17 January 2024
Dr. Seemal Desai shares insights on effective procedures for pigmentary disorders in patients with darker skin tones.
In the field of dermatology, addressing the specific needs of patients with skin of color has long been a challenge. However, recent advancements in procedures and therapies have opened up new possibilities for treating pigmentary disorders in these patients. Dr. Seemal Desai, a renowned dermatologist at Innovative Dermatology in Plano, TX, recently shared invaluable insights on this topic at the 2024 Winter Clinical Hawaii Dermatology Conference. His expertise and recommendations shed light on the most effective and safe procedures for patients with darker skin tones.
Acne and Post-Inflammatory Hyperpigmentation:
One of the most common concerns for patients with darker skin types is post-inflammatory hyperpigmentation resulting from acne. Dr. Desai emphasized the effectiveness of chemical peels as a cost-effective and impactful solution. He stressed the importance of patient preparation to optimize results, including discontinuing topical retinoids at least 7 days prior to treatment. Pre-treatment with hydroquinone was also recommended to prime the skin for the chemical peel. Dr. Desai shared his preferred chemical peeling agents, such as glycolic acid, salicylic acid, and trichloroacetic acid (TCA). He challenged the traditional understanding of TCA, stating that it can work as a superficial chemical peel at lower concentrations.
Dr. Desai introduced mandelic acid as an effective addition to chemical peels for treating melasma. He referenced a study supporting the efficacy of mandelic acid 40% in treating this condition. He also introduced the concept of “chemical peel cocktails” or sequential chemical peels, where multiple ingredients are layered in one session to provide quick and efficient results. These procedures can be done in less than 10 minutes in the office, making them highly convenient for both patients and dermatologists.
Acne Scars and Dark Circles:
Addressing acne scars, Dr. Desai recommended a combination of Jessner’s solution and 20% TCA. He highlighted the synergy achieved by combining alpha (mandelic acid) and beta (salicylic acid) hydroxy acids in chemical peels. Additionally, he shared a procedure involving 10% TCA with shallow depth micro-needling for treating infraorbital dark circles, showcasing impressive before-and-after images.
Vitiligo Evening of Skin Tone:
For patients with patchy vitiligo seeking an even skin tone, Dr. Desai recommended techniques involving liquid nitrogen and/or laser-assisted depigmentation. He emphasized the importance of treating hands, considering their cultural importance in beauty. Dr. Desai highlighted the significance of providing options for patients who desire an evening of the skin tone, even if complete repigmentation is not possible.
Patient Counseling on Cosmetic Procedures:
Dr. Desai provided guidelines for dermatologists when counseling patients with vitiligo on cosmetic procedures. He emphasized the safety of laser hair removal and intense pulsed light (IPL) for stable vitiligo, as long as low settings are used to avoid heat-induced trauma. He cautioned against ablative lasers, which can worsen the disease, and stressed the importance of doing test spots whenever possible. In the case of laser or device-induced depigmentation, he recommended aggressive treatment with systemic dexamethasone and topicals.
Caution Against Counterfeit Skin Bleaching Products:
Dr. Desai concluded his session by emphasizing the need to counsel patients on safe skin-lightening agents and cautioning against counterfeit products. He presented examples of products with harmful ingredients like lead, arsenic, and mercury, stressing the dermatologist’s role in advocating for evidence-based treatments.
Dr. Seemal Desai’s insights on procedures for patients with skin of color provide a valuable resource for dermatologists seeking to address the specific needs of this patient population. From chemical peels to innovative combinations of acids, his recommendations offer effective solutions for acne, post-inflammatory hyperpigmentation, melasma, acne scars, dark circles, and vitiligo. Furthermore, his emphasis on patient counseling and caution against counterfeit skin bleaching products highlights the importance of evidence-based treatments and patient safety in dermatology. With these advancements, dermatologists can now provide more tailored and effective care for patients with darker skin tones.