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There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.<ref name=Gupta2005rev>{{cite journal|last1=Gupta|first1=AK|last2=Gover|first2=MD|last3=Nouri|first3=K|last4=Taylor|first4=S|title=The treatment of melasma: a review of clinical trials.|journal=Journal of the American Academy of Dermatology|date=December 2006|volume=55|issue=6|pages=1048–65|pmid=17097400|doi=10.1016/j.jaad.2006.02.009}}</ref>
There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.<ref name=Gupta2005rev>{{cite journal|last1=Gupta|first1=AK|last2=Gover|first2=MD|last3=Nouri|first3=K|last4=Taylor|first4=S|title=The treatment of melasma: a review of clinical trials.|journal=Journal of the American Academy of Dermatology|date=December 2006|volume=55|issue=6|pages=1048–65|pmid=17097400|doi=10.1016/j.jaad.2006.02.009}}</ref>


Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.<ref name=":0">{{Cite web|url=https://www.aad.org/media/news-releases/variety-of-options-available-to-treat-pigmentation-problems|title=Variety of options available to treat pigmentation problems {{!}} American Academy of Dermatology|website=www.aad.org|access-date=2017-02-12}}</ref> Several are prescription only in the US, especially in high doses, such as [[hydroquinone]], [[azelaic acid]],<ref>{{Cite journal|last1=Mazurek|first1=Klaudia|last2=Pierzchała|first2=Ewa|date=2016-09-01|title=Comparison of efficacy of products containing azelaic acid in melasma treatment|journal=Journal of Cosmetic Dermatology|volume=15|issue=3|pages=269–282|doi=10.1111/jocd.12217|issn=1473-2165|pmid=27028014|s2cid=25303091}}</ref> and [[Kojic acid|koijic acid]].<ref>{{Cite journal|last1=Monteiro|first1=Rochelle C.|last2=Kishore|first2=B. Nanda|last3=Bhat|first3=Ramesh M.|last4=Sukumar|first4=D.|last5=Martis|first5=Jacintha|last6=Ganesh|first6=H. Kamath|date=2013-03-01|title=A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma|journal=Indian Journal of Dermatology|volume=58|issue=2|pages=157|doi=10.4103/0019-5154.108070|issn=1998-3611|pmc=3657227|pmid=23716817}}</ref> Some are available without prescription, such as [[niacinamide]],<ref>{{Cite journal|last1=Hakozaki|first1=T.|last2=Minwalla|first2=L.|last3=Zhuang|first3=J.|last4=Chhoa|first4=M.|last5=Matsubara|first5=A.|last6=Miyamoto|first6=K.|last7=Greatens|first7=A.|last8=Hillebrand|first8=G.G.|last9=Bissett|first9=D.L.|date=2002-07-01|title=The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer|journal=British Journal of Dermatology|volume=147|issue=1|pages=20–31|doi=10.1046/j.1365-2133.2002.04834.x|pmid=12100180|s2cid=39489580}}</ref><ref>{{Cite news|url=https://www.futurederm.com/spotlight-on-niacinamide/|title=Spotlight On: Niacinamide - FutureDerm|date=2007-10-30|newspaper=FutureDerm|access-date=2017-02-12|language=en-US}}</ref> or [[cysteamine hydrochloride]].<ref>{{Cite journal|last1=Mansouri|first1=P.|last2=Farshi|first2=S.|last3=Hashemi|first3=Z.|last4=Kasraee|first4=B.|date=2015-07-01|title=Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial|journal=The British Journal of Dermatology|volume=173|issue=1|pages=209–217|doi=10.1111/bjd.13424|issn=1365-2133|pmid=25251767|s2cid=21618233}}</ref><ref>{{Cite news|url=http://www.scientispharma.ch/product/cysteamine-cream/|title=Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment|newspaper=Scientis Pharma|access-date=2017-02-12|language=en-US}}</ref> Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,<ref>{{Cite journal|last=Draelos|first=Zoe Diana|date=2007-09-01|title=Skin lightening preparations and the hydroquinone controversy|journal=Dermatologic Therapy|volume=20|issue=5|pages=308–313|doi=10.1111/j.1529-8019.2007.00144.x|issn=1529-8019|pmid=18045355|s2cid=24913995}}</ref> and the use of it became more regulated in several countries and discouraged in general by [[World Health Organization|WHO]].<ref>{{Cite book|title=Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization|hdl = 10665/39218|isbn = 9789241571579|publisher = World Health Organization|year = 1994}}</ref> For the US only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.<ref>{{Cite web|url=https://echa.europa.eu/information-on-chemicals/evaluation/community-rolling-action-plan/corap-table/-/dislist/details/0b0236e1807e3dff|title=Hydroquinone - Substance evaluation - CoRAP - ECHA|website=echa.europa.eu|language=en-GB|access-date=2017-02-12}}</ref>
Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.<ref name=":0">{{Cite web|url=https://www.aad.org/media/news-releases/variety-of-options-available-to-treat-pigmentation-problems|title=Variety of options available to treat pigmentation problems {{!}} American Academy of Dermatology|website=www.aad.org|access-date=2017-02-12}}</ref>
===Topical Treatments===
Several are prescription only in the US, especially in high doses, such as [[hydroquinone]], [[azelaic acid]],<ref>{{Cite journal|last1=Mazurek|first1=Klaudia|last2=Pierzchała|first2=Ewa|date=2016-09-01|title=Comparison of efficacy of products containing azelaic acid in melasma treatment|journal=Journal of Cosmetic Dermatology|volume=15|issue=3|pages=269–282|doi=10.1111/jocd.12217|issn=1473-2165|pmid=27028014|s2cid=25303091}}</ref> and [[Kojic acid|koijic acid]].<ref>{{Cite journal|last1=Monteiro|first1=Rochelle C.|last2=Kishore|first2=B. Nanda|last3=Bhat|first3=Ramesh M.|last4=Sukumar|first4=D.|last5=Martis|first5=Jacintha|last6=Ganesh|first6=H. Kamath|date=2013-03-01|title=A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma|journal=Indian Journal of Dermatology|volume=58|issue=2|pages=157|doi=10.4103/0019-5154.108070|issn=1998-3611|pmc=3657227|pmid=23716817}}</ref> Some are available without prescription, such as [[niacinamide]],<ref>{{Cite journal|last1=Hakozaki|first1=T.|last2=Minwalla|first2=L.|last3=Zhuang|first3=J.|last4=Chhoa|first4=M.|last5=Matsubara|first5=A.|last6=Miyamoto|first6=K.|last7=Greatens|first7=A.|last8=Hillebrand|first8=G.G.|last9=Bissett|first9=D.L.|date=2002-07-01|title=The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer|journal=British Journal of Dermatology|volume=147|issue=1|pages=20–31|doi=10.1046/j.1365-2133.2002.04834.x|pmid=12100180|s2cid=39489580}}</ref><ref>{{Cite news|url=https://www.futurederm.com/spotlight-on-niacinamide/|title=Spotlight On: Niacinamide - FutureDerm|date=2007-10-30|newspaper=FutureDerm|access-date=2017-02-12|language=en-US}}</ref>, l-[[ascorbic acid]]<ref name="Kandhari Rao Arsiwala Ganjoo p=142">{{cite journal | last=Kandhari | first=Sanjeev | last2=Rao | first2=P. Narasimha | last3=Arsiwala | first3=Shehnaz | last4=Ganjoo | first4=Anil | last5=Sood | first5=Seema | last6=Kumar | first6=Dinesh | title=Expert opinion on current trends in hyperpigmentation management: Indian perspective | journal=International Journal of Research in Dermatology | publisher=Medip Academy | volume=8 | issue=1 | date=2021-12-24 | issn=2455-4529 | doi=10.18203/issn.2455-4529.intjresdermatol20214925 | page=142}}</ref>, retinoids such as [[tretinoin]]<ref name="Callender Baldwin Cook-Bolden Alexis pp. 69–81">{{cite journal | last=Callender | first=Valerie D. | last2=Baldwin | first2=Hilary | last3=Cook-Bolden | first3=Fran E. | last4=Alexis | first4=Andrew F. | last5=Stein Gold | first5=Linda | last6=Guenin | first6=Eric | title=Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice | journal=American Journal of Clinical Dermatology | publisher=Springer Science and Business Media LLC | volume=23 | issue=1 | date=2021-11-09 | issn=1175-0561 | doi=10.1007/s40257-021-00643-2 | pages=69–81}}</ref>, or [[cysteamine hydrochloride]].<ref>{{Cite journal|last1=Mansouri|first1=P.|last2=Farshi|first2=S.|last3=Hashemi|first3=Z.|last4=Kasraee|first4=B.|date=2015-07-01|title=Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial|journal=The British Journal of Dermatology|volume=173|issue=1|pages=209–217|doi=10.1111/bjd.13424|issn=1365-2133|pmid=25251767|s2cid=21618233}}</ref><ref>{{Cite news|url=http://www.scientispharma.ch/product/cysteamine-cream/|title=Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment|newspaper=Scientis Pharma|access-date=2017-02-12|language=en-US}}</ref> Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,<ref>{{Cite journal|last=Draelos|first=Zoe Diana|date=2007-09-01|title=Skin lightening preparations and the hydroquinone controversy|journal=Dermatologic Therapy|volume=20|issue=5|pages=308–313|doi=10.1111/j.1529-8019.2007.00144.x|issn=1529-8019|pmid=18045355|s2cid=24913995}}</ref> and the use of it became more regulated in several countries and discouraged in general by [[World Health Organization|WHO]].<ref>{{Cite book|title=Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization|hdl = 10665/39218|isbn = 9789241571579|publisher = World Health Organization|year = 1994}}</ref> For the US only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.<ref>{{Cite web|url=https://echa.europa.eu/information-on-chemicals/evaluation/community-rolling-action-plan/corap-table/-/dislist/details/0b0236e1807e3dff|title=Hydroquinone - Substance evaluation - CoRAP - ECHA|website=echa.europa.eu|language=en-GB|access-date=2017-02-12}}</ref>
===Oral===

