Hyperpigmentation or Hypermelanoses

Hyperpigmentation or Hypermelanoses

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

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: QS Nd:YAG and fractional lasers can be considered but carry risks, particularly in darker skin types.

Although treatment results are often temporary, combining therapies with consistent sun protection offers better long-term outcomes. Discontinuation of therapy frequently leads to recurrence.

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.

Melasma

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.

Contributing Factors

  • Key causes: Chronic UV exposure (primary factor), genetic predisposition, hormonal influences, and medications.
  • Other factors: Use of vegetable oils (e.g., mustard oil) on the face, phototoxicity, and a positive family history of melasma.

Clinical Presentation

Typically presents as symmetrical brown patches on the face. The most common type, epidermal melasma, can be identified through Wood’s lamp examination.

Management

  • General measures: Sun avoidance and daily broad-spectrum sunscreen (SPF 30+).
  • Topical treatments:
    • Hydroquinone, tretinoin, corticosteroids (alone or in combination).
    • Other agents include azelaic acid, kojic acid, arbutin, and ascorbic acid.
    • Triple combination therapy (hydroquinone + retinoic acid + corticosteroid) is the gold standard.
  • Chemical peels: Glycolic acid, TCA, and salicylic acid peels improve pigmentation but carry a risk of PIH in darker skin tones.
  • Laser therapy: QS Nd:YAG and fractional lasers show similar efficacy in men and women, though recurrence is frequent.

Post-Inflammatory Hyperpigmentation (PIH)

PIH 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.

Treatment Strategies

  • Sunscreen: Crucial to prevent further darkening.
  • Topical agents: Hydroquinone, tretinoin, corticosteroids, azelaic acid (6–12 months of treatment may be required).
  • Chemical peels: Glycolic acid combined with hydroquinone and tretinoin is effective for darker skin types.
  • Laser therapy: Generally avoided due to a high risk of worsening pigmentation.

Drug-Induced Hyperpigmentation

Hyperpigmentation can result from the deposition of drugs in the dermis or epidermis, commonly caused by medications like minocyclineantimalarialsamiodaroneNSAIDs, and heavy metals.

Management

  • Discontinue the causative drug.
  • Topical bleaching agents are generally ineffective for dermal pigmentation.
  • Laser therapy (Q-switched ruby, alexandrite, Nd:YAG lasers) has been used successfully to lighten drug-induced pigmentation, particularly from minocycline.

Erythema Dyschromicum Perstans (EDP)

Also known as “ashy dermatosis,” EDP presents as slate-blue macules with inflammatory borders.

Treatment Options

  • Traditional therapies (hydroquinone, tretinoin, corticosteroids) are often ineffective.
  • Clofazimine: Reduces inflammation but may cause orange discoloration.
  • Dapsone: May slow disease progression and improve pigmentation.

Periorbital Dark Circles

Dark circles under the eyes affect all demographics and can result from a combination of dermal melanin depositiongeneticssun exposurefatigue, and aging, among other factors. They often contribute to a tired appearance, causing cosmetic concerns.

Treatment Approaches

  • Topical agents: Bleaching creams, retinoids.
  • Chemical peels: TCA 3.75% combined with lactic acid 15% peels is an effective option, showing significant improvement after one session.
  • Laser therapyfillers, and surgical options (e.g., blepharoplasty) may be used for more severe cases.

Adverse effects of peels are typically mild and transient, including erythema, edema, and frosting.

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