Management of Hyperpigmentation in Darker Racial Ethnic Groups

Dyschromias, in particular hyperpigmentation, are major issues of concern for people of
color. Pigmentary disorders such as melasma and postinflammatory hyperpigmentation
(PIH) can cause psychological and emotional distress and can pose a negative impact on
a person’s health-related quality of life. The precise etiology of these conditions is unknown.
Therapies for melasma and PIH target various points during the cycle of melanin
production and degradation. Therapies for these conditions include topical agents and
resurfacing procedures. Hydroquinone remains the gold standard of topical agents. Other
efficacious agents include kojic acid, azelaic acid, mequinol, and retinoids. Cosmeceutical
agents include licorice, arbutin, soy, N-acetyl glucosamine, and niacinamide. Resurfacing
procedures that have been used to treat melasma and PIH include chemical peels, microdermabrasion,
lasers, and intense pulsed light. These procedures are best used in combination
with topical bleaching agents. Given the propensity of darker skin to hyperpigment,
resurfacing procedures should be used with care and caution. Maximal results are best
achieved with repetitive, superficial, resurfacing modalities. In addition, ultraviolet protective
measures such as broad-spectrum sunscreens are fundamental to the successful
management of these conditions.
Semin Cutan Med Surg 28:77-85 © 2009 Elsevier Inc. All rights reserved.

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