![]() We enrolled 68 healthy black subjects (21 men and 47 women) with moderate to severe lesions of postinflammatory hyperpigmentation on their faces, arms, or both areas. An unexpected finding was a clinically minimal but statistically significant lightening of these subjects' normal skin. However, we found that topical tretinoin lightened postinflammatory hyperpigmented lesions in black subjects. Tretinoin is thought to cause hyperpigmentation and a poorly tolerated dermatitis when applied to black skin. Because the deposition of melanin may be similar in hyperpigmented spots in both white and black persons, we studied the ability of tretinoin to lighten postinflammatory hyperpigmentation in black subjects. ![]() Recently, we and others noted that treatment with topical tretinoin (retinoic acid) lightened hyperpigmented spots in white subjects 7-12. Therapy for postinflammatory hyperpigmentation has been unsatisfactory agents such as topical hydroquinones may cause unsightly depigmentation, irritant dermatitis, and ochronosis 3-6. Disfigurement may be severe in persons with highly pigmented skin 1-3. These spots commonly persist for months but usually disappear eventually. Postinflammatory hyperpigmentation presents as irregular, darkly pigmented spots occurring after inflammation of the skin such as that caused by acne, folliculitis, eczema, or shaving irritation. ![]() Topical application of tretinoin significantly lightens postinflammatory hyperpigmentation to a clinically minimal but statistically significant degree, it also lightens normal skin in black persons. Retinoid dermatitis developed in 12 of the 24 tretinoin-treated subjects who completed the study (50 percent) and in 1 tretinoin-treated subject who withdrew from the study, but diminished as the study progressed. 0.1 unit change on an 8-point scale P = 0.055) and colorimetry (P<0.001). Normal skin was minimally lightened by tretinoin as compared with vehicle, according to both clinical evaluation (0.1 vs. The epidermal melanin content in the lesions decreased by 23 percent with tretinoin and by 3 percent with vehicle (P = 0.24). At the end of treatment, colorimetry demonstrated a 40 percent lightening of the lesions toward normal skin color in the tretinoin-treated lesions, as compared with an 18 percent lightening in vehicle-treated lesions (P = 0.05). The facial postinflammatory hyperpigmented lesions of the tretinoin-treated subjects were significantly lighter after the 40 weeks of therapy than those of the vehicle-treated subjects (P<0.001) overall improvement was first noted after 4 weeks of tretinoin treatment. At base line and after 40 weeks of treatment, each subject's postinflammatory hyperpigmented lesions and normal skin were assessed by clinical and colorimetric evaluations and by analysis of biopsy specimens. Twenty-four subjects applied tretinoin daily to the face, arms, or both areas, and 30 subjects applied vehicle cream. Fifty-four subjects completed a 40-week randomized, double-blind, vehicle-controlled study. We investigated the treatment of this hyperpigmentation with topical tretinoin (0.1 percent retinoic acid cream). Irregular disfiguring skin hyperpigmentation due to inflammation may develop in black persons. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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