Higher Rates of Post-Inflammatory Hyperpigmentation in Patients with Skin of Colour - EMJ

Higher Rates of Post-Inflammatory Hyperpigmentation in Patients with Skin of Colour

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ACCORDING to a recent retrospective study, patients with skin of colour have higher rates of post-inflammatory hyperpigmentation (PIH) following Mohs micrographic surgery (MMS). PIH is a disease leading to increased melanin in response to inflammation or injury, including surgical intervention, and is associated with significantly lowered quality of life, persisting for many years. Following MMS, two main factors are associated with PIH development: patient-specific or procedure-specific factors. The rising rates of keratinocyte carcinoma and rapidly changing population demographics in the USA underscore the importance of an enhanced understanding of factors contributing to PIH post-MMS.

The retrospective study comprised 83 cases in 72 skin-of-colour individuals with biopsy-proven diagnosis of keratinocyte carcinoma following MMS from 2020-2021. The study’s primary objective was to characterize the factors contributing to developing PIH post-MMS in individuals with skin of colour. Data analysis was performed using independent t-test, chi-square, fisher exact, and logistic regression.

Results demonstrated that patient-specific factors, including age, sex and immunosuppressed status, did not significantly alter rates of PIH. However, individuals with Fitzpatrick skin type (FST) IV to V were more likely to have PIH post-MMs than individuals with FST I to III. Researchers found that grafts and granulation led to a significantly higher rate of PIH versus layered linear repairs and flaps (87.5% versus 30.7%; P=0.003). Furthermore, patients with postoperative complications, including necrosis, dehiscence, infection or hematoma, compared to patients without complications, had higher rates of PIH (81.8% versus 29.2%; P=0.001).

The research group concluded that the study findings replicated results from prior studies that individuals with eumelanin-rich skin are particularly susceptible to PIH. Moreover, linear repair and flaps are a reconstructive approach not as commonly associated with PIH compared to grafts and granulation in patients with skin of colour. Therefore, in order to mitigate PIH, surgeons should consider procedural risk factors to choose the most appropriate reconstructive approach.



Hossain OB et al. Postinflammatory hyperpigmentation following Mohs micrographic surgery: an observational study. Journal of Drugs in Dermatology: JDD. 2024;23(5):316-21.

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