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Hyperpigmentation, Dark Spots

Hyperpigmentation is darkness either noted at sites of previous inflammation (bug bites, acne, trauma, surgery, etc.) or as a result of a primary skin process (melasma, sun damage). The main treatment for most hyperpigmentation includes the use of bleaching creams. The most common bleaching agent is hydroquinone in a concentration between 2-6%. Other topical agents with lightening effects include kojic acid, glycolic acid, and azeleic acid. In fact, glycolic acid peels have been widely employed in physician offices for the treatment of melasma.

Most recently, combinations of glycolic acid, retinoids, steroids, and hydroquinone have been developed to treat hyperpigmentation. Most of these combinations are prescription-only, however, use of low concentration hydroquinone and glycolic acid may be done with over-the-counter products. All patients undergoing treatment must be advised to avoid sun-exposure for risk of longer treatment times and higher probability of treatment failure.

Regarding melasma, newer treatments include the use of fractional resurfacing laser technology (Fraxel®, Starlux®). The data is still quite new, but the results noted have been extremely promising. Other laser technologies have been shown to inconsistently reduce melasma with a majority of cases eventually relapsing.

Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California

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