Seemal R. Desai

Progressive macular hypomelanosis: An update

Progressive macular hypomelanosis (PMH) is a common and often misdiagnosed disorder characterized by numerous nummular, coalescing hypopigmented macules on the trunk of adolescents, and young adults. It was originally described in patients with Fitzpatrick skin types V-VI from tropical countries, but is now understood to have a worldwide distribution in a variety of skin types. The pathogenesis of PMH is unknown, but is thought to involve Propionibacterium acnes, which has been found in abundance in the pilosebaceous units of lesional skin. Biopsies of lesions demonstrate normal architecture of epidermis and dermis, but exhibit decreased melanin content. It is important to note that this is different from vitiligo, which has a total absence of melanin. Many patients with PMH often times go misdiagnosed for tinea (pityriasis) versicolor, postinflammatory hypopigmentation, and other dyschromias. Topical antifungal and corticosteroid therapy have proven ineffective in PMH, but successes have been reported with topical and systemic antibacterial treatment modalities and even phototherapy. Given the increasing prevalence of patients with skin of color, it is important to better understand the nature of this condition, along with its diagnosis, management, and treatment.

Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience

Rosacea has been reported less frequently among individuals with skin of color than in those with white skin, but rosacea is not a rare disease in this population. In fact, rosacea might be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin. The susceptibility of persons with highly pigmented skin to dermatologic conditions like rosacea, whose triggers include sun exposure, is probably underestimated. Many people with skin of color who have rosacea might experience delayed diagnosis, leading to inappropriate or inadequate treatment; greater morbidity; and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. In this article, we review the epidemiology of rosacea in skin of color and highlight variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. We present strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.