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Skin Hyperpigmentation in Indian Population: Insights and Best Practice


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Skin pigmentation is one of the most strikingly variable phenotypes in humans, therefore making cutaneous pigmentation disorders frequent symptoms manifesting in a multitude of forms. The most common among them include lentigines, postinflammatory hyperpigmentation, dark eye circles, and melasma. Variability of skin tones throughout the world is well-documented, some skin tones being reported as more susceptible to pigmentation disorders than others, especially in Asia and India. Furthermore, exposure to ultraviolet radiation is known to trigger or exacerbate pigmentation disorders. Preventive strategies for photoprotection and treatment modalities including topical and other medical approaches have been adopted by dermatologists to mitigate these disorders. This review article outlines the current knowledge on pigmentation disorders including pathophysiology, molecular profiling, and therapeutic options with a special focus on the Indian population.
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Indian Journal of Dermatology • Volume 61 • Issue 5September-October 2016 • Pages ***-***
Skin hyperpigmentation in Indian population:
insights and best practice
Issue Highlights
Anti-inflammatory and
immunomodulatory actions of
Lichen planus pigmentosus
Anti-CCP autoantibodies in
inflammatory skin disorders
Psychosocial impact of acne
Cutaneous leishmaniasis in a
non-endemic area
“Holi” dermatoses in children
Terbinafine resistance in
980nm diode laser
Belimumab in systemic lupus
Inpatient dermatology
Angioma serpiginosum in a
patchy and blaschkoid
Cutaneous larva migrans on
glans penis
ISSN: 0019-5154
Volume 61 Issue 5 September-October 2016
Indian Journal of
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© 2016 Indian Journal of Dermatology | Published by Wolters Kluwer - Medknow 487
Skin pigmentation is one of the most strikingly variable phenotypes in humans,
therefore making cutaneous pigmentation disorders frequent symptoms manifesting in a
multitude of forms. The most common among them include lentigines, postinflammatory
hyperpigmentation, dark eye circles, and melasma. Variability of skin tones throughout the
world is well-documented, some skin tones being reported as more susceptible to pigmentation
disorders than others, especially in Asia and India. Furthermore, exposure to ultraviolet
radiation is known to trigger or exacerbate pigmentation disorders. Preventive strategies for
photoprotection and treatment modalities including topical and other medical approaches have
been adopted by dermatologists to mitigate these disorders. This review article outlines the
current knowledge on pigmentation disorders including pathophysiology, molecular profiling,
and therapeutic options with a special focus on the Indian population.
Key Words: Hyperpigmentation disorders, reconstructed skin models, sunscreen, ultraviolet
radiation, ultraviolet protection
Skin Hyperpigmentation in Indian Population: Insights and Best Practice
Stephanie Nouveau, Divya Agrawal1, Malavika Kohli2, Francoise Bernerd, Namita Misra1,
Chitra Shivanand Nayak3
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DOI: 10.4103/0019‑5154.190103
Variability of constitutive pigmentation around the world
is well-established, with some skin tones, especially in
Asian and Indian subjects, reported to be more susceptible
to pigmentation disorders than other human groups.[1,2]
This review mostly focuses on the skin pigmentation
and its variation, as well as associated pigmentary
disorders among the Indian population. The influence
of ultraviolet (UV) exposures on skin pigmentation and
their role in pigmentary disorders will be discussed with
insights in UV-induced biomarkers that were previously
identified, using reconstructed skin models relevant
for decoding the underlying mechanisms. Furthermore,
treatment strategies as well as photoprotective measures
for pigmentation disorders are included.
Melanogenesis and Skin Complexion
Melanin is the primary pigment that determines the
color of the skin. Melanin is produced by epidermal
melanocytes through enzymatic oxidation of tyrosine,
a process known as melanogenesis which takes place
within specific organelles, melanosomes.[3] After
maturation, melanin is transferred into the surrounding
keratinocytes. The epidermal melanin unit is defined as
the association that involves one melanocyte and about
forty keratinocytes. Constitutive pigmentation depends
on the amount of melanins, their quality and relative
composition between eumelanin (brown/black pigment)
and pheomelanin (yellow-reddish pigment), the mode
From the Department of Advanced
Research, L’Oreal Research and
Innovation, France, 1Department
of Advanced Research, L’Oreal
India Pvt. Limited, 2Department
of Dermatology, Jaslok Hospital
and Breach Candy Hospital Trust,
3Department of Dermatology,
Leprology and Venereology,
Topiwala National Medical College
and B. Y. L. Nair Charitable
Hospital, Mumbai, Maharashtra,
Address for correspondence:
Dr. Chitra Shivanand Nayak,
Department of Dermatology,
Leprology and Venereology,
Topiwala National Medical College
and B. Y. L. Nair Charitable
Hospital, Mumbai,
Maharashtra, India.
This is an open access article distributed under the terms of the Creative
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How to cite this article: Nouveau S, Agrawal D, Kohli M, Bernerd F,
Misra N, Nayak CS. Skin hyperpigmentation in Indian population: Insights
and best practice. Indian J Dermatol 2016;61:487‑95.
Received: March, 2016. Accepted: June, 2016.
What was known?
Skin hyperpigmentations represent one of the major dermatological concerns for populations with pigmented skin phototypes, with a high prevalence in the Indian population. The usual
treatments are based on the use of topical depigmenting agents to decrease the amount of melanin content or laser technologies. However the role of solar exposure is often ignored.
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
488Indian Journal of Dermatology 2016; 61(5)
of transfer and processing of melanosomes inside the
keratinocytes, and not on the number of melanocytes,
which is relatively constant in a given skin site,
irrespective of the color skin type. The type and amount
of melanin are under the control of several genes with a
great number of alleles, resulting in wide variations of skin
colors. While pheomelanin is thought to be photoreactive,
eumelanin has been found to dissipate >99.9% of
absorbed UV and visible rays and therefore acts as primary
photoprotectant.[4] Interestingly, a recent study shows
that human epidermis comprises approximately 74%
of eumelanin and 26% pheomelanin, regardless of the
degree of pigmentation.[5] The same study showed a good
correlation between constitutive pigmentation and total
melanin content assessed by three different methods.
Variation in skin tone is one of the prominent
distinguishable features of human beings. Skin
pigmentation in humans is variable and has evolved
predominantly to regulate the penetration of UV
levels.[2] A direct correlation has been observed between
the geographical distribution of UV radiation and skin
pigmentation worldwide.[6] Dark-skinned populations are
predominantly seen in geographical areas located closer
to the equator as these areas receive high amounts of
UVB radiation. Light-skinned populations are observed to
be located far from the tropics and closer to the poles,
which receive low-intensity UVB radiance.[7] In females,
the lighter skin complexion is thought to have evolved
to allow UVB-induced synthesis of Vitamin D3 required
for pregnancy and lactation.[2]
As mentioned above, human skin pigmentation is a
heritable trait controlled by a number of genes. In a
study by Shriver et al.,[8] genotyping studies revealed
differences in the allelic frequencies of several genes
in three populations of different descent. Among these,
TYR and OCA2 genes were found to play a role in skin
pigmentation in African and European populations. In
another genome-wide association study, polymorphisms
in SLC24A5, TYR, and SLC45A2 genes were found to be
significantly associated with skin pigmentation in a
population of South Asian descent.[9]
The color of the Indian skin shows a wide variability.
