From the Guidelines
For inflammatory hyperpigmentation, I strongly recommend using azelaic acid 20% cream, as it has been shown to be effective in reducing dyspigmentation and has anti-inflammatory properties. This recommendation is based on the guidelines of care for the management of acne vulgaris, which suggests that azelaic acid is a useful adjunctive acne treatment and is recommended in the treatment of postinflammatory dyspigmentation 1.
Key Points to Consider
- Azelaic acid 20% cream is a category B medication in pregnancy, making it a relatively safe option for pregnant women 1.
- It is essential to use sunscreen with SPF 30+ every morning, reapplied every 2 hours when outdoors, to prevent further hyperpigmentation.
- Retinoids like tretinoin 0.025-0.05% can be added at night (alternate with azelaic acid) after the first month if tolerated, as they can help increase cell turnover and reduce inflammation.
- A patch test should be done to check for irritation, and the treatment should be discontinued if severe irritation occurs.
- Results typically begin to show after 4-6 weeks of consistent use, and if no improvement is seen after 12 weeks or if the condition worsens, consultation with a dermatologist is recommended.
Additional Considerations
- Other treatments like hydroquinone 4% cream and topical corticosteroids like triamcinolone 0.1% cream can be considered, but azelaic acid 20% cream is a more suitable option due to its anti-inflammatory properties and effectiveness in reducing dyspigmentation.
- Topical dapsone 5% gel can also be considered, especially in adult females with acne, but its effectiveness in reducing hyperpigmentation is not as well established as azelaic acid 1.
From the Research
Inflammatory Hyperpigmentation Treatment
- Inflammatory hyperpigmentation can be treated with various creams, with niacinamide being a potential ingredient due to its anti-inflammatory properties 2, 3, 4.
- A study found that a serum containing 5% niacinamide, 3% tranexamic acid, and 1% kojic acid significantly improved the appearance of post-inflammatory hyperpigmentation and hyperpigmentation in Brazilian female subjects with Fitzpatrick skin types I-IV 5.
- Niacinamide has been shown to inhibit melanosome transfer from melanocytes to keratinocytes, resulting in reduced cutaneous pigmentation 3.
- Topical retinoids are also used to treat pigmented skin, including melasma and post-inflammatory hyperpigmentation, and are generally well-tolerated in pigmented skins 6.
Key Ingredients
- Niacinamide: anti-inflammatory, antimicrobial, antioxidant, antipruritic, and anticancer properties 2, 3, 4.
- Tranexamic acid: inhibits the release of inflammatory mediators involved in triggering melanogenesis 5.
- Kojic acid: inhibits melanin production 5.
- Retinoids: important class of drugs for treating dermatoses in pigmented skin, including melasma and post-inflammatory hyperpigmentation 6.
Treatment Efficacy
- A 12-week clinical study found significant improvement in the appearance of post-inflammatory hyperpigmentation and hyperpigmentation with a serum containing 5% niacinamide, 3% tranexamic acid, and 1% kojic acid 5.
- Niacinamide has been shown to decrease hyperpigmentation and increase skin lightness compared to vehicle alone after 4 weeks of use 3.
- Topical retinoids are effective in managing acne, psoriasis, photoaging, and other dermatoses in pigmented skin 6.