Oral medication with [[procyanidin]] plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.<ref>{{Cite journal|last=Handog|first=Evangeline|date=2009-07-20|title=A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women|journal=International Journal of Dermatology|volume=48|issue=8|pages=896–901|doi=10.1111/j.1365-4632.2009.04130.x|pmid=19659873|s2cid=28886093|doi-access=free}}</ref> Other treatments that do not involve topical agents are also available, including fraction lasers<ref>{{Cite web|url=http://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|title=Laser Skin Whitening - Advantages and Disadvantages {{!}} Skin Whitening News|website=skinwhiteningnews.org|language=en-US|access-date=2017-02-12|date=2014-04-05}}</ref> and dermabrasion.<ref name=":0" />
Oral medication with [[procyanidin]] plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.<ref>{{Cite journal|last=Handog|first=Evangeline|date=2009-07-20|title=A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women|journal=International Journal of Dermatology|volume=48|issue=8|pages=896–901|doi=10.1111/j.1365-4632.2009.04130.x|pmid=19659873|s2cid=28886093|doi-access=free}}</ref> Other treatments that do not involve topical agents are also available, including fraction lasers<ref>{{Cite web|url=http://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|title=Laser Skin Whitening - Advantages and Disadvantages {{!}} Skin Whitening News|website=skinwhiteningnews.org|language=en-US|access-date=2017-02-12|date=2014-04-05}}</ref> and dermabrasion.<ref name=":0" />
===Laser Treatments===
Laser toning using [[Yttrium aluminium garnet|YAG]] lasers and [[Intense pulse light]] have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation<ref name="Arora Sarkar Garg Arya 2022 p. ">{{cite journal | last=Arora | first=Pooja | last2=Sarkar | first2=Rashmi | last3=Garg | first3=Vijay K | last4=Arya | first4=Latika | title=Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation | journal=Journal of Cutaneous and Aesthetic Surgery | volume=5 | issue=2 | date=2022-01-27 | pmid=23060704 | doi=10.4103/0974-2077.99436 | url=https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3461803/ | access-date=2022-03-15 | page=}}</ref>


==See also==
==See also==

Revision as of 06:47, 15 March 2022

Hyperpigmentation
SpecialtyDermatology

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

Causes

Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris.[1][2][3]: 854  People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.[4]

Many forms of hyperpigmentation are caused by an excess production of melanin.[4] Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing colour in the body in places such as the eyes, skin, and hair. As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.[5]

Hyperpigmentation is associated with a number of diseases or conditions, including the following:

Hyperpigmentation can sometimes be induced by dermatological laser procedures.

Diagnosis

  • A physical examination including, Wood's lamp examination and a detailed history, usually sufficient for diagnosis.
  • Skin examination.
  • Viewing medical history.

Treatment

There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.[9]

Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.[10]

Topical Treatments

Several are prescription only in the US, especially in high doses, such as hydroquinone, azelaic acid,[11] and koijic acid.[12] Some are available without prescription, such as niacinamide,[13][14], l-ascorbic acid[15], retinoids such as tretinoin[16], or cysteamine hydrochloride.[17][18] Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,[19] and the use of it became more regulated in several countries and discouraged in general by WHO.[20] For the US only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.[21]

Oral

Oral medication with procyanidin plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.[22] Other treatments that do not involve topical agents are also available, including fraction lasers[23] and dermabrasion.[10]

Laser Treatments

Laser toning using YAG lasers and Intense pulse light have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation[24]

