was worsening, which prompted her to seek treatment with me. The consultation revealed that she had a limited budget and that she did not wish to have the downtime associated with conventional chemical peeling due to work commitments. Following her assessment, I diagnosed PIH secondary to acne. I explained in detail about the causes of acne and hyperpigmentation at a cellular level, as I often find that understanding this aids compliance with the Dr Simi Adedeji treats a patient’s concerns subsequent skincare routine and therefore helps in while factoring in a budget achieving optimal results. An important part of the consultation was managing patient expectations The treatment of acne and hyperpigmentation can pose a with regards to what could be achieved, depending on whether particular challenge in many patients, more so in skin of colour the pigmentation was epidermal or dermal. Usual methods of where the tendency to form hyperpigmentation is greater.1 Without determining this include stretching the skin to observe for lightening appropriate precautions, attempts to treat the hyperpigmentation of the pigmentation or using Wood’s lamp; however, I have found that may inadvertently worsen the condition. It is estimated that by 2050, Wood’s lamp is not effective in differentiating between dermal and nearly one half of the US population will have skin of colour.2 epidermal pigmentation in Fitzpatrick type VI skin. According to the last UK consensus in 2011, 40.2% of residents Because of the history of how the pigmentation developed, my in London identified as non-white,3 and 14% of the population in findings on examination of her skin, combined with my professional England and Wales is non-white. As the incidence and prevalence of experience of treating previous similar patients, I classed her post-inflammatory hyperpigmentation (PIH) is likely to continue to rise pigmentation as predominantly epidermal. In my experience, this it is important that aesthetic professionals, especially in and around type of hyperpigmentation is much more responsive to chemical London, understand how to treat PIH effectively. resurfacing or peels than dermal pigmentation, which may require Hyperpigmentation, especially when it affects the face, has a different interventions such as laser for effective treatment.7 social stigma attached to it and can cause the sufferer significant Before treatment it was vital that my patient understood that the psychological distress as it can take years to resolve,1 thereby treatment was a journey, rather than a one-off intervention. impacting on confidence and quality of life.4 Additionally, by the time a patient approaches an aesthetic Pre treatment practitioner for help with this condition, they will usually have used Taking into account the patient’s budget and preference of minimal numerous over-the-counter products at a considerable expense, peeling, I created a personalised treatment plan which consisted of a so their trust and confidence is at a low. It is therefore important to course of chemical skin resurfacing using gentle combination acids, be able to treat PIH correctly and effectively. A standard approach supported by a homecare regime. As requested by the patient, the would likely be chemical peel treatments, but as the patient wanted skin will not experience the level of peeling associated with traditional to specifically avoid this, the case study describes the treatment of chemical peels from this treatment. acne and PIH in skin of colour, using non-hydroquinone products I recommended a course of six treatments performed two weeks and skin-resurfacing acids. apart in clinic; however, for budgeting reasons we revised this and spaced the treatments out so that they were four weeks apart.
Case Study: Treating Acne and Hyperpigmentation
Patient presentation My 27-year-old female patient with Fitzpatrick skin type VI presented to clinic complaining of acne scarring. At the time, she was wearing makeup and no obvious acne scarring was visible. When she returned for her formal consultation, she attended without makeup and it was clear that the scarring she was describing was in fact hyperpigmentation. During the consultation, we discussed and prioritised her areas of concern, how the condition affected her emotionally, her aesthetic goals and any previous treatments she had tried. She described suffering from acne breakouts, which left dark marks on her skin including a line of pigmentation across her nose (known as the allergic salute sign), from habitually rubbing her nose.5,6 These marks were her primary concern and they were extremely dark compared to her normal skin tone. She had previously tried numerous over-the-counter products and a chemical peel at another aesthetic clinic, which had not helped. During the consultation, I noticed that she seemed embarrassed by her skin and maintained poor eye contact. Her main concern was that the blemishes were lasting a long time (months to years) and that she was developing new spots before the blemishes had time to
Hyperpigmentation, especially when it affects the face, has a social stigma attached to it and can cause the sufferer significant psychological distress
Reproduced from Aesthetics | Volume 7/Issue 2 - January 2020
