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Best Practices in the Treatment of Hyperpigmentation

By: Ahmed Abdullah, MD
Posted: April 27, 2012, from the May 2012 issue of Skin Inc. magazine.
professional skin care client with hyperpigmentation

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Most commonly, active ingredients in topical formulations work by affecting tyrosinase, the enzyme found in melanocytes that stimulates the production of melanin. Such ingredients are beneficial when melanin production must be regulated, as in melasma, in which the ongoing use of a skin lightener is necessary. When excess pigment production is no longer an ongoing issue, discoloration may simply need to be cleaned up. Such circumstances are best treated through professional treatments and the use of alpha hydroxy acids (AHAs) or retinol to exfoliate and rejuvenate the skin. Among the topical agents available to skin care professionals for the treatment of hyperpigmentation are the following.

Hydroquinone. This is frequently referred to as the gold standard for hyperpigmentation and with good reason: It has been used for more than 50 years and is the only U.S. Food and Drug Administration (FDA)-approved product for skin lightening. It is often formulated with antioxidants, retinoids and hydroxy acids to improve results. Unfortunately, it can be irritating to certain individuals and may cause serious reactions when used in high concentrations.

Azelaic acid. This was developed for the treatment of acne. However, it has proven to be beneficial in the treatment of hyperpigmentation, especially PIH from acne lesions.3 In one study, it demonstrated results similar to 4% hydroquinone, but without its side effects.4

Kojic acid. This is a naturally occurring derivative of certain fungal species that features an efficacy similar to hydroquinone. In fact, hydroquinone and glycolic acid can produce better results when kojic acid is added to the formulation.5 The drawback is that it has the potential to cause contact dermatitis.6

Mandelic acid. This AHA is derived from almonds and is used in the treatment of several skin conditions, including all types of hyperpigmentation. It is often combined with salicylic acid and administered as a peel, in which case it has fewer side effects than a glycolic peel and has demonstrated better efficacy.7

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