See also

References

  1. ^ "Hyperpigmentation". Dermatalogic Disease Database. American Osteopathic College of Dermatology. Retrieved 2006-03-08.
  2. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  3. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  4. ^ a b Chandra, M; Levitt, J; Pensabene, CA (May 2012). "Hydroquinone therapy for post-inflammatory hyperpigmentation secondary to acne: not just prescribable by dermatologists". Acta Dermato-Venerologica. 92 (3): 232–5. doi:10.2340/00015555-1225. PMID 22002814.
  5. ^ Hyperpigmentation on Face (Acne Scars) Hyperpigmentation, Dark Spots, Acne Scars, Meladerm".
  6. ^ "Melasma". American Academy of Dermatology, Inc.
  7. ^ "Schimke immunoosseous dysplasia | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2019-03-13.
  8. ^ Kannan, R.; Ng, M. J. (2008). "Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link, Rajendran Kannan, MB BS MD". Canadian Family Physician. 54 (4): 529–532. PMC 2294086. PMID 18413300.
  9. ^ Gupta, AK; Gover, MD; Nouri, K; Taylor, S (December 2006). "The treatment of melasma: a review of clinical trials". Journal of the American Academy of Dermatology. 55 (6): 1048–65. doi:10.1016/j.jaad.2006.02.009. PMID 17097400.
  10. ^ a b "Variety of options available to treat pigmentation problems | American Academy of Dermatology". www.aad.org. Retrieved 2017-02-12.
  11. ^ Mazurek, Klaudia; Pierzchała, Ewa (2016-09-01). "Comparison of efficacy of products containing azelaic acid in melasma treatment". Journal of Cosmetic Dermatology. 15 (3): 269–282. doi:10.1111/jocd.12217. ISSN 1473-2165. PMID 27028014. S2CID 25303091.
  12. ^ Monteiro, Rochelle C.; Kishore, B. Nanda; Bhat, Ramesh M.; Sukumar, D.; Martis, Jacintha; Ganesh, H. Kamath (2013-03-01). "A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma". Indian Journal of Dermatology. 58 (2): 157. doi:10.4103/0019-5154.108070. ISSN 1998-3611. PMC 3657227. PMID 23716817.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ Hakozaki, T.; Minwalla, L.; Zhuang, J.; Chhoa, M.; Matsubara, A.; Miyamoto, K.; Greatens, A.; Hillebrand, G.G.; Bissett, D.L. (2002-07-01). "The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer". British Journal of Dermatology. 147 (1): 20–31. doi:10.1046/j.1365-2133.2002.04834.x. PMID 12100180. S2CID 39489580.
  14. ^ "Spotlight On: Niacinamide - FutureDerm". FutureDerm. 2007-10-30. Retrieved 2017-02-12.
  15. ^ Kandhari, Sanjeev; Rao, P. Narasimha; Arsiwala, Shehnaz; Ganjoo, Anil; Sood, Seema; Kumar, Dinesh (2021-12-24). "Expert opinion on current trends in hyperpigmentation management: Indian perspective". International Journal of Research in Dermatology. 8 (1). Medip Academy: 142. doi:10.18203/issn.2455-4529.intjresdermatol20214925. ISSN 2455-4529.
  16. ^ Callender, Valerie D.; Baldwin, Hilary; Cook-Bolden, Fran E.; Alexis, Andrew F.; Stein Gold, Linda; Guenin, Eric (2021-11-09). "Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice". American Journal of Clinical Dermatology. 23 (1). Springer Science and Business Media LLC: 69–81. doi:10.1007/s40257-021-00643-2. ISSN 1175-0561.
  17. ^ Mansouri, P.; Farshi, S.; Hashemi, Z.; Kasraee, B. (2015-07-01). "Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial". The British Journal of Dermatology. 173 (1): 209–217. doi:10.1111/bjd.13424. ISSN 1365-2133. PMID 25251767. S2CID 21618233.
  18. ^ "Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment". Scientis Pharma. Retrieved 2017-02-12.
  19. ^ Draelos, Zoe Diana (2007-09-01). "Skin lightening preparations and the hydroquinone controversy". Dermatologic Therapy. 20 (5): 308–313. doi:10.1111/j.1529-8019.2007.00144.x. ISSN 1529-8019. PMID 18045355. S2CID 24913995.
  20. ^ Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization. World Health Organization. 1994. hdl:10665/39218. ISBN 9789241571579.
  21. ^ "Hydroquinone - Substance evaluation - CoRAP - ECHA". echa.europa.eu. Retrieved 2017-02-12.
  22. ^ Handog, Evangeline (2009-07-20). "A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women". International Journal of Dermatology. 48 (8): 896–901. doi:10.1111/j.1365-4632.2009.04130.x. PMID 19659873. S2CID 28886093.
  23. ^ "Laser Skin Whitening - Advantages and Disadvantages | Skin Whitening News". skinwhiteningnews.org. 2014-04-05. Retrieved 2017-02-12.
  24. ^ Arora, Pooja; Sarkar, Rashmi; Garg, Vijay K; Arya, Latika (2022-01-27). "Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation". Journal of Cutaneous and Aesthetic Surgery. 5 (2). doi:10.4103/0974-2077.99436. PMID 23060704. Retrieved 2022-03-15.{{cite journal}}: CS1 maint: unflagged free DOI (link)

External links

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