Hourblin et al. studied a range of skin parameters
including color, among 1204 women volunteers across
Indian four cities.[10] They reported that the complexion
in Indian population ranged from whitish to brown and
that skin complexion ranged from fairer in North India
to darker in South India [Figure 1]. This wide diversity
in pigmentation among the Indian population can occur
due to the presence of several gene polymorphisms.
In this context, Mukherjee et al. studied allelic
frequencies of single nucleotide polymorphisms in
four pigmentation-related genes including SLC45A2,
SLC24A5, MC1R, and TYRP1 in 749 individuals from 11
sub-populations suggesting significant allelic variations
across studied populations.[11]
Common Pigmentary Disorders Focus on
the Indian Scenario
This section includes studies carried out on the variation
of Indian skin tones across various geographical
locations and their susceptibility to common
pigmentation disorders. A large sample study across
four Indian cities revealed that more than 80% of the
population present skin color heterogeneity on the face,
irrespective of age and gender.[10] This heterogeneity
mainly results from hyper-pigmented spots, melasma
and ill-defined pigmented macules and dark circles.[10]
In addition, these different lesions often coexist. In
this study, hypopigmentary disorders are less frequent,
such as vitiligo, pityriasis alba, pityriasis versicolor,
hypopigmented leprosy, nevus achromicus, and
albinism and some hyper-pigmentary disorders such as
idiopathic guttate and confluent hypermelanosis, lichen
amyloidosis, and nevus of Ota.[12,13] Pigmentary disorders
cause psychological distress and negatively impact
the quality of life of an individual.[14] Three important
hyperpigmentary disorders in India, namely, melasma,
postinflammatory hyperpigmentation (PIH) and actinic
lentigines will be detailed below, and the role of UV
exposure in their pathogenesis will be emphasized.
Melasma, an acquired pigmentary disorder is characterized
by hyperpigmented brown to grayish brown macules
on the face. It occurs mainly in women (90% cases)
and 10% of males of all ethnic and racial groups.[15] In
India, 20–30% of 40–65 years old women present a facial
melasma.[10] The current classification of melasma is based
0510 15 20 25 30 35 40
L* (Luminance)
b* (yellow)
Figure 1: Indian skin colorimetric classification in the skin color volume projected on
the L*/b* plane of the L*a*b* space (CIE 1976). The vertical axis L* is the luminance
or lightness of the skin and the horizontal axis b* is the yellow component of the
skin. Skin color categories from fair to intense dark and individual typological
angles are indicated
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
489 Indian Journal of Dermatology 2016; 61(5)
on the site of lesion and on the depth of pigmentation
that is determined histologically or instrumentally
within the epidermis, dermis or both.[16-19] While the
exact cause of melasma is currently unknown, exposure
to UV, increased estrogen levels (observed mainly
during pregnancy or use of oral contraceptives), genetic
predisposition and phototoxic drugs are known to play
a major role in the development of this hypermelanosis
disorder.[18] Other factors implicated in its etiology include
ovarian dysfunction, thyroid and/or liver diseases.[16] The
role of UV exposure has been shown to being crucial in
development but mainly exacerbation of melasma.[20-22]
Epidemiological studies revealed that in more than 25%
of cases, an association with sun exposure has been
declared.[23,24] At the molecular level, it is well-established
that exposure to UV rays induce increased production of
alpha-melanocyte-stimulating hormone and corticotrophin
as well as interleukin (IL)-1 that, in turn, contribute to
increased melanin production. In addition, overexpression
of dermal stem cell factor and its receptor, c-kit, have
been identified in melasma lesions and are believed to
increase melanogenesis.[25] More generally in melasma,
paracrine melanogenic factors have been identified from
keratinocytes, mast cells or dermal fibroblasts.[20] However,
it seems that melasma results from complex interactions
of various causative factors, UV exposure(s) included.
Postinflammatory hyperpigmentation
PIH is an acquired pigmentary skin disorder.[26] It
occurs as a result of an inflammatory reaction, induced
by cutaneous diseases including acne vulgaris,
atopic dermatitis, psoriasis, impetigo, lichen planus,
pityriasis rosea, irritant and allergic contact,
photocontact-dermatitis and insect bites as well as a
complication of laser therapy. It has been shown that
severity and frequency of PIH are both increased in
individuals with skin of color of both genders.[27,28]
In India, a majority of subjects with an acne history
present pigmented postinflammatory marks: More than
70% before 35 years old, both in women and men. This
prevalence rapidly decreases with age to involve <10% of
people older than 50 years. This observation is directly
related to the high prevalence of acne in progress
observed in the study.[10] PIH can last from months to
years and may significantly impair the quality of life
of affected individuals. The severity of PIH has been
observed to be higher in prolonged and/or recurrent
inflammation when compared with short-term acute
inflammation.[29] Inflammation of the epidermis results
in the production and release of several cytokines,
prostaglandins, and leukotrienes, that stimulate the
epidermal melanocytes leading to an increased synthesis
of total melanin.[27,30] Most of these factors are also
produced under solar stimulation supporting the role of
UV exposure in the initiation and exacerbation of PIH.
In addition, cutaneous inflammation also causes damage
to the basal layer resulting in a leakage of melanins from
basal keratinocytes and the subsequent accumulation
of melanophages in the dermis thereby exacerbating
dermal hyperpigmentation. Esthetic procedures and
light-based treatments can also induce PIH, especially in
darker-skinned patients.[31]
Actinic lentigines also called solar lentigines or lentigo
senilis, are light brown to dark brown, spots, even-colored
or reticulated patches occurring mainly in sun-exposed
areas. The dorsal aspects of the hands, extensor forearms,
upper trunk and face are the most commonly affected
sites. They might be sometimes solitary, but these
lesions are more often multiple. Actinic lentigines are
considered to be a clinical sign of photoaging and their
frequency increases with age.[32-35] Their number is an
indicator of the amount of sun exposure over the course
of a life-time and therefore shows an increased risk for
developing skin cancers.[36-38] They are more characteristic
of fair to the medium photoaged skin, and prevalence in
India is quite close to other Asian countries. It affects
one-third of women about 50 years old in the large
sample study carried out in India and concerns half of
the population over 70 years old.[10] Actinic lentigines
are sometimes difficult to distinguish from seborrheic
keratosis or simplex lentigos. The presence of the three
entities often causes distress to the individual due to
their color, number, size, location, and their known
link to aging for two of them. At the histological level,
actinic lentigines are characterized by a hyperpigmented
basal layer which is due to an increased total melanin
content of the epidermis (hypermelaninosis).[39] The
number of melanocytes was found increased in some
studies (hypermelanocytosis),[40] whereas others did
not reveal any differences.[39] The global architecture
of the epidermis is often disorganized with broadened
rete-ridges and includes long, short, crowded, and
bulbous buds.[34,41-43] In addition, the rete-ridges of the
dermal-epidermal junction are altered and elongated
resulting in a protrusion of the epidermis into the
dermis.[41,42,44] Although a strong association between
actinic lentigines development and UV exposure has been
observed, the underlying molecular mechanisms are still
not fully understood. a potential role of keratinocyte
growth factor has been recently suggested as well as the
involvement of other dermal factors.[43,45]
Periorbital hyperpigmentation
Periorbital hyperpigmentation (POH) also known as
dark circles or periorbital melanosis or periocular
hyperpigmentation which surround the eyelids is
a significant problem found especially in Asians.
