Cosmetic Question: What are the best treatments for hyperpigmentation?
Cosmetic Answer: Much depends on your skin and what causes the darkening. This topic and treatment can become complex. Here are the 3 most common causes of hyperpigmentation and the 4 principles of treating hyperpigmentation.
The Three Common Causes of Hyperpigmentation and Their Treatment
- Sun damaged skin – facial skin color is blotchy all over.
- First treatment, tretinoin (Retin A), glycolic and skin lightening creams.
- Second treatment, SkinPen microneedling.
- Third treatments, glycolic or TCA peels or color-removing lasers
- Most aggressive treatment, skin resurfacing laser or deep phenol peels.
- Melasma – very dark color usually over the upper cheeks, caused by hormones
- If from birth control pills, change or stop the pill.
- Treat as you would for sun damaged skin.
- Melasma color tends to quickly return if treatment stops.
- Post-inflammatory hyperpigmentation or PID – skin quickly darkens from even mild injury.
- Prevention, prevention, prevention – this discoloration can last years.
- 6 weeks before surgery, apply skin lightening creams to the surgical area twice a day.
- Once skin turns dark, 100% shea or cocoa butter-DO NOT USE SOAP.
- Hydroquinone tends not to work well with PID but can be tried.
- If acne develops, immediately treat acne including antibiotics and a skin lightener.
The Four Principles for Treating Hyperpigmentation
- Protect the skin from the sun
- Sun block on all exposed areas face and neck.
- Sun protective clothing, e.g. Solumbra, for the rest of the body.
- Once skin darkens, even with treatment, it tends to darken again with sun exposure.
- Initial treatment = tretinoin (Retin A) + glycolic + skin lighteners
- After 3 – 6 months, replace 4% hydroquinone with Lytera from Skinmedica by Allergan
- Why? Hydroquinone in time can give skin a permanent grey tone.
- PID – post-inflammatory skin darkening – easy to prevent, hard to reverse.