Guide to Treating Hyperpigmentation

An internationally recognized expert in skin of color, Dr. Heather Woolery-Lloyd gave an excellent presentation reviewing the treatment of hyperpigmentation in Miami. She reported “melasma is one of the hardest conditions that I treat.” Melasma is a disease primarily affecting women in their 30s, 40s and 50s, which can have a tremendous impact on the quality of life. Dr. Woolery-Lloyd referenced the “melasma dialogue” she has with her patients which emphasizes education about the cause, prevention, treatment and course of melasma. She stressed UV radiation as the driver of melasma and, therefore, one of the essential tools for treatment is strict sun avoidance and sun protection. Higher SPFs (>50) are recommended as well as addition of visible light coverage with iron oxides.

Coverage: SDPA 20th Annual Fall Dermatology Conference Nov. 17-20, 2022, in Miami

In addition to sun avoidance and protection, Dr. Woolery-Lloyd outlined how she prescribes hydroquinone (HQ) in the treatment phase in this patient population. She typically starts with a treatment of HQ 8% for four to six weeks. Refills are not provided to these patients without being seen by a provider, and she only uses HQ for a maximum of two to three courses per year. The use of non-HQ skin brighteners such as azelaic acid 20%, thiamidol, tranexamic acid and cysteamine cream were also explored by Dr. Woolery-Lloyd.

She also reviewed post-inflammatory hyperpigmentation and hypopigmentation. Similar to melasma, this is most common in skin of color. Dr. Woolery-Lloyd discussed the importance of first addressing any underlying condition, such as acne or atopic dermatitis. An acne hyperpigmented macule can take up to four months to resolve without treatment. Treatment of these patients typically include HQ and HQ-free skin brighteners. She reported post-inflammatory hypopigmentation is very difficult to treat; therefore, setting realistic expectations of results for these patients is essential. For the treatment of post-inflammatory hyperpigmentation due to eczema, Dr. Woolery-Lloyd emphasized aggressive treatment to avoid permanent post-inflammatory changes. Compounding pharmacies can add HQ to a steroid and once clear, she recommends using azelaic acid with triamcinolone to the extremities. Additional topics of discussion included ochronosis, drug-induced facial hyperpigmentation and maturational dyschromia.

Byline: Sarah B.W. Patton

Pictured: Heather Woolery-Lloyd, MD, Baumann Cosmetic and Research Institute