The overall prevalence of Indian women is 50%
with moderate to severe dark circles on the upper
eyelid and increases with age. In a study, the most
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
490Indian Journal of Dermatology 2016; 61(5)
common form of POH was constitutional/genetic
type (n = 103, 51.5%) followed by postinflammatory
type (n = 45, 22.5%) with very little knowledge
about etiology.[46] Other studies describe POH as
acquired idiopathic patterned facial pigmentation[47]
or idiopathic cutaneous hyperchromia at the orbital
region (ICHOR)[48] that manifests due to genetically
determined increased pigmentary functional activity.
Both studies have indicated sun exposure as a risk
factor for aggravation. Ranu et al.[49] attributed vascular
factors, constitutional factors and postinflammatory
pigmentation and shadow effects as reasons for ICHOR.
Verschoore et al.[48] also found vascular factors to be
causative in periorbital pigmentation. Malakar et al.[50]
concluded that periorbital melanosis was an extension
of pigmentary demarcation lines of the face.
Ultraviolet-induced Damage: A Cause for
Exacerbation of Pigmentation Disorders
Considering that UV exposure is the most important
factor that influences skin pigmentation, and more so
in fairer skin tones (photo-types I–IV) and the major
environmental stress involved in the development of
several hyperpigmentation disorders, researches on the
precise biological effects of UV exposure are crucial.
UVB (290–320 nm) are the more energetic of the UV
rays and are capable of inducing direct DNA damage
through the production of cyclobutane pyrimidine
dimers and 6–4 photoproducts.[51] In contrast, UVA
rays (320–400 nm) mainly cause the production of
reactive oxygen species (ROS) that, in turn, can be
responsible for indirect DNA damage and activation of
several pathways. UVA rays can also penetrate deep
into the skin, reaching the basal layer of the epidermis
and dermis.[52] UVA rays are considered as major actors
for the photoaging process. Several works studied the
effect of UV radiation on the skin at the molecular
level. Reconstructed skin models have been shown
to mimic the biological properties of human skin
in vivo, such as the three-dimensional architecture,
the formation of a fully differentiated epidermis and
a dermal equivalent that comprises matrix components
and living dermal fibroblasts. The effects of both
UVA and UVB on keratinocytes and fibroblasts were
examined in a reconstructed skin model.[53] After UVB
exposure, several well-known epidermal biomarkers of
a sunburn reaction were found induced similarly to
the in vivo situation, such as DNA lesion formation,
p53 accumulation or sunburn cell formation.[54] Apart
from the classical activation of melanogenesis by UV
exposure, it has been shown that both DNA damage but
also the subsequent accumulation of p53 protein act as
stimulators of melanogenesis, resulting in an increased
pigmentation.[55,56] UVA exposure led to ROS formation in
both compartments, with direct alterations in the dermal
equivalent, and an increase in inflammatory mediators
such as IL-1 or IL-6.[57] Both UVA and UVB induced
expression of matrix degrading enzymes such as matrix
metalloproteinases 1 (MMP-1), either directly in dermal
fibroblasts after UVA exposure or through secretion
of soluble epidermal factors after UVB exposure.[58]
Marionnet et al. recently studied the biological effects
of UVA1 (340–400 nm) exposure. UVA1 is the most
abundant part of the sun UV spectrum that reaches the
earth surface, leading to high annual doses in Asia and
India.[59] It was observed that although less energetic
than UVB or UVA2, UVA1 induced ROS production in
the whole skin depth, thymine dimer formation, lipid
peroxidation and apoptosis in fibroblasts. Further,
using a full genome transcriptomic study, a differential
regulation of 461 genes in epidermal keratinocytes
and 480 genes in dermal fibroblasts was found induced
by exposure to UVA1, of which genes encoding heat
shock and oxidative stress proteins were clearly
up-regulated. Genes belonging to a variety of functional
families were also found modulated by UVA1 exposure,
especially genes related to immune function, including
proinflammatory actors. Among them, several have
been shown participating in UV-induced pigmentation.
Altogether, this data support the fact that the whole UV
spectrum is responsible for cellular responses and tissue
damage that are in turn involved in the stimulation
of pigmentation and development or exacerbation of
pigmentary lesions.
Correction of Pigmentary Disorders
Treatments of pigmentary disorders
Topical treatment is an effective treatment modality
for pigmentary disorders and hydroquinone (HQ), a
hydroxyphenol, has been widely used across the world as
the treatment of choice.[60]
HQ inhibits tyrosinase and 4% can be used twice daily for
up to 6 months for PIH. Nonphenolic agents, such as kojic
acid and tretinoin,[61,62] are also proven effective topical
depigmenting agents. Monteiro et al. found that 0.75%
kojic acid cream was less efficacious and had a slower rate
of clinical improvement when compared to 4% HQ cream
which is a better topical hypopigmenting agent.[63]
However, monotherapy is often associated with
undesirable side effects, in contrast, a combined therapy,
such as Kligman and Willis’s triple combination,[64] is
favored since offering an improved efficacy coupled with
minimized side-effects.
