摘要

Objectives: To evaluate whether real-time exposome monitoring via wearable sensors improves clinical outcomes in melasma and PIH among skin of color patients compared to standard care. Introduction: Pigmentary disorders like melasma and PIH are common in skin of color and are triggered by environmental exposures—UV, visible light, pollution, heat, and humidity. Though the exposome’s role is well-recognized, real-time monitoring tools are lacking. Wearable sensors offer a way to personalize care, but their utility in pigmentary disorders is untested. This RCT evaluated whether real-time exposome feedback via wearables could improve adherence and outcomes in melasma and PIH among Fitzpatrick IV–VI patients. Materials / method: We conducted a 5-site RCT with 500 patients (18–55 years, Fitzpatrick IV–VI) with melasma or PIH. All received standard care. The intervention group (n=250) wore sensors tracking UV, heat, humidity, and AQI, linked to an app giving real-time alerts and nudges. Controls (n=250) wore sensors without feedback. Primary outcome: change in melanin index at 12 weeks. Secondary: mMASI/PIH scores, GAIS, adherence, flares, and satisfaction. Analysis was ITT using mixed-effects models. Results: At 12 weeks, the intervention group showed greater reduction in melanin index (−16.2%) vs controls (−8.4%; p<0.001). mMASI/PIH scores improved more in the intervention group (p=0.006). Adherence to sunscreen use increased by 33%. GAIS scores favored the intervention (69.2% vs 42.8% “much improved” or better). Exposome-triggered flares were reduced by 41%. No device-related adverse events were reported.