Expert guide: Aesthetic & Cosmetology 2015 32 June 2015 June 2015 33 I n West Africa, the most common complaint that plastic surgeons or dermatologists find is related to acquired pigmentary changes. Among them, postinflammatory hy-perpigmentation and melasma are the most frequently seen. Introduction and Definition Postinflammatory hyperpigmenta-tion, also called postinflammatory melanoderma, is an excessive pig-mentation of the skin produced by a previous irritation. Skin damage that re-sults in inflammation can induce postin-flammatory hyperpig-mentation. Common triggers are acne le-sions, allergic or irri-tant contact derma-titis, folliculitis caused by ingrown hairs, scratches, insect bites or trau-ma. Hyperpigmentation can also de-velop after cosmetic procedures like chemical peels, hair removal or laser resurfacing.Melasma is a hyperpigmentary disor-der that occurs typically as symmet-rical lesions on the face. The cheeks, forehead, upper lip, nose and chin are commonly involved. It affects primarily darker skin type females at puberty or later in life. It is known both for causing significant psycho-social stress and for its difficulty to treat. There is a hormonal compo-nent, since episodes of melasma are associated with pregnancy and the use of hormonal birth control.There have been de-scribed several mech-anisms that produce hyperpigmentation. Among them is the stimulation of mel-anocytes by inflam-matory mediators (IL-1-alpha or ET-1). Other known stimulators of melano-cytes are superoxide and nitric oxide generated in damaged skin.The melanin produced during inflam-mation can also enter the dermis, be phagotised by macrophages and re-tained in the upper dermis for a long Dr. Juan Aguiar, MD info@doctoraguiar.com +240 556 666 160 5 Tips to treat hyperpigmentation on black skin By Dr. Juan Aguiar, MD Guinea time, since the removal of dermal melanin is a very slow process.The use of hydroquinone has been the first-line treatment for hyper-pigmentation. Hydroquinone 1,5 to 2% is available over-the-counter and preparations with higher concentra-tions have to be prescribed by phy-sicians. The mechanism of action is the suppression of melanin for-mation by the reversible inhibition of tyrosinase (the main enzyme in-volved in the conversion of tyrosine to melanin) and the selective dam-age to melanosomes and melano-cytes. Therefore, the mechanism of action of topical hydroquinone is through prevention of new melanin production. Tip 1. Prevention, prevention and prevention The most important advice for our patients is always prevention. They must avoid all the known triggers that cause hyperpigmentation. The importance of daily sun protection can’t be stressed enough. It not only plays an important role in the pre-vention and treatment of pigmen-tary disorders, the use of sunscreen strongly decreases the rates of skin cancer and photoaging. Still, many patients with skin of color assume that due to the darker skin tone, they can skip sunscreen altogether.Tip 2. Find the underlying problem A common mistake among many patients suffering from hyperpig-mentation disorders is self-medica-tion without treating the underlying cause. It is imperative to conduct a thorough initial consultation and health history to determine the ex-act cause of the disorder and estab-lish an early intervention. When the cause is explained to the patients, their compliance with the therapy will increase. We have to inform the patients that in cases of dermal pigmentation, the treatment will be challenging and that perseverance and patience will be imperative.Tip 3. Combined therapies work bet-ter