Several studies have been performed to explore the
role of topical retinoids in the treatment of pigmentary
disorders including melasma, actinic lentigines, and
PIH.[28] Clinical studies have demonstrated the efficacy of
retinoids such as tretinoin (all-trans retinoic acid [RA]),
isotretinoin (13-cis-RA), tazarotene, and adapalene in
the treatment of these disorders. A summary of retinoids
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
491 Indian Journal of Dermatology 2016; 61(5)
in the treatment of hyperpigmentation disorders is
provided in Table 1. Adapalene gel also improved
actinic lentigines in another randomized trial.[69] HQ
and triple combination formulations are currently the
gold standard for treating melasma.[75] Other groups
have studied triple combination consisting of tretinoin,
HQ and fluocinolone acetonide, a corticosteroid in
multi-center, randomized, investigator-blind studies, and
observed reduction in melasma.[71-73] Triple combination
creams were also found effective in lightening actinic
lentigines in a randomized clinical trial.[74] Other topical
agents including azelaic acid, kojic acid, ascorbic acid,
glycolic acid, and salicylic peels have also been tried
with variable degrees of success.[76] Newer topical agents
including soy extracts, licorice extract, mulberroside
F, N-acetyl glucosamine, niacinamide, resveratrol,
rucinol, dioic acid, and ellagic acid have revealed
considerable amount of success in the treatment of
hyperpigmentation disorders.[77]
During the last decade, laser technologies have been
increasingly used in the treatment of dermatological
disorders. Currently, several laser options are available
for the treatment of hyperpigmentation disorders
including Q-switched (QS) ruby, QS alexandrite, QS
neodymium:yttrium-aluminum-garnet (Nd:YAG), and
fractional photothermolysis. A summary of different
lasers used in the treatment of hyperpigmentation
disorders is provided in Table 2. In a study by Taylor
et al., QS ruby laser-based treatment of eight subjects
with melasma and PIH was found ineffective.[88]
However, multiple sessions of the low dose QS ruby
laser was found beneficial in the treatment of melasma
in fifteen Korean women, leading to decreased
melasma area and severity index scores after the final
treatment.[78] Treatment of melasma with QS alexandrite
laser alone showed mixed results. However, improved
outcome of treatment with QS alexandrite laser was
observed when combined with pulsed CO2 laser.[79]
The use of QS Nd:YAG laser was found effective in
the treatment of melasma. In a study comprising
25 women with melasma, 44% of the women showed
marked improvement with QS Nd:YAG treatment during
a 2-month follow-up posttreatment.[83] Fractional laser
photothermolysis is commonly used in the treatment of
hyperpigmentation disorders. Rokhsar and Fitzpatrick
examined the efficacy of fractional photothermolysis in
the treatment of melasma and found that 60% of the
patients showed 75–100% improvement.[85] Fractional
photothermolysis was found to confer at least 20%
improvement in six Chinese patients with resistant
melasma.[84] Further, fractional photothermolysis
was found effective in the treatment of PIH[87] and
refractory arcuate hyperpigmentation.[86]
Table 1: A summary of various retinoids in the treatment of hyperpigmentation disorders
Topical agent Hyperpigmentation
disorder treated
Usage and effectiveness Citation
Tretinoin Melasma Topical 0.1% tretinoin produces significant clinical
improvement of melasma, mild side effects, but
improvement is slow
Griffiths et al.,[65]
Kimbrough-Green et al.[66]
Tretinoin Postinflammatory
Topical 0.1% application of tretinoin significantly
lightens postinflammatory hyperpigmentation and,
to a clinically minimal but statistically significant
degree, lightens normal skin in black persons
Bulengo-Ransby et al.[67]
Tretinoin Actinic lentigines Topical 0.1% tretinoin significantly improves both
clinical and microscopical manifestations of actinic
lentigines; these lesions do not return for at least
6 months after therapy is discontinued
Rafal et al.[68]
Adapalene Actinic lentigines Adapalene gel 0.1% and 0.3%, the mean number
of actinic keratoses was reduced by 0.5±0.9 and
2.5±0.9, respectively
Kang et al.[69]
Tazarotene Postinflammatory
Tazarotene 0.1% cream produces significantly
greater reduction in overall disease severity,
intensity and area of hyperpigmentation within
18 weeks compared to vehicle
Grimes and Callender[70]
Triple combination of
tretinoin, HQ and fluocinolone
Melasma Tretinoin (RA) 0.05%, HQ 4.0%, and FA 0.01%;
RA + HQ + FA produces significant improvement in
melasma compared with the other treatment groups
Taylor et al.,[71] Chan
et al.,[72] Grimes et al.[73]
Triple combination of
tretinoin, HQ and fluocinolone
Solar lentigines Triple combination cream; significantly reduced
melanin levels and lentigines count in 2 weeks
Hexsel et al.[74]
HQ: Hydroquinone, RA: Retinoic acid, FA: Fluocinolone acetonide
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
492Indian Journal of Dermatology 2016; 61(5)
Daily Photo-protection, a Way to Prevent
Pigmentary Disorders
Since solar exposures have been clearly involved in
several short- and long-term harmful effects on the
skin including the development of pigmentary disorders,
strategies to achieve an even tone complexion and treat
skin hyperpigmentation include exogenous protection
approaches such as photoprotection, for reducing the
deleterious effects of UV exposure.[89] They comprise a
battery of exogenous and complementary photoprotective
cautions or items such as sun avoidance, clothing or
use of broad-spectrum sunscreens. Clothing and hats
have been proposed as an important photoprotective
strategy[90] with some advantages such as the high
compliance from patients. Studies by Gambichler et al.
concluded that 67% of the 236 tested summer apparels
offered a UV protection factor (UPF) value of 15 and
above.[90] They also observed that 70% of the wool,
polyester, and fabric blends brought UPF values of above
thirty as compared to <30% of cotton, linen, and viscose
fabrics. Other studies have shown that rather than the
nature of the garment, their weaving (tight or not) is
absolutely crucial.[91,92]
However, clothing does not offer protection against UV
exposure to the uncovered anatomical sites such as a
facial region for which the use of sunscreens remains the
most efficient exogenous photoprotective strategy.
Two types of sunscreens have to be distinguished,
i.e., organic or mineral-based sunscreens. The first ones
act by strong absorption of wavelengths over a defined
spectrum (in UVB or UVA or both), whereas those of
mineral origin (titane dioxide and zinc oxide) reflect or
diffuse UV rays along the all UV band.[93] This explains why
these mineral-based sunscreens are most often combined
with organic sunscreens to extend the broadness of
protection. Currently used organic sunscreens comprise
butyl methoxydibenzoylmethane (BMDM or avobenzone),
terephthalylidene dicamphor sulfonic acid (TDSA or
Mexoryl® SX), drometrizole trisiloxane (DTS or Mexoryl®
XL), methylene bis-benzotriazolyl tetramethylbutylphenol
and bis-ethylhexyloxyphenol methoxyphenyl
triazine.[94] TDSA or Mexoryl® SX has been previously
shown to prevent DNA damage,[95] photoaging,[96]
UV induced-pigmentation,[97] and UV-induced
immunosuppression.[98] Final sunscreen products are
usually a combination of UVB and UVA absorbers (and
mineral sunscreens) leading to an absorption profile
against the majority of the UV spectrum. Broad-spectrum
sunscreens (UVB-UVA) offer considerable protection
against UV exposure, especially in daily UV exposure
conditions, representative of realistic everyday life sun
exposure conditions. This was illustrated by Marionnet
et al., who assessed gene expression in reconstructed
skin models following exposure to standard UV daylight
spectrum (daily UV radiation [DUVR]) using quantitative
polymerase chain reaction arrays.[99] DUVR exposure led
to altered regulation of 35 genes in fibroblasts and 66
genes in keratinocytes, which were involved in a host
of processes including oxidative stress response, cell
growth, and inflammation among others. In contrast,
DUVR-exposed models in the presence of a sunscreen
product with sun protection factor of 13 and UVA
protection factor of 10.5 showed a significant reduction
in DUVR-induced alterations of gene expression. Regular
use of broad spectrum sunscreen has been shown to
be effective in reducing the development of squamous
cell carcinoma as well as actinic keratoses[100] and
clinical signs of photoaging.[101] Regarding pigmentary
disorders, ICHOR has been shown being prevented using
In India, high incidence of melasma in high-altitude,
sun-exposed environments confirms that skin
disorders often seen in darker skin phenotypes
are related to UV exposure.[102] Further, the use
of sunscreens has been shown to offer protection
against hyperpigmentation disorders[103] The primary
treatment of PIH aims at preventing and treating the
underlying inflammatory condition. A study in Moroccan
pregnant women demonstrated the effectiveness of
photoprotection from melasma using sunscreen on
the darker skin sites.[104] Only 3% of the 185 patients
who used sunscreens developed melasma. As Indians
present with several sun-induced damages including
hyperpigmentation and photoaging,[10] the use of
sunscreens is therefore of paramount importance in the
Indian scenario. In a previous study with more than 300
Indian patients with melasma, only 10% of the patients
were found to use sunscreens.[105] This emphasizes the
need for greater awareness of UV-induced skin disorders
and their prevention in the Indian society.
