Hyperpigmentation or Hypermelanoses

Hyperpigmentation encompasses conditions such as post-inflammatory hyperpigmentation, melasma, and drug-induced pigmentation, all of which tend to have a chronic course and significant psychological impact on affected individuals.

Melasma is a common pigmentary disorder, presenting as light to dark-brown patches on sun-exposed areas such as the face, neck, and forearms. It predominantly affects women but can also occur in men, often leading to emotional distress and a reduced quality of life. It is more prevalent in individuals with Fitzpatrick skin types IV–VI. Typically presents as symmetrical brown patches on the face.

PIH or Post Inflammatory Hyperpigmentation results from inflammatory skin conditions (e.g., acne, dermatitis) or cosmetic procedures (e.g., laser therapy, chemical peels). It is particularly severe when the basal cell layer is disrupted and is more common in individuals with darker skin.

Drug Induced Hyperpigmentation can result from the deposition of drugs in the dermis or epidermis, commonly caused by medications like minocycline, antimalarials, amiodarone, NSAIDs, and heavy metals.

Periorbital Dark Circles or Dark circles under the eyes affect all demographics and can result from a combination of dermal melanin deposition, genetic susceptibility, sun exposure, fatigue, and ageing, among other factors. They often contribute to a tired appearance, causing cosmetic concerns.

Treatment Approaches

Sunscreens: Regular application is essential to prevent exacerbation.
Topical agents: Hydroquinone, tretinoin, corticosteroids (monotherapy or combination).
Chemical peels: Glycolic acid, salicylic acid, trichloroacetic acid (TCA).
Laser therapy

Management of hyperpigmentation requires a multimodal approach, combining sun protection, topical treatments, chemical peels, and, in some cases, laser therapy. While results are often temporary, adherence to treatment protocols and consistent sun avoidance can enhance outcomes and prevent recurrence. Combining therapies with consistent sun protection offers better long-term outcomes. Discontinuation of therapy frequently leads to recurrence, and so regular maintenance treatments are usually required.