Skin of Color Savvy: Insights on Hyperpigmentation from EADV, With Michelle Rodrigues, MBBS

Welcome to Skin of Color Savvy: The Art and Science of Treating Patients of Color!

In this Savvy Stories episode of Skin of Color Savvy: The Art and Science of Treating Patients of Color, recorded on-site at the European Academy of Dermatology and Venereology (EADV) Congress in Paris, HCPLive spoke with Michelle Rodrigues, MBBS, dermatologist, founder and director of the Pigment and Skin of Colour Centre at Chroma Dermatology in Australia, and associate professor at the University of Melbourne. Rodrigues discusses her presentation at the Skin of Color Society’s (SOCS) symposium, “Unmasking Facial Hyperpigmentation in Richly Pigmented Skin Types,” and offers practical insights for clinicians managing these complex and often misunderstood disorders.

In this podcast, produced by HCPLive and hosted by SOCS, Rodrigues explains that facial hyperpigmentation is a broad clinical category, with over 45 potential causes. Differentiating among conditions such as melasma, post-inflammatory hyperpigmentation (PIH), acquired dermal macular hyperpigmentation (ADMH), and exogenous ochronosis can be challenging even for experienced dermatologists. She emphasizes that accurate diagnosis is essential, as management strategies vary widely. Misclassification, she notes, can lead to unnecessary or even harmful treatments.

To improve diagnostic precision, Rodrigues advocates for greater use of dermoscopy. This noninvasive technique can reveal key visual clues: for example, melasma typically spares the eyelids and earlobes, whereas PIH and ADMH may present with “peppering” patterns or ashy-gray hues. In ochronosis, blue-gray amorphous areas and obliteration of eccrine structures may appear. She stresses that subtle color differences in richly pigmented skin—ranging from shades of brown to violaceous or grayish tones—offer valuable diagnostic guidance.

Rodrigues also discusses the psychosocial impact of facial hyperpigmentation, citing global data showing high rates of depression, anxiety, and social isolation among affected patients. These burdens are compounded in individuals with richly pigmented skin, who often face diagnostic delays, limited treatment access, and unique cosmetic challenges in covering pigmentation changes.

On the treatment front, Rodrigues underscores that broad-spectrum photo protection, including visible light and long-wave UVA (UVA1) coverage, is foundational. Topical antioxidants, niacinamide, and emerging non–hydroquinone-based agents such as thiamidol offer promising results, while traditional hydroquinone and retinoid combinations remain the gold standard when used with care. She also highlights the potential role of oral antioxidants, tranexamic acid, and low-dose isotretinoin in selected cases.

Rodrigues concludes by encouraging clinicians to refine their diagnostic skills, adopt a “360-degree” approach to photoprotection, and engage with the Skin of Color Society for mentorship and collaboration. Her key message: with careful assessment and culturally informed care, dermatologists can significantly improve outcomes for patients with facial hyperpigmentation in richly pigmented skin.

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

Editor's note: This summary was created with the help of AI tools.