What are the treatment options for hyperpigmentation, according to the American Academy of Dermatology (AAD)?

From the Guidelines

Hyperpigmentation can be effectively treated with a combination of topical medications, chemical peels, and laser therapies, with autologous platelet concentrates (APCs) emerging as a promising treatment option, as demonstrated by recent studies 1. The primary treatments for hyperpigmentation include:

• Topical medications such as hydroquinone, retinoids, azelaic acid, kojic acid, vitamin C, and tranexamic acid, which work by inhibiting melanin production or increasing cell turnover
• Chemical peels containing glycolic acid, salicylic acid, or trichloroacetic acid, which can be effective when applied by dermatologists at varying strengths depending on skin type and hyperpigmentation severity
• Laser and light therapies, including intense pulsed light (IPL), Q-switched lasers, and fractional lasers, which target melanin deposits without damaging surrounding tissue
• Autologous platelet concentrates (APCs), which have shown promising results in the treatment of hyperpigmentation, particularly in the periorbital area, with high patient satisfaction rates and significant improvement in skin thickness and periocular wrinkles 1 The most effective treatment plan should be determined by a dermatologist based on skin type, hyperpigmentation cause, and medical history, with sun protection being essential during and after treatment, including daily application of broad-spectrum SPF 30+ sunscreen, wearing protective clothing, and avoiding peak sun hours 1. Some key considerations for treatment include:
• Treatment duration, which can vary from weeks to months depending on the hyperpigmentation's cause and severity
• The need for ongoing maintenance therapy, particularly for chronic conditions like melasma
• The potential benefits and risks of each treatment option, including the use of APCs, which have been shown to be safe and effective in several studies 1

From the FDA Drug Label

HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. According to the information provided, treatment options for hyperpigmentation include:

• Hydroquinone, a skin bleaching cream, for the gradual bleaching of hyperpigmented skin conditions, as indicated in the drug label 2. Key words are hyperpigmentation, hydroquinone, and skin bleaching cream.

From the Research

Treatment Options for Hyperpigmentation

According to the American Academy of Dermatology (AAD), hyperpigmentation can be treated with various topical agents, including:

• Hydroquinone, which is considered the gold-standard treatment for epidermal hyperpigmentation 3, 4
• Kojic acid, which can be used as a first-line treatment for hyperpigmentation 5
• Glycolic acid, which can be used as a first-line treatment for hyperpigmentation 5
• Azelaic acid, which can be used to reduce hyperpigmentation 3
• Arbutin, which can be used to reduce hyperpigmentation 3
• Licorice extract, which can be used to reduce hyperpigmentation 3

Combination Therapy

Combination therapy, which involves using multiple topical agents together, can be more effective than monotherapy in treating hyperpigmentation 6. This approach can help to reduce the appearance of hyperpigmentation and improve treatment outcomes.

Alternative Treatments

Alternative treatments for hyperpigmentation include:

• Chemical peels, which can be used to remove the top layers of skin and reduce the appearance of hyperpigmentation 5, 4
• Laser therapy, which can be used to target and reduce hyperpigmentation 5, 4
• Microneedling, which can be used to stimulate collagen production and improve skin texture 5
• Platelet-rich plasma, which can be used to stimulate collagen production and improve skin texture 5

Considerations for Skin of Color

When treating hyperpigmentation in skin of color, it is essential to consider the potential risks of hypopigmentation or irritation 7, 3, 4. A systematic approach to diagnosis and treatment, based on the disease pathogenesis, can help to ensure effective and safe treatment outcomes.