Decoding Scarring and Dyschromias in Deeper Skin Tones: Insights from Dermatologic Treatment Protocols

Our skin, with its rich spectrum of colors, reflects the beautiful diversity of humanity. Unfortunately, within scientific literature and investigation, skin of color often gets left out of the discussion. As a result, treatments for this population have not been given the attention that they deserve.

At the Scar Healing Institute, we make it a priority to offer safe and varied treatment to all of our patients. In this blog post, we draw upon insights from dermatologic treatment protocols to explore the complexities of scarring and dyspigmentation in darker skin tones.

Understanding Scarring:

Scarring in deeper skin tones presents distinct characteristics compared to lighter skin tones. Conditions like keloids and hypertrophic scars are more prevalent, characterized by raised, thickened tissue extending beyond the original wound area. Trauma, burns, acne, or surgical incisions can trigger these scars. The heightened melanin production in deeper skin tones often leads to post-inflammatory hyperpigmentation (PIH), where scars darken and persist long after the initial injury has healed.

Managing Scarring:

Dermatologists rely on a range of treatment modalities to address scarring in individuals with Fitzpatrick skin types IV to VI, as outlined in this article. These may include:

1. Topical Treatments: Harnessing the efficacy of hydroquinone, retinoids, and azelaic acid to mitigate hyperpigmentation and encourage cellular turnover.
2. Laser Therapy: Leveraging fractional lasers, fully ablative, vascular, Q-switched, or pulsed dye lasers to target scar tissue, promoting changing in collagen synthesis and restructuring for improved texture and reduced pigmentation. When pursuing laser therapy, we recommend expert providers who have experience treating skin of color. Proper usage of the laser is critical to successful cosmetic outcomes. Since some of these laser wavelengths compete with the melanin in the cells, a precise user like those at the Scar Healing Institute  is key!
3. Intralesional Injections: Administering corticosteroids directly into keloid or hypertrophic scars to flatten and soften their appearance.
4. Surgical Interventions: Employing precise excision techniques followed by meticulous closure to minimize the risk of recurrent keloids or hypertrophic scarring.

Understanding Dyspigmentation:

Dyspigmentation encompasses irregular changes in skin coloration, often appearing as uneven patches or spots. In individuals with deeper skin tones, dyspigmentation can manifest as PIH, melasma, or hypopigmentation. Factors such as inflammation, hormonal fluctuations, and sun exposure exacerbate these conditions, contributing to emotional distress and self-esteem issues.

Managing Dyspigmentation Beyond the Treatment Setting:

To effectively manage dyspigmentation in deeper skin tones even after treatment, dermatologists may recommend two main things:

1. Topical Agents: Prescribing depigmenting agents like hydroquinone, kojic acid, or retinoids to fade dark spots and promote even skin tone.
2. Sun Protection: Emphasizing the importance of daily sunscreen application with broad-spectrum SPF to shield against UV-induced pigmentation.

Scarring and dyspigmentation pose significant challenges for individuals with deeper skin tones, impacting both appearance and emotional well-being. However, with insights gleaned from dermatologic treatment protocols, there is promise for improvement. By comprehending the unique needs of Fitzpatrick skin types IV to VI and implementing tailored interventions, dermatologists can empower patients to achieve clearer, more radiant skin, restoring confidence and enhancing quality of life. If you’re grappling with scarring or dyspigmentation concerns, consulting with a qualified dermatologist can provide personalized care and guidance tailored to your individual needs and goals.