Postinflammatory hyperpigmentation: protocol for development of a core outcome set for clinical trials

12-Week, Single-Center Study of a Targeted Pigment-Correcting Dark Spot Treatment for Post-Inflammatory Hyperpigmentation and Solar Lentigines

Purpose

Post-inflammatory hyperpigmentation (PIH) and solar lentigines are dark spots of skin from excessive melanin production due to injury or UV exposure. This 12-week single-center study assessed the efficacy and tolerability of a novel targeted pigment-correcting spot treatment gel suspension cream (Dark Spot Treatment) for improving mild-to-moderate PIH or solar lentigines.

Patients and Methods

Female participants (N = 41) aged 25-65 with mild-to-moderate facial dark spots applied Dark Spot Treatment daily for 12 weeks. Investigators assessed overall hyperpigmentation, skin tone evenness, and dark spot intensity, contrast, and size at Weeks 2, 4, 8, and 12. Participant self-assessments occurred at Weeks 1, 2, 4, 8, and 12. Tolerability was assessed by clinical grading and participant reporting.

Results

Dark Spot Treatment improved overall hyperpigmentation, skin tone evenness, and dark spot intensity and contrast at Weeks 2 through 12, and dark spot size at Weeks 4 through 12 (all p < 0.001 compared to baseline). Participant self-assessments showed high overall satisfaction. Dark Spot Treatment was well tolerated.

Conclusion

The novel pigment-correcting Dark Spot Treatment significantly improved the appearance of PIH and solar lentigines, had high participant satisfaction, and was well tolerated.

Review of Laser Treatments for Post-Inflammatory Hyperpigmentation in Skin of Color

Post-inflammatory hyperpigmentation is an extremely common disorder of pigmentation in skin of color. It most frequently and severely affects phototypes that are rich in melanin and often has a chronic and unpredictable course. It presents significant treatment challenges and often requires a multi-factorial approach. We review the literature available for the optimal use of laser-based devices in the treatment of post-inflammatory hyperpigmentation, particularly for Fitzpatrick skin phototypes III-VI. For the treatment of post-inflammatory hyperpigmentation in skin of color, lasers remain second line to topical agents based on the variable response, cost, and risk of complications with laser use. For post-inflammatory hyperpigmentation resistant to topicals, laser devices, particularly neodymium:yttrium-aluminum-garnet and fractional photothermolysis systems, can provide adjunctive treatment in skin of color patients when appropriate parameters are used. Future studies would benefit from an objective and consistent assessment to assist with a systematic analysis.

Improvements and advances in core outcome set methodology: proceedings of the CS-COUSIN & COMFA Joint Meeting

A COS is a systematically developed list of outcomes recommended for reporting all studies within a particular disease area. The Cochrane Skin–Core Outcome Set Initiative (CS-COUSIN) and the Core Outcome Measures in Food Allergy (COMFA) Initiative Joint Meeting was held virtually on September 23 through 28, 2021. This meeting brought together core outcome set (COS) developers within the domains of dermatology and food allergy, respectively. The meeting assessed the state of COS methodology, provided a forward look, and facilitated the networking of members of individual COS groups. The meeting hosted several expert-led key addresses and focus sessions, in which work was critically discussed, new developments were shared, and groundwork was laid for future projects. The conference emphasized the importance of ongoing COS work to improve patient outcomes and limit research waste.

Core outcome sets in clinical laser research: how better evidence can be better for patients

Core outcome sets, or the minimum sets of outcomes that would be used in all clinical studies of a given disease or condition, have the potential to revolutionize clinical research in laser and energy devices. Currently, laser studies, like other clinical investigations in medicine, measure whatever outcomes the individual investigators deem appropriate, making it difficult to compare safety and efficacy of various treatments through meta-analyses. The development of core outcome sets is rigorous, and involves systematic literature reviews, interviews with various stakeholders such as industry researchers, regulatory bodies, non-physician providers, patients and family members, as well as an international Delphi consensus process with input from both patients and physicians. Following the establishment of core outcome sets, core outcome measures are developed, with one measure being the preferred means for assessing each core outcome. Uptake of core outcome sets and measures can make it much easier to combine the results of different studies of the same condition across treatment modalities and geographic regions. Once researchers are all reporting, at a minimum, the same outcomes and using the same outcome measures, patients will truly be well-served, and we will then be working cooperatively, worldwide, to answer the same important questions. In doing so, we will move the science of laser medicine forward.