Derm Topics

How to Diagnose and Treat Hypopigmentation with Dr. Hamzavi

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic & Surgical Conference, interviewed Dr. Iltefat Hamzavi, dermatologist with Henry Ford Health and associate professor of dermatology at Wayne State University School of Medicine. Dr. Hamzavi addresses how to diagnose and treat hypopigmentation, a catch-all for pigmentary conditions where the pigment is not too dark or completely devoid of pigment. Watch as Dr. Hamzavi provides his three tips for categorizing hypopigmented lesions. If you can’t categorize them, you can’t treat them! He also shares conditions that present as hypopigmentation, and tips for using a wood’s lamp to make an accurate diagnosis. 

Further Reading

If you want to read more about conditions that present as hypopigmentation, check out the following articles published in the Journal of Drugs in Dermatology:

Re-pigmentation of Hypopigmentation: Fractional Lasers vs Laser-Assisted Delivery of Bimatoprost vs Epidermal Melanocyte Harvesting System

Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted.

Methods & Materials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system.

Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser).

Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation.

J Drugs Dermatol. 2019;18(11):1090-1096.

Disorders of Hypopigmentation

The most common cause of depigmentation worldwide is vitiligo. This disorder affects 1-2% of the world’s population and is seen in all races. Vitiligo is an autoimmune disorder in which the predominant cause is an attack by CD8+ cytotoxic T cells on melanocytes in the epidermis. This condition can have a significant negative impact on the quality of life of affected individuals. Treatment options currently include psychological counseling, topical therapy, systemic therapy, phototherapy, surgical therapy, and depigmentation. In patients with stable, refractory disease, successful repigmentation has been achieved using mini-punch grafting, blister grafting, and non-cultured epidermal suspension (NCES) grafting. Emerging therapies include the Janus kinase (JAK) inhibitors ruxolitinib and tofacitinib. Further studies exploring the pathogenesis of vitiligo are warranted in order to optimize treatment for affected patients.

J Drugs Dermatol. 2019;18(3 Suppl):s115-116.

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