Diagnostic tools for hyperpigmentation disorders in skin of color: An updated review

Abstract

Hyperpigmentation disorders are highly prevalent and disproportionately affect patients with skin of color. Studies suggest that over 65% of Black or African American patients haveexperienced at least one episode of hyperpigmentation due to skin damage or irritation. Notably, melasma and postinflammatory hyperpigmentation are the two most common forms of dyschromia in patients with skin of color. Additionally, otherconditionssuch as lichen planus and erythema dyschromicum perstans can have a more severe presentation and significant morbidity in this patient population. Thus, hyperpigmentation disorders can benefit greatly from prompt and accurate diagnosis that results in more precise management. In this review, we present the most updated information regarding dermoscopy, reflectance confocal, and conventional light microscopy in the diagnosis of hyperpigmentation disorders in skin of color. In addition, we summarize the benefits and pitfalls of some of these techniques, with a special emphasis on their accuracy and potential to assess favorable treatment outcomes. We also describe recent studies that have compared these diagnostic techniques across many disorders of hyperpigmentation and the practical findings that can be applied to everyday practice. We recognize that the cost of equipment, clinician training, and device availability are all critical factors when choosing the ideal diagnostic tool and provide varied approaches to improve accuracy. Today, diagnosing and treating hyperpigmentation skin conditions has become easier through technological advances.More reliable, noninvasive techniques such as dermoscopy and reflectance confocal microscopy show promise as adjuncts to guide laser and light therapies and monitor treatment response in dermatology clinics and clinical trials.