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Management of Facial Hyperpigmentation


Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (hormones) and exogenous factors (such as use of cosmetics and perfumes, and exposure to sun radiation). Melasma (chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl’s melanosis, poikiloderma of Civatte, erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations.

Treatment of melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum sunscreens. Several hypopigmenting agents have been used with differing results. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1 % is an established treatment. Topical azelaic acid 15 to 20% can be as efficacious as hydroquinone, but is less of an irritant. Tretinoin is especially useful in treating hyperpigmentation of photoaged skin. Kojic acid, alone or in combination with glycolic acid or hydroquinone, has shown good results, due to its inhibitory action on tyrosinase. Chemical peels are useful to treat melasma: trichloroacetic acid, Jessner’s solution, Unna’s paste, α-hydroxy acid preparations, kojic acid, and salicylic acid, alone or in various combinations have shown good results. In contrast, laser therapies have not produced completely satisfactory results, because they can induce hyperpigmentation and recurrences can occur. New laser approaches could be successful at clearing facial hyperpigmentation in the future.

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Table I


  1. 1.

    Diaz-Pérez J.L., Mitxelena J., Diaz-Ramón L., et al. Discromías. Medicine 1999; 136: 6425–6430

    Google Scholar 

  2. 2.

    Serrano S., Fernández-Vozmediano J.M. Hiperpigmentaciones por medicamentos. Monogr Dermatol 1996; 9: 45–55

    Google Scholar 

  3. 3.

    Armijo M., Ortega R.M. Discromías. In: Armijo M., Camacho F., editors. Dermatología. 3rd ed. Madrid: Aula Médica Ed., 1998: 353–380

    Google Scholar 

  4. 4.

    Kaminsky C.A., Kaminsky A.R. Discromías. Monogr Dermatol 1992; 5: 81–93

    Google Scholar 

  5. 5.

    Camacho F., Pathak M.A. Hipermelanosis cervicofaciales. Monogr Dermatol 1996; 5: 279–290

    Google Scholar 

  6. 6.

    Warren F.M., Davis L.S. Erythromelanosis follicularis faciei in women. J Am Acad Dermatol 1995; 32: 863–866

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Litt J.Z. Steroid induced rosacea. Am Fam Physician 1993; 48: 67–71

    PubMed  CAS  Google Scholar 

  8. 8.

    Henmdrix Jr J.D., Greer K.E. Cutaneous hyperpigmentation caused by systemic drugs. Int J Dermatol 1992; 31: 458–466

    Article  Google Scholar 

  9. 9.

    Hoffmann E., Habermann R. Arzneiliche und gewerbliche Dermatosen durch Kriegsersatzmittel (Vaseline, Schmieröl) und eigenartige Melanodermatiden. Dtsch Med Wochenschr 1918; 44: 261–264

    Article  Google Scholar 

  10. 10.

    Vazquez M., Maldonado H., Benaman C. et al. Melasma in men; a clinical and histologic study. Int J Dermatol 1988; 27: 25–27

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Pandya A.G., Guevara IL. Disorders of hyperpigmentation. Dermatol Clin 2000; 18: 91–98

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Katsambas A., Antoniou Ch. Melasma. Classification and treatment. J Eur Acad Dermatol Venereol 1995; 4: 217–223

    Article  Google Scholar 

  13. 13.

    Pérez N.P., Sánchez J.L., Aquilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol 1983; 81: 543–545

    PubMed  Article  Google Scholar 

  14. 14.

    Lufti R.J., Fridmanis M., Misrunas A.L. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of melasma. J Clin Endocrinol Metab 1985; 61: 28–31

    Article  Google Scholar 

  15. 15.

    Sánchez N.P., Pathak M.A., Sato S., et al. Melasma. A clinical, light microscopic, ultrastructural and immunofluorescence study. J Am Acad Dermatol 1981; 4: 698–710

    PubMed  Article  Google Scholar 

  16. 16.

    Palumb A., Dischia M., Misuraca G. Mechanism of inhibition of melanogenesis by hydroquinone. Biochem Biophys Acta 1991; 1073: 85–90

    Article  Google Scholar 

  17. 17.

    Arndt K.A., Fitzpatrick T.B.: Topical use of hydroquinone as a depigmenting agent. JAMA 1965; 194: 965–967

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Snider R.I., Theirs B.H. Exogeneous ochronosis. J Am Acad Dermatol 1993; 28: 662–664

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Salopek T.G., Jimbow K. New treatment options for the patient with facial hyperpigmentation. Curr Opin Dermatol 1995; 61–68

    Google Scholar 

  20. 20.

    Jimbow K. N-acetyl-cysteaminylphenol as a new type of depigmenting agent for the melanoderma of patients with melasma. Arch Dermatol 1991; 127: 1528–1534

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Camacho F., Sotillo I., Moreno J.C. Melanoma. Introducción. Inmunoterapia del melanoma con BCG. Acido azelaico como tratamiento complementario del melanoma maligno. Symposium de Inmunología y Dermatología. Madrid: Grupo Jarpyo Ed., 1987: 38–48

    Google Scholar 

  22. 22.

    Fitton A., Goa K.L. Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs 1991; 41: 780–798

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Balina L.M., Graupe K. The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol 1991; 30: 893–895

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Kimbrough-Green C.K., Griffiths C.E., Finkel L.J. Topical retinoic acid (tretinoin) for melasma in black patients. Arch Dermatol 1994; 130: 727–733

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Lim J.T. Treatment of melasma using Kojic Acid in a gel containing Hydroquinone and Glycolic Acid. Dermatol Surg 1999; 25: 282–284

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Cotellesa C., Peris K., Onorati M.T., et al. The use of chemical peelings of different cutaneous hyperpigmentations. Dermatol Surg 1999; 25: 450–454

    Article  Google Scholar 

  27. 27.

    Pandya A.G., Guevara I.L. Disorders of hyperpigmentation. Dermatol Clin 2000; 1891–1898

    Google Scholar 

  28. 28.

    Grimes P.E. The safety and efficacy of salycilic acid chemical peels in darker racial-ethnic groups. Dermatol Surg 1999; 25: 18–22

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Gupta G., McKay I.R., McKay R.M. Q-switched ruby laser in the treatment of labial melanotic macules. Lasers Surg Med 1998; 25: 219–222

    Article  Google Scholar 

  30. 30.

    Manaloto R.S., Alster T. Erbium: YAG Laser resurfacing for refractory Melasma. Dermatol Surg 1999; 25: 121–123

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Nouri K., Bowes L., Chartier T., et al. Combination treatment of melasma with pulsed CO2 Lase followed by Q-Switched Alexandrite Laser: a pilot study. Dermatol Surg 1999; 25: 494–497

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Francisco Camacho.

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Pérez-Bernal, A., Muñoz-Pérez, M.A. & Camacho, F. Management of Facial Hyperpigmentation. Am J Clin Dermatol 1, 261–268 (2000).

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  • Hydroquinone
  • Fusca
  • Tretinoin
  • Glycolic Acid
  • Azelaic Acid