Pigmentary disorders range from too little pigment (eg, vitiligo) to too much pigment (eg, melasma). In this MDedge Roundtable, Dr Steven Feldman is joined by Drs Amy McMichael and Nada Elbuluk to cover the broad spectrum of pigmentary diseases and how best to treat them. They also discuss concerns about popular over-the-counter therapies and explain how sun exposure can affect patients with skin of color, particularly those with pigmentary disorders.
The Roundtable panelists begin with a look at the spectrum of pigmentary disorders and the role that inflammation plays in these conditions.
Hypopigmentation is then addressed in more depth, with emphasis on the broad range of available therapies, including FDA-approved topical ruxolitinib and Janus kinase inhibitors currently in clinical trials. The panelists explore the range of causes for vitiligo and discuss rarer forms of hypopigmentation such as idiopathic guttate hypomelanosis, tinea versicolor, trichrome vitiligo, hypopigmented sarcoidosis, and seborrheic dermatitis. They emphasize the need to individualize treatment plans according to a patient's native pigmentation, age, and extent and location of disease. They further discuss how conditions can manifest differently in patients with darker skin.
The panelists then turn to hyperpigmentation and the role of inflammation. They discuss therapies for melasma and less common disorders such as lichen planus pigmentosus, erythema dyschromicum perstans, pigmented contact dermatitis, and maturational dyschromia.
Patients often gravitate toward over-the-counter products such as shea butter and coconut products, but the panelists warn that these can be counterproductive.
In addition, sun exposure can worsen pigmentary disorders and make them more refractory to treatment, according to the experts, who strongly urge clinicians to incorporate sun protection into patients' treatment plans.
Steven R. Feldman, MD, PhD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Accordant; Almirall; Alvotech; Arcutis; Arena; argenx; Biocon; Bristol Myers Squibb; Boehringer Ingelheim; Dermavant; Fortel; Helsinn; Janssen; Leo; Micreos; Mylan; Novartis; Ono; Pfizer; Samsung; Sanofi; Sun; UCB; vTv; Voluntis
Serve(d) as a speaker or a member of a speakers bureau for: AbbVie; Alvotech; Amgen; Bristol Myers Squibb; Janssen; Lilly; Regeneron; Sanofi; Sun
Received research grant from: AbbVie; Almirall; Bristol Myers Squibb; Galderma; Janssen; Lilly; Novartis; Pfizer; UCB
Have a 5% or greater equity interest in: Sensal Health
Amy McMichael, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: UCB; Lilly; Pfizer; Galderma; Janssen; Arcutis; Almirall; AbbVie; Galderma; Bristol Myers Squibb; Sanofi-Genzyme
Received research grant from: Procter & Gamble; Galderma; Incyte; Concert
Nada Elbuluk, MD, has disclosed the following relevant financial relationships:
Advisory board for: Allergan; Eli Lilly; Galderma; Incyte; Janssen; La Roche-Posay; L'Oréal
Consultant for: Avita Medical; Beiersdorf; Incyte; Scientis US; Unilever; VisualDx
Speaker for: Dior; Estée Lauder; La Roche-Posay; Medscape; Scientis US
Author for: McGraw Hill
Board member for: Global Vitiligo Foundation; Women's Dermatologic Society
Editorial board for: Journal of the American Academy of Dermatology; Cutis
Received payment from: Allergan; Avita Medical; Beiersdorf; Dior; Eli Lilly; Estée Lauder; Galderma; Incyte; Janssen; La Roche-Posay; L'Oréal; Medscape; Scientis US; Unilever; VisualDx
Received royalties from: McGraw Hill
Stock options for: VisualDx