Table 2: A summary of lasers in the treatment of
hyperpigmentation disorders
Laser type Hyperpigmentation
disorder treated
Q-switched ruby
Melasma Jang et al.[78]
alexandrite laser
combined with
pulsed CO2 laser
Melasma Angsuwarangsee
and Polnikorn,[79]
Nouri et al.[80]
garnet laser
Melasma Zhou et al.,[81]
Choi et al.,[82]
Cho et al.[83]
Fractional laser Melasma,
Naito,[84] Rokhsar and
Fitzpatrick,[85] Cho
et al.,[86] Katz et al.[87]
Nouveau, et al.: Skin hyperpigmentation in Indian population: Insights and best practice
493 Indian Journal of Dermatology 2016; 61(5)
Future Outlooks
Hyperpigmentation disorders are common within
the Indian population. Most of these disorders are
attributed to or exacerbated by solar exposure.
Photoprotection has been recommended as the best
and primary strategy to achieve a flawless skin to
inhibit the triggering events. One of the most efficient
strategies to achieve an efficient photoprotection
implies the regular use of a broad-spectrum sunscreen.
In India, photoprotection is often ignored and
hence regular sunscreen use is not followed. Indian
population also presents a large variety of sun-induced
damage including hyperpigmentation and photoaging.
Campaigns to raise awareness of UV-induced skin
hyperpigmentation are necessary to educate the
general public and enhance the strict use of sunscreen
for the management of these disorders.
Molecular characterization of the Indian skin needs
to be carried out to develop better skin products
targeted specifically to the Indian market. Testing of
new ingredients that modulate pigmentation through
controlled clinical trials would also be desirable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
What is new?
The role of solar UV exposures in the development or exacerbation of pigmentary
disorders is now indisputable. The contribution of the whole UV spectrum, including
UVB, UVA2 and long UVA1 wavelengths is now evidenced up to the molecular level. A
first line of prevention and treatment of hyperpigmented disorders is therefore a regular
use of a broad spectrum photoprotection, together with education of the population.
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... Hyperpigmentary disorders such as melasma and postinflammatory hyperpigmentation (PIH) are important dermatological concerns for individuals with pigmented skin phototypes, and these disorders present with a high prevalence in the Indian population. 1 Melasma is the most common cause of hyperpigmentation with a prevalence of 33.6%, followed by PIH at 12.5% and ephelids or freckles at 6.9%. 2 PIH is a type of epidermal hyperpigmentation with hypermelanosis, that can be triggered by various stimuli, including dermatoses, trauma, cutaneous procedures, ultraviolet radiation or drugs. 3 On the other hand, exposure to UV radiation, increased estrogen levels, genetic predisposition, and phototoxic drugs may play a crucial role in the development of melasma. ...
... The role of UV exposure has been observed to be important in development and mainly in exacerbation of melasma. 1 Skin Solutions, Second Floor, JK Chambers Building, Shop No. 209, Vashi-Turbhe Rd, Sector 17, Vashi, Navi Mumbai 400705, Maharashtra, India Numerous topical depigmenting agents, including both pharmacological agents and cosmetic agents have been used clinically, with variable degrees of success. 4 Firstline therapy of PIH involves the use of topical depigmenting agents along with photoprotection. ...
Full-text available
Background: Epidermal hyperpigmentation is an important dermatological concern with a high prevalence in the Indian population. Kojic acid-based depigmenting formulations have proven to be effective in the management of epidermal hyperpigmentation. A questionnaire-based survey was conducted to assess physicians’ knowledge about epidermal hyperpigmentation and practice patterns about a novel depigmenting formulation containing a combination of kojic acid dipalmitate 4%, azelaic acid 12%, glycolic acid 3%, niacinamide 4%, arbutin 2%, glycogen liquid 2%, sodium hyaluronate solution 2%, and shea butter 1% for epidermal hyperpigmentation treatment in India. Methods: The survey was conducted among 235 dermatologists across different geographical regions of India over 3 months. The questionnaire evaluated prevalence and choice and duration of therapies for epidermal hyperpigmentation in Indian clinical practice, and dermatologists’ real-life experience with efficacy of the novel formulation. Descriptive statistics were used to summarize survey results. Results: All 235 dermatologists completed the questionnaire and responded to questions based on experience in treating patients with epidermal hyperpigmentation. In all, 58% dermatologists preferred kojic acid-based combinations. Furthermore, 57% of dermatologists agreed that glycolic acid can enhance the penetration of kojic acid and azelaic acid, 47.45% strongly agreed that a kojic acid-based formulation could be a safe alternative to steroid and hydroquinone-based formulations. Overall, 67% of dermatologists agreed that the kojic acid-based formulations with additional moisturizers helped in faster resolution of epidermal hyperpigmentation compared to other depigmenting formulations. Conclusions: The survey findings indicate that the novel kojic acid-based formulation with additional moisturizers could be a preferred choice for epidermal hyperpigmentation management.
... 1 Color of the human skin is primarily due to the melanin pigment which is produced by the melanocytes present in the lower epidermis. 2 It is the amount of melanin pigment which determines the various shades of skin and can result in hypopigmentary disorders or hyperpigmentary disorders. 3 Basically the hyperpigmentation means darkening of the skin, attributed by increase in melanin. ...
... Some people like Asians are more prone to develop pigmentation. 2 Few aggravating factors like UV radiation, hormones and certain medication have role in development of hyperpigmentation. 6 There are many disorders whose clinical presentation is only the hyperpigmentation. ...
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Hyperpigmented skin lesions are the cause of concern for general people and are commonest reason for dermatology consultation. An accurate histopathological diagnosis helps a dermatologist in appropriate management of such lesions A retroprospective study of 100 cases of skin biopsies in hyperpigmented lesions was conducted from January 2020 to July 2021 at our institute. Inadequate skin biopsies, lesions of neoplastic or congenital etiology were excluded from the study. A clinico-histopathological correlation was also done. Out of 100 skin biopsies studied, most cases (50%) were in the age group of 21-40 years. Females were more affected than males; F:M ::1.27:1 and the most common histopathological diagnosis was Lichen planus and its variants (38%). Hyperpigmented skin lesions can be the only presentation of wide variety of the skin lesions. To make the diagnosis;proper and detailed history, clinical examination and microscopic examination of the biopsies is must which helps the doctor to treat the patients effectively.
