Dyspigmentation from acne or inflammatory skin disease is a frustrating problem for both patients and dermatologists.
Postinflammatory hyperpigmentation can last up to 2 years without proper treatment. Dark skin individuals (skin types IV-VI) often have dyschromia, while lighter skin patients (skin types I-III) can have both dyschromia and erythema.
For dyschromia and erythema, cosmeceutical skin care preparations with green tea polyphenols, caffeine, niacinamide, grape seed extract, or coffeeberry may help reduce the inflammation associated with acne scars.
For darker skinned patients, hydroquinone is still the mainstay of therapy. Many dermatologists, given the risks, have shied away from hydroquinone 4% creams. Most of these risks, however, are associated with long-term use.
Short-term, higher dose treatment regimens are more efficacious, have less reported risks, encourage repeated use, and ensure greater compliance as patients see quick results.
Short bursts of compounded hydroquinone has excellent results in skin of color patients. In my practice, I use hydroquinone 8%-10% mixed with retinoic acid 0.025% cream and hydrocortisone 1% cream applied at bedtime for a maximum of 6-8 weeks on acne scars or melasma. This short pulse therapy provides immediate lightening of dark spots and minimizes the risks associated with long-term hydroquinone use.
Patients must be counseled about the risks of ochronosis: They cannot be pregnant, nursing or planning to become pregnant. The skin of some patients may become irritated; for these patients I switch to every-other-day dosing.
After 6-8 weeks of compounded hydroquinone treatment, a step-down treatment regimen – including glycolic acid peels or topical agents like broad spectrum sunscreens and preparations containing arbutin, niacinamide, soy, licorice root extract, or bearberry – provide excellent treatments for continued skin lightening.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.