Practical Approaches to Hyperpigmentation and Hypopigmentation, With Nada Elbuluk, MD, MSc, and Michelle Rodrigues, MBBS

In the second featured clip from the most recent episode of the Skin of Color Savvy podcast, 2 Skin of Color Society (SOCS) leaders, Michelle Rodrigues, MBBS, founder and director of Chroma Dermatology, and Nada Elbuluk, MD, MSc, assistant professor at the USC Keck School of Medicine, explore the diagnostic complexity of pigmentary disorders in patients with skin of color, emphasizing the importance of precision, pattern recognition, and patient-centered care.

Their conversation reinforces a key message: pigmentary change is not a diagnosis in itself, but rather a clinical sign with a broad and nuanced differential. Rodrigues opens by noting that terms such as “hyperpigmentation” or “hypopigmentation” are often used too broadly, which can lead to oversimplification and mismanagement. Instead, she emphasizes the need to identify the underlying cause, whether inflammatory, autoimmune, medication-related, or genetic. Elbuluk builds on this point by highlighting how post-inflammatory hyperpigmentation remains one of the most common concerns among patients of color, often arising from acne, eczema, or other inflammatory dermatoses.

While frequently dismissed as cosmetic, both experts stress that pigmentary disorders can have a profound psychosocial impact and deserve thoughtful evaluation and treatment. A significant portion of the discussion focuses on clinical assessment strategies. Rodrigues underscores the value of a careful history and physical examination, paying close attention to lesion distribution, color variation, borders, and evolution over time.

She also highlights dermoscopy as a valuable, noninvasive tool that can help distinguish epidermal from dermal pigment and guide management decisions, potentially reducing the need for biopsy in select cases. Elbuluk adds that understanding a patient’s background—including prior inflammation, treatments, and cultural skin-care practices—is essential to accurate diagnosis.

The conversation also addresses conditions such as vitiligo and acquired dermal macular hyperpigmentation, underscoring how these disorders may present differently across skin tones and how delayed diagnosis can worsen outcomes. Both speakers emphasize the importance of setting realistic expectations with patients, as pigmentary disorders often require prolonged treatment courses and careful maintenance.

Together, Rodrigues and Elbuluk advocate for a more deliberate, informed approach to pigmentary disease—one that recognizes both the biological complexity and emotional weight of these conditions for patients with skin of color.

To learn more about SOCS’s programs and initiatives, visit Skin of Color Society.

Editor’s note: This summary was edited with the help of AI tools.