... Melanin loss and irregular depigmentation loss can represent serious aesthetic and dermatological problems on the face in humans [1][2][3]. Conversely, increased melanin synthesis and excessive accumulation of melanin pigment can cause various skin diseases such as acanthosis nigricans, cervical poikiloderma, melasma, periorbital hyperpigmentation, lentigines, neurodegeneration associated with Parkinson's disease, skin aging, and risk of skin cancer [3,4]. ...
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Curculigo latifolia (family Amaryllidaceae) is used empirically for medicinal purposes. It is distributed throughout Asian countries, especially Indonesia. This study aimed at standardizing the C. latifolia plant, analyzing its phytochemical profile, and evaluating its pharmacological effects. The powder from each organ (root, stem, and leaves) was standardized organoleptically and microscopically. Samples were extracted by graded maceration using hexane, ethyl acetate, and ethanol. The extracts were determined for total phenolic content (TPC) and total flavonoid content (TFC). Antioxidant (radical scavenging and metal ion reduction) and antityrosinase activities were determined by spectrophotometric methods. Extracts were analysed for phytochemical profiles by LC-ESI-MS. The highest TPC and TFC were found in the ethanolic extract of the root organ (68.63 ± 2.97 mg GAE/g) and the ethyl acetate extract of the stem (14.33 ± 0.71 mg QE/g extract). High antioxidant activities were found in the ethanolic root extract (20.42 ± 0.33 µg/mL) and ethanolic stem extract (45.65 ± 0.77 µg/mL) by DPPH• and NO• assays, respectively. The ion reduction activity (by CUPRAC assay) was most significant in the ethyl acetate stem extract (390.42 ± 14.49 µmol GAEAC/g extract). Ethanolic root extract was the most active in inhibiting tyrosinase (IC50 value of 108.5 µg/mL). The correlation matrix between TPC and antioxidant activities showed a moderate to robust correlation, whereas the TPC and antityrosinase activity showed a robust correlation. The TFC and antioxidant or antityrosinase activities showed a weak to moderate correlation. The LC-ESI-MS data identified major phenols in the active extracts, including methyl 3-hydroxy-4-methoxy-benzoate, quercetin, 4-O-caffeoylquinic acid-1, and curculigoside. Overall, this study suggests that extracts from the C. latifolia plant offer potent antioxidant and antityrosinase activities, allowing them to be used as natural antioxidants and candidates for skin-lightening compounds.
... Skin tone and pigmented regions related to the concentration and distribution of skin pigments. They serve as important indicators of an individual's skin condition [1][2][3] and play important roles in skincare products and diagnostics. 4,5 However, detecting subtle variations in these attributes can be challenging for the naked eye, potentially leading to subjective interpretations. ...
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Background Skin tone and pigmented regions, associated with melanin and hemoglobin, are critical indicators of skin condition. While most prior research focuses on pigment analysis, the capability to simulate diverse pigmentation conditions could greatly broaden the range of applications. However, current methodologies have limitations in terms of numerical control and versatility. Methods We introduce a hybrid technique that integrates optical methods with deep learning to produce skin tone and pigmented region‐modified images with numerical control. The pigment discrimination model produces melanin, hemoglobin, and shading maps from skin images. The outputs are reconstructed into skin images using a forward problem‐solving approach, with model training aimed at minimizing the discrepancy between the reconstructed and input images. By adjusting the melanin and hemoglobin maps, we create pigment‐modified images, allowing precise control over changes in melanin and hemoglobin levels. Changes in pigmentation are quantified using the individual typology angle (ITA) for skin tone and melanin and erythema indices for pigmented regions, validating the intended modifications. Results The pigment discrimination model achieved correlation coefficients with clinical equipment of 0.915 for melanin and 0.931 for hemoglobin. The alterations in the melanin and hemoglobin maps exhibit a proportional correlation with the ITA and pigment indices in both quantitative and qualitative assessments. Additionally, regions overlaying melanin and hemoglobin are demonstrated to verify independent adjustments. Conclusion The proposed method offers an approach to generate modified images of skin tone and pigmented regions. Potential applications include visualizing alterations for clinical assessments, simulating the effects of skincare products, and generating datasets for deep learning.
... This enzyme also participates in several biological processes in arthropods, such as wound healing, cuticle sclerotization, and protective encapsulation [39]. Tyrosinase inhibitors are therefore relevant for medical and cosmetic purposes, managing conditions related to excessive melanin production, in agricultural industries as pest control agents, and in the food industry as anti-browning ingredients [40,41]. Over the past decade, some natural tyrosinase inhibitors such as kojic acid and arbutin were identified, and the only cosmetic ingredient that can be obtained synthetically is hydroquinone [42,43]. ...
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This study assessed the halophyte species Limonium spathulatum (Desf.) as a possible source of natural ingredients with the capacity to inhibit enzymes related to relevant human health disorders and food browning. Extracts using food-grade solvents such as water and ethanol were prepared by maceration from dried L. spathulatum leaves. They were evaluated for in vitro inhibition activity of enzymes such as acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), α-glucosidase, tyrosinase and lipase, related to Alzheimer’s disease, type-2-diabetes mellitus, skin hyperpigmentation, and obesity, respectively. These extracts were also appraised for in vitro acute toxicity on tumoral and non-tumoral cell lines and their chemical composition by high-performance liquid chromatography coupled with electrospray ionization mass spectrometry (HPLC-ESI-MS/MS). The extracts were more effective towards BChE than AChE. The best results were obtained with the hydroethanolic and water extracts, with IC50 values of 0.03 mg/mL and 0.06 mg/mL, respectively. The hydroethanolic extract had the highest capacity to inhibit α-glucosidase (IC50: 0.04 mg/mL), higher than the positive control used (acarbose, IC50 = 3.14 mg/mL). The ethanol extract displayed the best inhibitory activity against tyrosinase (IC50 = 0.34 mg/mL). The tested samples did not inhibit lipase and exhibited low to moderate cytotoxic activity against the tested cell lines. The hydroethanolic extract had a higher diversity of compounds, followed by the ethanol and water samples. Similar molecules were identified in all the extracts and were mainly hydroxybenzoic acids, hydroxycinnamic acids, and flavonoids. Taken together, these results suggest that L. spathulatum should be further explored as a source of bioactive ingredients for the food, cosmetic, and pharmaceutical industries.
... Darker skin types have a twice the amount of epidermal melanin in their melanosomes compared to lighter skin types. 1 Furthermore, melanosome breakdown inside the keratinocyte is slower in darkly pigmented skin than in lighter skin types. 2 Hyperpigmentation of the skin is one of the most distinctively varied human phenotypes, and making cutaneous pigmentation disorders one of the most common causes of a wide range of symptoms. 3 Lentigines, melasma, post-inflammatory hyperpigmentation, and dark under-eye circles are the most prevalent among them. 4 The diversity in skin tones across the world is welldocumented, with some considered to be more prone than others to pigmentation disorders, particularly in India. ...
