Postinflammatory Hyperpigmentation Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 23, 2012
 

Medication Summary

Topical treatments include hydroquinone, azelaic acid, corticosteroids, tretinoin cream, GA, and trichloroacetic acid.[24] Skin whitening products are used for clinical treatment of postinflammatory hyperpigmentation.[25] They act at various levels of melanin production in the skin, some being competitive inhibitors of tyrosinase, while others inhibit the maturation of this enzyme or the transport of melanosomes from melanocytes to surrounding keratinocytes. Soy products containing serine protease inhibitors appear to have potential as a new therapeutic option for the treatment of hyperpigmentation.[26]

Wide-spectrum sunscreens are an integral part of any treatment regimen. Winhoven et al report successful therapy with oral isotretinoin in an Asian patient.[27] Combined therapy using Q-switched ruby laser and cutaneous bleaching with tretinoin and hydroquinone may be used for periorbital skin hyperpigmentation in selected patients.[28]

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Depigmenting agents

Class Summary

These agents are used for gradual bleaching of hyperpigmented skin.

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Hydroquinone (Ambi Skin Tone, Melanex, Nuquin HP)

 

A 1,4-benzenediol that suppresses melanocyte metabolic processes, especially enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylamine. Exposure to sun reverses effects and causes repigmentation.

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Azelaic acid (Azelex, Finevin)

 

May have bleaching effect on skin. Also, may have an antimicrobial effect.

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Keratolytic agents

Class Summary

These agents cause cornified epithelium to swell and soften and then become macerated and desquamated.

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Trichloroacetic acid topical (Tri-Chlor)

 

Cauterizes skin, keratin, and other tissues.

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Retinoids

Class Summary

Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes and modulate keratinocyte differentiation.

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Tretinoin topical (Avita, Renova, Retin-A)

 

Inhibits microcomedo formation and eliminates lesions. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Also available as 0.01% and 0.025% gels.

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Corticosteroids

Class Summary

These drugs have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

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Hydrocortisone topical (Cortaid, Dermacort, Westcort)

 

An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects, resulting in anti-inflammatory activity.

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Desonide (DesOwen, Tridesilon)

 

Stimulates synthesis of enzymes that decrease inflammation. Suppresses mitotic activity and causes vasoconstriction.

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Betamethasone topical (Alphatrex, Diprolene, Maxivate)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Nadia I Kihiczak, MD  Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey Medical School

Nadia I Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Basil M Hantash, MD, PhD  Chairman, Elixir Institute of Regenerative Medicine

Basil M Hantash, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Photo of a 42-year-old African American woman with macules of postinflammatory hyperpigmentation on the left side of her face as a result of acne excoriée.
 
 
 
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