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Reviewing Considerations for Pigmentary Disorders With Nicole Gunasekera, MD, MBA


Nicole Gunasekera, MD, MBA, presented a session on disorders of pigmentation at the 2023 SDPA Annual Summer Dermatology Conference.

"Post-inflammatory hyperpigmentation in acne is a really, really common condition,” said Nicole Gunasekera, MD, MBA, as she began her session, “Disorders of Pigmentation”1 at the 2023 Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference. “This is often really, really bothersome to patients.”


Gunasekera’s session looked at an overview of several pigmentary disorders, including hyperpigmentation, vitiligo, melasma, and more.

“When thinking about how to approach post-inflammatory hyperpigmentation, it’s really important to first consider that the skin condition is still active. And if it’s still active, then the treatment plan has to be maintenance for the active condition,” she said.


When discussing hyperpigmentation caused by inflammatory skin conditions such as atopic dermatitis, Gunasekera said it is important to consider that several therapies for hyperpigmentation can lead to irritation, ultimately leading to potential flares.

“I use them with caution, and I try to work with people and really get their eczema under control first,” she said.

Gunasekera also emphasized the importance of communicating with patients about the length of time it may take to see results and improvement in hyperpigmentation, further noting that advising that patients being treated for hyperpigmentation limit their time in the sun and take measures such as wearing SPF.


“Vitiligo can present very differently in different people,” Gunasekera said. “One thing that is really tough for patients with vitiligo is [that] development of new spots is really unpredictable.”

Gunasekera went on to discuss the psychosocial burden of a pigmentary disorder like vitiligo.

“Even though vitiligo is not medically dangerous, it can be really psychologically devastating for a lot of patient,” she said, noting that isolation, depression, and more, can frequently be associated with the condition.

Gunasekera emphasized that some patients may have prior experiences wherein their concerns were dismissed by clinicians due to the lack of medical danger associated with the condition, reiterating the importance of sensitivity when caring for patients with the condition.

Congenital Dermal Melanocytosis

A type of birthmark, congenital dermal melanocytosis is one condition Gunasekera advised attendees to be cognizant of.

She cited one real-world example from her residency wherein a pediatric patient was brought into the emergency department with congenital dermal melanocytosis. The patient was temporarily removed from their parents by Child Protective Services, as the marks on their body were mistaken for bruises.

“Things that can help you distinguish between this condition are history of this being present since birth. That should point you more towards congenital dermal melanocytosis,” Gunasekera said. “And then in bruising, you’ll usually see bruises in different stages of healing.”


  1. Gunasekera N. Disorders of pigmentation. Session presented at the 2023 Society of Dermatology Physician Assistants (SPDA) Annual Summer Dermatology Conference; June 22-25, 2023; Boston, MA.
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