From the Guidelines
Hyperpigmentation treatment should prioritize topical therapies, including hydroquinone, tretinoin, and tranexamic acid, as they have shown efficacy in reducing melanin production and promoting skin rejuvenation. Hyperpigmentation appears as darkened patches or spots on the skin, resulting from excess melanin production, and common symptoms include dark spots, uneven skin tone, and patches that are darker than surrounding skin, often worsening with sun exposure 1. Treatment options include topical retinoids like tretinoin (0.025-0.1%), which increase cell turnover; hydroquinone (2-4%), which inhibits melanin production; and tranexamic acid, which has recently gained attention for its potential in treating melasma 1.
Some key points to consider when treating hyperpigmentation include:
- The Melasma Area and Severity Index (MASI) and the Modified Melasma Area and Severity Index (m-MASI) can be used to measure the extent of facial hyperpigmentation and assess response to treatment 1
- Topical therapies may be combined with procedural therapies, such as autologous platelet concentrates, which have emerged as a novel treatment for melasma, although more research is needed to fully evaluate their efficacy and safety 1
- Compounded topical medications offer customized solutions, with popular formulations including Kligman's formula, triple combination creams, and custom blends with kojic acid, niacinamide, or tranexamic acid
- For optimal results, apply these medications to clean, dry skin once or twice daily as directed, and always use broad-spectrum SPF 30+ sunscreen during the day, as sun exposure can worsen hyperpigmentation
It is essential to consult a dermatologist to determine the best course of treatment for individual cases of hyperpigmentation, as they can provide personalized recommendations and monitor progress 1.
From the Research
Symptoms of Hyperpigmentation
- Hyperpigmentation is a common dermatological condition that alters the color of the skin, making it discolored or darkened 2
- It can significantly negatively impact a person's quality of life 3
- Hyperpigmentation disorders affect individuals worldwide and can be caused by various factors such as inflammation, sun exposure, and skin injuries 3, 2
Available Treatment Options
- Topical formulations of conventional agents such as hydroquinone, kojic acid, and glycolic acid are commonly used as first-line treatments for hyperpigmentation 2
- Oral formulations of therapeutic agents such as tranexamic acid, melatonin, and cysteamine hydrochloride can also be used to treat hyperpigmentation 2
- Chemical peels and laser therapy are second-line approaches that can be used under the observation of expert professionals 2
- Novel formulations such as solid lipid nanocarriers, liposomes, phytochemicals, platelet-rich plasma, and microneedling are emerging therapies for managing hyperpigmentation 2
- Topical retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide, and plant-derived products have been shown to be effective in treating postinflammatory hyperpigmentation (PIH) 4
- Sunscreens with SPF30 or greater are recommended to prevent further hyperpigmentation 4
Compounded Topical Medications
- Hydroquinone is a commonly used topical agent for treating hyperpigmentation, but it can have side effects and is not approved for over-the-counter use in the United States 3
- A non-hydroquinone topical formulation containing epidermal growth factor, tranexamic acid, vitamin C, arbutin, niacinamide, and other ingredients has been shown to be safe and effective in improving hyperpigmentation 5
- Retinoids and azelaic acid can be used to treat acne and hyperpigmentation in skin of color, and have been shown to be safe and beneficial in this patient population 6