My Favorite Rx for Hyperpigmentation

August 30, 2016

Hyperpigmentation is a battle for many. The fight can range from a pesky sometimes occurrence to constant stigmatization and serious bullying from one’s peers.

To get an idea of what really works not only in theory but (most importantly) in practice, we asked 6 of CSF’s 2016 faculty members to weigh in on their best tips for battling the dreaded hyperpigmentation. See what doctors Joel Cohen, Barry Lycka, Corey Maas, Joel Schlessinger, Allan Wirtzer and Julie Woodward consider their go-to treatments!

There is no sense in treating hyperpigmentation in patients who have a blatant disregard for prevention! So, like many, Joel Cohen, MD, of Englewood, CO, first insists on “absolutely diligent sun protection and compliance with reapplying.” Next, he asks patients “to use topical skin lighteners regularly – like PCA SKIN non-HQ pigment gel or SkinMedica Lytera – twice daily.” This regimen is taken up a notch for three months following significant sun exposure (whether that is during summer, ski season or any other season). At that point Dr. Cohen prescribes “Triluma or another HQ-formulation and chemical peels every four to six weeks.” If additional treatment is needed thereafter “various lasers” are made a part of the equation.

Dr. Julie Woodward of Durham, NC, makes sure to first “measure the melanin and erythema levels with a colorimeter before initiating treatment so that the patients can objectively know if the treatment is working after a couple of months. Previously she used hydroquinone 4%, but since this has known risks, she now tends to suggest “dual therapy with SkinCeuticals Advanced Pigment Corrector in the morning followed by sunscreen, and then elure (lignin peroxidase) in the evening. The APC has four ingredients: one that blocks tyrosinase to lower the production of melanin, a second that prevents the transfer of melanin to the melanocytes, a third that stabilizes fibroblasts and the last is an exfoliator to help the others penetrate. At 12 weeks, this tested equal to hydroquinone. Lumixyl and Epionce are other good AM options. The elure bleaches melanin that is already staining the keratinocyte and tends to work more rapidly than the products that prevent production, so the patient can see some more immediate results. Chemical peels are also useful for generalized pigmentation and liquid nitrogen is useful to spot treat lentigos. Lasers and IPL or BBL are also options, but these need to be maintained with the above mentioned topicals.”

In regard to topical treatments, they are clearly a preferred first step for many physicians. We asked Dr. Joel Schlessinger of Omaha, NE, for his favorite topical treatment products. He replied, “I still love the Obagi Nu-Derm system for a product with 4% hydroquinone and the Jan Marini Luminate Facial Lotion, which actually performed better when tested against a standard 4% hydroquinone product. The benefits of the Jan Marini Luminate Facial Lotion are that it has retinol and a complex of lighteners, but contains no hydroquinone at all. Clearly, there are other products out there and we use all of them in our clinic, but these two are my go-to products.”

In San Francisco, CA, Dr. Corey Maas likes to use topicals, but prefers to start with them in conjunction with a slightly more aggressive plan. Typically, his go-to is “a deep micro-fractional laser – ablative or non-ablative – with aggressive topical steroids, retinoids and naturopathic depigmenting agents.”

Dr. Barry Lycka of Edmonton, Alberta, reminds us that “hyperpigmentation of the face – for all intents and purposes – is either melasma or post-inflammatory hyperpigmentation. Of the two, the former is the most difficult to treat.” He employs three preferred treatment methods, the first of which is topical treatments – in his case, preferably “ZO or Obagi with Tazarac.” The next step is “a series of light chemical peels.” Lastly, he prefers to employ PRP.

Dr. Allan Wirtzer of Sherman Oaks, CA, always starts from the position that general hyperpigmentation is likely due to some external factor, so he first “hunts for the clue” to help guide the treatment course. As with the others, he also uses a combination of sunscreen and bleaching ingredients, and in the past has also used Q switched tag lasers for focused treatments areas. But he recognizes that, at times, he comes up against a really stubborn case of hyperpigmentation. When he finds the usual tools in his arsenal need reinforcement, he calls upon his secret weapon: the “Dermchat” open forum discussion group. Dermchat is a wonderful space to give and receive feedback, insights and practical tips.

We couldn’t agree more, Dr. Wirtzer! Discussion amongst colleagues is incredibly valuable. That said, we know we haven’t covered every possible course of treatment in this blog, so let us ask you: What’s your go-to treatment for hyperpigmentation?

We welcome you to share your thoughts below!

Natasha Mohr

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  • An excellent hydroquinone free alternative is NIA 24 Rapid Depigmentation Serum. It contains topical niacin a clinically proven to stimulate DNA repair, hexylresorcinol (an excellent alternative to hydroquinone) and Vitamin C for brightening, exfoliating and an additional tyrosinase inhibitor.