INTRODUCTION
Hyperpigmentation and dyschromia are amongst the most common dermatologic concerns for patients seeking care.1 They can affect patients of all skin types and ages, and most commonly occurs after inflammation or injury to the skin. Hyperpigmentation that occurs as a sequela of inflammatory lesions, such as acne or atopic dermatitis is termed postinflammatory hyperpigmentation (PIH).2 PIH disproportionately affects patients with skin of color (SOC), with one study citing that 65.3% of African Americans, 52.7% of Hispanics, and 47.4% of Asians were affected by acne-induced PIH.3
Hyperpigmentation and/or PIH results from an overproduction of melanin or an irregular distribution of melanin pigment in the skin.2 Dyspigmentation results from excessive ultraviolet (UV) exposure and subsequent photodamage, environmental pollution, hormonal influence, and sequelae from inflammatory skin conditions.2,4 Furthermore, hormonal shifts can stimulate melanin production and contribute to melasma and hyperpigmentation. Inflammatory cytokines in the setting of acne or atopic dermatitis can stimulate melanocyte activity, which also leads to increased production of melanin and its subsequent transfer to surrounding keratinocytes.2 Air pollution can induce pigmentation by penetrating the skin to activate aryl hydrocarbon receptors that promote reactive oxygen species and oxidative stress that trigger melanocyte stimulation and hyperpigmentation.5 Frequent UV exposure can also lead to melanin production and can exacerbate hyperpigmentation. Dermal hyperpigmentation may also result from inflammation-induced damage to basal keratinocytes, causing the release of melanin into the dermis and its subsequent uptake by macrophages.2 Dermal hyperpigmentation is often refractory to treatment.
Effective management of epidermal hyperpigmentation should emphasize sun protection with sunscreen as well as treatment of underlying inflammatory conditions. Topical depigmenting agents such as hydroquinone, azelaic acid, kojic acid, glycolic acid, thiamidol, melasyl, licorice extract, and retinoids can be useful to help reduce the severity of hyperpigmentation in the skin.2,6,7 Patients requiring additional treatment beyond topical therapy and sun protection can be offered systemic oral agents such as tranexamic acid, as well as chemical peels and laser/light therapy.4 Chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and Jessner's solution can also be used to help lighten dark spots, as well as energy-based devices such as fractional photothermolysis, Nd:YAG laser, microneedling, and intense pulsed light (IPL). However, hyperpigmentation can remain difficult to remove and
Hyperpigmentation and/or PIH results from an overproduction of melanin or an irregular distribution of melanin pigment in the skin.2 Dyspigmentation results from excessive ultraviolet (UV) exposure and subsequent photodamage, environmental pollution, hormonal influence, and sequelae from inflammatory skin conditions.2,4 Furthermore, hormonal shifts can stimulate melanin production and contribute to melasma and hyperpigmentation. Inflammatory cytokines in the setting of acne or atopic dermatitis can stimulate melanocyte activity, which also leads to increased production of melanin and its subsequent transfer to surrounding keratinocytes.2 Air pollution can induce pigmentation by penetrating the skin to activate aryl hydrocarbon receptors that promote reactive oxygen species and oxidative stress that trigger melanocyte stimulation and hyperpigmentation.5 Frequent UV exposure can also lead to melanin production and can exacerbate hyperpigmentation. Dermal hyperpigmentation may also result from inflammation-induced damage to basal keratinocytes, causing the release of melanin into the dermis and its subsequent uptake by macrophages.2 Dermal hyperpigmentation is often refractory to treatment.
Effective management of epidermal hyperpigmentation should emphasize sun protection with sunscreen as well as treatment of underlying inflammatory conditions. Topical depigmenting agents such as hydroquinone, azelaic acid, kojic acid, glycolic acid, thiamidol, melasyl, licorice extract, and retinoids can be useful to help reduce the severity of hyperpigmentation in the skin.2,6,7 Patients requiring additional treatment beyond topical therapy and sun protection can be offered systemic oral agents such as tranexamic acid, as well as chemical peels and laser/light therapy.4 Chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and Jessner's solution can also be used to help lighten dark spots, as well as energy-based devices such as fractional photothermolysis, Nd:YAG laser, microneedling, and intense pulsed light (IPL). However, hyperpigmentation can remain difficult to remove and
