The Dermatologist readers offer pearls from their clinical practice.
It is helpful to explain pigmentary issues to patients in a way that is easy to understand. Here are some approaches I have used.
For hypopigmentation, I describe tiny pigment factories (melanocytes) in which the workers work harder and shovel more pigment when the sun shines on them and that is how we tan. When the skin is injured or inflamed (ie, pitriasis alba, tinea versicolor, etc.), these workers get injured and they slow down and thus the skin gets lighter in these affected areas. I then explain that when the skin heals and the sun shines, the workers (hopefully) will resume working at full steam.
In cases of vitiligo, the factories go out of business and the workers are laid off. But sometimes the factories can be rebuilt with the proper treatment and the workers can return.
To explain hyperpigmentation, I call the dark spots “footprints.” I explain that these are areas where the skin injury took place and that, in time, hopefully the normal color will return. I sometimes use the factory analogy and explain that the workers get “angry” and try to protect the skin by shoveling harder. Sometimes, I actually explain the problem with details. These approaches, of course, depend upon the age and scientific knowledge of the patients.
Herb Goodheart, MD