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Background: Hyperpigmentation is the third most common dermatological disorder and has major psychosocial impairment. It comes in a variety of forms. The most well-known are age spots, freckles, melasma and post-inflammatory hyperpigmentation. Hyperpigmentation in friction-prone areas (armpits, inner thighs, elbows, knees, groin, etc.) has a significant impact on affected individuals. Unfortunately, there are currently no well-tolerated options available that are intended particularly for these sensitive areas. Methods: Dermatologists across India were provided a questionnaire consisting of questions related to number of the patients seen with hyperpigmentation in intimate & high friction areas every week and their clinical experience regarding the use of Pigmentbio Sensitive areas containing active ingredients (Andrographolide+Glabridin+Lysine azelate+Laminaria ochroleuca extract). The results were analyzed using a visual analogue scale. Results: The study included a total of 1402 patients, and 75 dermatologists provided complete responses. The majority (96%) of the dermatologists recommended Pigmentbio Sensitive areas for intimate & high friction areas. These dermatologists also rated tolerability and safety of Pigmentbio Sensitive areas as "excellent" to "good" based on various criteria. These included tolerability after waxing and shaving the bikini line, soothing effect after mechanical erythema from taking off tight clothing, hydrating power when compared to other products, cosmetic acceptability for frictional and intimate areas, and safety on intimate areas. Conclusions: This study findings indicated that Pigmentbio Sensitive areas is a preferred formulation by dermatologists across India for the management of hyperpigmentation in intimate & high friction areas with proven tolerability and safety.
... Tyrosinase, the rate limiting enzyme catalyzes the synthesis of melanin in melanocytes which provides epidermal protection from harmful ultraviolet radiation. However, excessive production of melanin causes complications both in human beings and in fruits & vegetables 19,20 . ...
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Three depsides, namely sekikaic acid (1), homosekikaic acid (2), and 4′-O-demethylsekikaic acid (3) were isolated from acetone fraction of Ramalina spp. The structures were characterized by using spectroscopic techniques like 1 H NMR, 13 C NMR, ESI MS and IR. The quantitative determinations of these compounds were conducted by reversed phase high performance liquid chromatography with photodiode array detector (LC-PDA). The developed assay method could be considered as a suitable quality control method for Ramalina spp. The content on percentage dry basis of these compounds were 1.39%, 0.98% and 0.58% for compound 1, 2 and 3, respectively. It is the first time report for tyrosinase inhibition activity for depsides. All of these compounds exhibited inhibition for tyrosinase enzyme with the IC 50 values 110.3±3.5, 90.1±1.4, and 206.4±5.1 µg/mL by the compounds 1, 2 and 3, respectively. The structure activity relationship of despides showed that the methoxy group at ring A might have enhanced the inhibitory activity. Therefore, these compounds may have their potential use in cosmetics with further studies.
... 2001), but its overproduction or accumulation in an abnormal amount in epidermal layers of human body may lead to many skin disorders such as lentigines, melasma, freckles, abnormal pigmentation, periorbital hyperpigmentation, degeneration of neurons linked with Parkinsonism and melanoma or skin cancer risk (Cestari et al., 2014;Dorga and Sarangal, 2014;Nouveau et al., 2016). The whole process of melanin synthesis is known as melanogenesis. ...
This study is aimed to synthesize morpholine- and thiazolidine-based novel 5-(substituted)benzylidene)-2-(morpholinoimino)-3-phenylthiazolidin-4-ones (3–26) and characterized by molecular spectroscopy. The synthesized compounds were subjected to antioxidant activity with anticholinesterase, tyrosinase, and urease inhibition activities and evaluated the structure–activity relationship (SAR) of enzyme inhibition activities. Compound 11 was found to be the most active antioxidant. In anticholinesterase inhibition, compound 12 (IC50: 17.41 ± 0.22 μM) was the most active against AChE, while compounds 3–26 ( except 3, 8, and 17) showed notable activity against BChE. Compounds 17 (IC50: 3.22 ± 0.70 mM), 15 (IC50: 5.19 ± 0.03 mM), 24 (IC50: 7.21 ± 0.27 mM), 23 (IC50: 8.05 ± 0.11 mM), 14 (IC50: 8.10 ± 0.22 mM), 25 (IC50: 8.40 ± 0.64 mM), 26 (IC50: 8.76 ± 0.90 mM), and 22 (IC50: 9.13 ± 0.55 mM) produced higher tyrosinase inhibition activity. In urease inhibition activity, compounds 20 (IC50: 16.79 ± 0.19 μM), 19 (IC50: 18.25 ± 0.50 μM), 18 (IC50: 20.24 ± 0.77 μM), 26 (IC50: 21.51 ± 0.44 μM), 25 (IC50: 21.70 ± 0.06 μM), and 24 (IC50: 22.49 ± 0.11 μM) demonstrated excellent activities. Besides, the molecular docking study was applied to better understand the inhibitory mechanism between (1–26) compounds and enzymes at the molecular level. According to the results of this study, the synthesized compounds exhibited a better binding affinity toward these enzymes compared to the positive control. Further, molecular mechanics Poisson–Boltzmann surface area (MM/PBSA) binding free energy and molecular dynamics (MD) simulation analyses were performed for AChE with compound 26, which showed high inhibitory activity in silico and in vitro studies. In conclusion, novel morpholine and thiazolidine-based derivative compounds may be pharmacologically effective agents for AChE, BChE, tyrosinase, and urease enzymes.
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Background: The color of Indian skin shows great diversity and pigmentary disorders are a major concern of Indian women. Despite great variations in climate, diet, and social parameters within India, studies of the range of skin types have been rather scarce. Aims: This study was aimed at characterizing the color of Indian skin in various geographical locations, its characteristics in terms of overall skin complexion and pigmentary disorders, and the impact of age on these features. Methods: An extensive descriptive study, including skin color parameters (objective measurements and evaluations by dermatologists, clinically or from photographs) was carried out involving 1,204 female volunteers of different ages living in four different Indian cities. Results: Important differences in skin complexion according to the geographical location were observed. Age seemed to have little impact on complexion. Hyperpigmented spots were frequent and were noted at early stages and many lentigines were found. Melasma affected about 30% of middle-aged women, but many other ill defined, pigmented macules were also observed. Additionally, we found pigmented lip corners associated with marionette lines, and linear nasal pigmentation. Conclusions: Indian skin color is diverse and pigmentary disorders are common. Skin complexion is not greatly affected by age. Some hyperpigmented disorders occur at early stages and increase with age, contributing to overall unevenness of facial color.
