Ask Dr. Bailey: The Best Way to Treat Hyperpigmentation
I'm often asked how to treat hyperpigmentation of facial skin. I received a really good question on Facebook from one of our customers in Barcelona, Spain. I wanted to address this question for everyone interested in treating this stubborn skin problem.
Hi Dr. Bailey, I have hyperpigmentation on my face. It might be from acne prone skin because I have acne whole my life since teen age and now I have lots of large pores and hyperpigmentation. I have used your Vitamin C Serum and Replenix CF Cream for couple of months. Then heard of hydroquinone and went to dermatology and she prescribed me for 4 months and she told me to wait for few months to see if I have to use hydroquinone again; but I'm scare to use it again and also didn't see really good improvement so can you please suggest or recommend for my hyperpigmentation please. Thank you. Dhundup P, Barcelona, Spain
When I treat facial skin hyperpigmentation from acne (called post-inflammatory hyperpigmentation) or from melasma, I throw the works at it because it is a tough skin problem. It also requires patience and persistence!
First, I always select a broad spectrum sunscreen that must be worn 365 days a year from sun up to sun down. It even needs to be worn on days one is indoors because UVA rays come through windows to darken skin. I trust zinc oxide for broad spectrum sun protection. I use oil-free and oil-absorbing products for acne-prone skin such as my Sheer Strength Pure Physical Sunscreen. Citrix Sunscreen is another good choice. When outdoors, I ask my patients to wear a full-brimmed hat and seek shade for additional UV ray protection.
Second, I select products that turn down the skin's pigment production.
The most effective is a retinoid such as prescription tretinoin (Retin-A) or my Retinol Intensive Night Cream. Retinoids are applied at night. Once the skin has adjusted to the retinoid, I add an AHA during the day to lighten existing skin pigment and enhance skin penetration of the retinoid. My favorite products for acne-prone skin are my Glycolic Acid Face Cream or Glytone Exfoliating Lotion.
For prescription medicines, hydroquinone is a really helpful medicine to treat hyperpigmentation. However, it must be used in 4% or higher to really work, in my experience. I combine it with an AHA and retinoid such as I mentioned already. These ingredients work together and help each other penetrate into the skin.
A note of caution regarding hydroquinone - this intense skin care routine to fight hyperpigmentation can be irritating. People can also be allergic to hydroquinone. I prefer to use it for a finite amount of time such as 4 months because hydroquinone can produce a condition called ochronosis, which can lead to permanent gray mottling of the skin. When I am treating a patient with this combination of ingredients, we watch their progress carefully and give their skin a rest if any irritation develops.
I would like to emphasize that it is important to select compatible skin care products that soothe irritation and that create the optimal complete skin care routine. Below, I'll detail the skin care steps I typically follow.
For your morning routine:
- Cleanse with VaniCream Soap or Toleriane Cleanser followed by a toner such as my Naturally Hydrating Pore-Cleansing Toner
- Apply Green Tea Cream or Replenix CF Cream (better for acne-prone skin)
- Apply Glycolic Acid product
- Apply Zinc Oxide Sunscreen
- Apply Mineral Makeup (if used)
For your evening routine:
- Cleanse with the cleanser above and a Clarisonic System, if available, followed by the same toner used in your morning routine
- Apply Green Tea (or Replenix) then tretinoin, or go straight to my Retinol Cream, which has both the green tea and the retinoid. If skin is on the dryer side, apply a moisturizer too.
When we use the hydroquinone product, it is applied after the toner or after the Green Tea/Replenix.
Here at Advanced Skin Care and Dermatology Physicians, I also have my hyperpigmentation patients see my aesthetician for microdermabraision treatments at 6 week intervals to enhance results.
This is an intense routine, however, it can make a big difference for everyone wishing to treat this stubborn skin problem!
Since many people deal with these same issues, I wanted to post it as part of our “Ask Dr. Bailey” series. Thank you for your question!
Warmly, Cynthia Bailey, MD, Board Certified Dermatologist
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