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 Green Tea Antioxidant Skin Therapy 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
Hello Dhundup, 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. Ideally, we also want the sunscreen to contain over 3.2% iron oxide, which has been shown to block visible light that darkens facial skin pigment problems.
I use oil-free and oil-absorbing products for acne-prone skin such as my Sheer Strength Pure Physical Matte Tinted Sunscreen. When outdoors, I ask my patients to wear a full-brimmed hat which you can find here and seek shade for additional UV ray protection.
Second, I select products that turn down the skin's pigment production. Find all of the best in my Ultimate Pigment and Sun Damage Repair Kit.
This treatment includes:
The most effective non-prescription retinoid, which is my Retinol Intensive Night Cream in my Pigment Repair Kit. Retinoids are always 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 is my oil-free Glycolic Acid Face Cream that comes in my Pigment Repair kit.
For skin lighteners, hydroquinone is a really helpful medicine to treat hyperpigmentation. It can be used in 2% without a prescription. 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 with an intensive routine such as this, it is important to select compatible skin care products that soothe irritation and that create the optimal complete skin care routine. My Ultimate Pigment and Sun Damage Repair Kit is made from compatible products, designed to enhance skin penetration of the active ingredients, and comes with detailed instructions. I created my Kit because many people deal with these same issues. I wanted to post my answer as part of our “Ask Dr. Bailey” series. Thank you for your question!
Cynthia Bailey, MD, Board Certified Dermatologist
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