This chapter provides an overview of the epidemiology, pathophysiology, course, measurement, and potential therapies for pigmentation disorders in scars. Pigmentation problems are a common consequence of deep partial- and full-thickness burns, other skin trauma or disease, and surgical procedures. Both hypopigmentation and hyperpigmentation can cause esthetic and psychological issues, which may influence quality of life. The role of melanocytes and the maturation of pigmentation problems are discussed. To determine the severity of pigmentation problems and for therapeutic evaluation, different subjective and objective methods have been validated. Simple and easy-to-use measurement instruments are available based on spectrophotometric techniques. Also scar assessment scales with subscales for color and pigmentation are convenient and validated methods for quantitative evaluation of skin pigment disorders. Treatment options are discussed and include camouflage therapy, topical treatments, chemical peels, laser therapy, dermatography, dermabrasion, microneedling, skin grafting, cell therapy, and excision. It is advised to first try the conservative options and to dose and monitor the treatment to prevent overshoot and complications.
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