Publication:

The psychosocial burden of hyperpigmentation in fitzpatrick skin types IV to VI

Hyperpigmentation, which includes conditions like post-inflammatory hyperpigmentation (PIH) and melasma, disproportionately affects individuals with Fitzpatrick skin types IV-VI. Although medically benign, hyperpigmentation can cause significant emotional and social distress. Despite growing awareness of dermatologic disparities, research exploring the psychosocial burden of hyperpigmentation among individuals with Fitzpatrick skin types IV-VI remains limited. This review synthesizes existing literature on the psychosocial impacts associated with hyperpigmentation, focusing on individuals with melanin-rich skin. Studies reveal consistent associations between hyperpigmentation and diminished self-esteem, anxiety, depression, and social withdrawal. In many cases, the psychosocial toll was disproportionately greater than the clinical severity of the hyperpigmentation. Cultural beliefs, including colorism and societal beauty standards that favor fair skin, were found to influence how patients perceive their hyperpigmentation, pursue treatment and engage with healthcare providers. There was a notable lack of inclusive clinical studies, culturally sensitive care models and dermatological mental health care. In addition, physicians receive limited medical training on skin of color, further contributing to misdiagnosis and inappropriate treatment. Addressing these gaps involves a multifactorial approach including increasing representation amongst dermatological research, developing inclusive educational resources for physicians, incorporating culturally sensitive care, and launching public health campaigns promoting skin health and inclusivity. Recognizing both the clinical and psychological severity associated with hyperpigmentation allows for greater patient-centered care, fostering patient trust, engagement, and treatment compliance.