In skin-of-color patients with psoriasis or atopic dermatitis who achieve cutaneous plaque/eczema clearance on biologic therapy but retain prominent post-inflammatory hyperpigmentation, do you immediately add pigment-directed topicals or rely solely on sustained biologic suppression for pigment resolution?

This is a tough question, and as with most things, it will be largely patient-dependent. There are no phenomenal treatments for post-inflammatory pigment alteration (PIPA), and they all have risks, and we know that over time the changes will improve with continued disease control as your only intervention. Therefore, the weighing of risks and benefits can be somewhat challenging.

I believe it is important for the patient to be very well informed so that they can be the decision maker around the approach. Counselling around the natural course is very important, being sure to emphasize: (1) it was the disease driving discoloration--some patients misattribute the topicals to causing this issue, limiting their desire to use as needed for small ...