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Despite their preponderance amongst the ultraviolet (UV) range received on Earth, the biological impacts of longwave UVA1 rays (340-400 nm) upon human skin have not been investigated so thoroughly. Nevertheless, recent studies have proven their harmful effects and involvement in carcinogenesis and immunosuppression. In this work, an in vitro reconstructed human skin model was used for exploring the effects of UVA1 at molecular, cellular and tissue levels. A biological impact of UVA1 throughout the whole reconstructed skin structure could be evidenced, from morphology to gene expression analysis. UVA1 induced immediate injuries such as generation of reactive oxygen species and thymine dimers DNA damage, accumulating preferentially in dermal fibroblasts and basal keratinocytes, followed by significant cellular alterations, such as fibroblast apoptosis and lipid peroxidation. The full genome transcriptomic study showed a clear UVA1 molecular signature with the modulation of expression of 461 and 480 genes in epidermal keratinocytes and dermal fibroblasts, respectively (fold change> = 1.5 and adjusted p value
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Harmful consequences of sun exposure range from sunburn, photoageing and pigmentary disorders to skin cancer. The incidence and extent of these detrimental effects are largely due to the degree of constitutive pigmentation of the skin. The latter can be objectively classified according to the individual typology angle (°ITA) based on colorimetric parameters. The physiological relevance of the ITA colorimetric classification was assessed in 3500 women living in various geographical areas. Furthermore, in order to understand the relationship between constitutive pigmentation and ultraviolet radiation (UVR) sensitivity, we worked on ex vivo human skin samples of different colour exposed to increasing UVR doses. For each sample we defined the biologically efficient dose (BED), based on the induction of sunburn cells, and analysed UVR-induced DNA damage (cyclobutane thymine dimers, CPD). We found a significant correlation between ITA and BED. We also found a correlation between ITA and DNA damage. As the epidermal basal layer also hosts melanocytes and in order to analyse the relationship between skin colour and DNA damage occurring specifically within this cell type, we performed double staining for CPD and tyrosinase-related protein (TRP) 1, a key enzyme in melanin synthesis. We found that DNA damage within melanocytes depends on ITA. Taken together our results may explain the higher risk of lighter skin types developing skin cancers, including melanoma, as well as the development of pigmentary disorders in moderately pigmented skin. They show that skin classification based on ITA is physiologically relevant (as it correlates with constitutive pigmentation) and further support the concept of a more personalized approach to photoprotection that corresponds to a particular skin colour type's sensitivity to solar UVR.
Background: Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective: To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods: Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results: The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions: Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma.
The skin constitutive pigmentation is given by the amount of melanin pigment, its relative composition (eu/pheomelanin) and distribution within the epidermis, and is largely responsible for the sensitivity to UV exposure. Nevertheless, a precise knowledge of melanins in human skin is lacking. We characterized the melanin content of human breast skin samples with variable pigmentations rigorously classified through the Individual Typology Angle (ITA) by image analysis, spectrophotometry after solubilization with Soluene-350 and high-performance liquid chromatography (HPLC) after chemical degradation. ITA and total melanin were found correlated, ITA and PTCA (degradation product of DHICA melanin), and TTCA (degradation product of benzothiazole-type pheomelanin) as well but not 4-AHP (degradation product of benzothiazine-type pheomelanin). Results revealed that human epidermis comprises approximately 74% of eumelanin and 26% pheomelanin, regardless of the degree of pigmentation. They also confirm the low content of photoprotective eumelanin among lighter skins thereby explaining the higher sensitivity towards UV exposure. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Melasma is a common skin pigmentation condition. Given therapeutic difficulty as one of the biggest concerns, understanding of the etiology and pathogenesis of melasma becomes essential. UV irradiation, female sex hormones, and inflammatory processes are addressed as triggering factors with genetic predisposition. The mechanism of UV-induced melanogenesis has been extensively investigated as a model system to study melasma pathogenesis. Hitherto, treatment modalities for melasma are similar to other hyperpigmentation disorders. However, individual triggering factors induce a separate pigmentation disease, whose pathogenic mechanisms and clinical phenotypes are different from the ones encountered in melasma. Fortunately, there have been ongoing updates on melasma pathogenesis with regard to major triggering factors. Presence of certain factors working independently of UV exposure and role of dermal factors and microRNAs are being identified as novel discoveries about melasma pathogenesis. In this review, the melasma pathogenesis is reviewed in association with updated and new findings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Unlabelled: BACKGROUND & SCOPE OF THE REVIEW: This review focuses on the UV radiation effects on skin, emphasizing the photoaging process, and the photoprotection conferred by tretinoin (all-trans retinoic acid or ATRA). Tretinoin is still the best tested retinoid to reverse photoaged skin. Major conclusions: Tretinoin can be used for photoaging treatment or combined treatment by different mechanisms. It binds to and activates retinoic acid receptors, inducing changes in gene expression that leads to cell differentiation, decreased cell proliferation, and inhibition of tumourigenesis. It has been demonstrated that photoaging resulting from UV-B radiation can be treated by retinoid formulations. Pretreatment of human skin with tretinoin blocks dermal matrix degradation followed by sun exposure, inhibiting the induction of the activated protein-1 (AP-1) transcription factor and AP-1 regulated matrix-degrading metalloproteinases. GENERAL SIGNIFICANCE AND INTEREST: Tretinoin should be considered as a key factor as it is the most potent and best-studied retinoid. In addition, the development of advanced drug delivery systems, especially novel nanoformulations, has contributed to overpass some technical drawbacks besides the skin irritation potential. The triple combination of tretinoin, hydroquinone and corticosteroids is still considered the gold standard for melasma. Although there are other novel therapeutic approaches, more high-quality clinical trials are still needed.
Postinflammatory hyperpigmentation (PIH) is a common consequence following cutaneous inflammation in dark-skinned individuals with Fitzpatrick skin phototypes (SPTs) III–VI. The exact pathogenesis of this condition is unknown, but is believed to be an integral part of the normal response of the skin to inflammatory stimuli. PIH can last from months to years and may significantly impair quality of life of affected individuals. The primary treatment of PIH is prevention and treatment of the underlying inflammatory condition. In addition to prevention, there are a variety of medication and procedures used to treat PIH. Although topical skin-depigmenting agents remain the treatment of choice for PIH, lasers and light sources may be an effective adjunctive therapy or alternative for treatment failures. When treating PIH, any treatment options selected should be optimized and utilized carefully because the treatments itself may worsen the PIH.
Periorbital hyperpigmentation (POH) is one of the most commonly encountered conditions in routine dermatology practice. There are only few published studies about its prevalence, classification, and pathogenesis but none showing its association with habits, and other medical conditions in Indian patients. To determine prevalence and type of POH, common causative factors, and its association with personal habits and other disorders within various age and sex groups. Two hundred patients attending the dermatology OPD were included in study and were subjected to detailed history, careful clinical and Wood's lamp examination, eyelid stretch test and laboratory investigations. Clinical photographs of all patients were taken. POH was most prevalent in 16-25 years age group (47.50%) and in females (81%) of which majority were housewives (45.50%). Commonest form of POH was constitutional (51.50%) followed by post inflammatory (22.50%). Lower eyelids were involved in 72.50%. Grade 2 POH was seen in 58%. Wood's lamp examination showed POH to be dermal in 60.50%. Faulty habits were observed viz. lack of adequate sleep (40%), frequent cosmetic use (36.50%), frequent eye rubbing (32.50%), and lack of correction for errors of refraction like myopia in 12% patients. Strong association of POH with stress (71%), atopy (33%) and family history (63%) was noted. Periorbital hyperpigmentation is a multi-factorial entity. It is absolutely essential to classify the type of POH and determine underlying causative factors in order to direct appropriate measures for better and successful outcome in future.