Managing Pigmentary Changes and Scars in Skin of Color

Conclusions

• Dyspigmentation is a very common complication of scarring in skin-of-color patients, with post-inflammatory hyperpigmentation, erythema, telangiectasia, and hypopigmentation all requiring attention.
• Post-inflammatory hyperpigmentation can persist for months to years depending on location and depth, so patients need realistic counseling about its natural course.
• A stepwise topical regimen plus sun protection and antioxidants can help, but irritation-prone products should be introduced cautiously in skin of color.
• Oral tranexamic acid appears to be a useful adjunct for melasma and PIH, especially in laser-induced cases.
• Laser toning with nano- or picosecond 1064 nm devices can effectively improve PIH when used with conservative settings and repeated sessions.
• Uniform residual pigmentation is preferable to patchy discoloration, because even-toned change is better tolerated and less cosmetically troubling.
• For vascular components of scars, pulsed-dye or other vascular lasers can improve erythema when appropriate cooling and non-purpuric settings are used.
• Combining vascular lasers, pigment lasers, topical agents, and injections such as steroid plus 5-FU often produces better scar outcomes than any single modality alone.
• Fractional resurfacing can improve both scar texture and associated dyspigmentation, but lower density and multiple sessions are important in darker skin types to reduce PIH risk.
• Focal-point or intradermally focused laser technologies are promising because they target dermal pigment or scar tissue while sparing the epidermis, lowering the risk of adverse pigment change.