For patches of hypopigmentation, lightbased therapies are an option for speeding up the return of pigments.
“I believe that, if we effectively manage the underlying psoriasis, we may be able to reduce the severity and duration of pigmentary alteration,” says Dr. Alexis. “So, it makes it especially important not to undertreat this disease in darker skinned patients where there is the additional burden of pigmentary alterations.”
The treatment approach for this group is similar to treatment for lighter skinned patients, but with a few nuances.
For example, while hypopigmentation secondary to corticosteroid is a risk for all patients, its impact is greater and more debilitating in darker skinned patients. The duration of corticosteroid use should, therefore, be limited, and clinicians should ensure that patients fully understand where and how to apply them and not to over apply in order to minimize the risk of hypopigmentation, Dr. Alexis says.
When it comes to choice of other topical therapies, tolerability is important because irritant dermatitis secondary to the topical therapy could induce more hyper- or hypopigmentation, he adds.
Use of phototherapy and the excimer laser risks worsening hyperpigmentation, so patients need to be warned about this, says Dr. Alexis, and also that phototherapy will promote diffuse tanning of the skin. Patients may not expect this overall darker skin tone, and it may not match their personal or cultural view of what their skin color should be, he explains.
1. Xiao Y, Zhang X, Luo D, Kuang Y, Zhu W, Chen X, Shen M. The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials. Psychology Research and Behavior Management. 2019; 12: 97–106; doi: 10.2147/PRBM.S195181.
2. Ferreira BI, Abreu JL, Reis JP, Figueiredo AM. Psoriasis and Associated Psychiatric Disorders: A Systematic Review on Etiopathogenesis and Clinical Correlation. J Clin Aesthet Dermatol. 2016 Jun; 9(6): 36–43.