Los Angeles —Topical bleaching agents can safely treat post-inflammatory hyperpigmentation in darker skin types as long as treatment is conservative and monitored closely, says Pearl E. Grimes, M.D., director of the Vitiligo and Pigmentation Institute of Southern California.
Dr. Grimes says today's "designer" bleaching agents that contain hydroquinone 4 percent as an active ingredient are the gold standard for treating hyperpigmentation, but they certainly can sometimes irritate darker skin (Fitzpatrick types IV, V and VI).
"That doesn't mean you can't use these products, because you can," she says. "You have to be cognizant of the potential for irritation and just monitor patients.
Three topical agents Dr. Grimes provided Cosmetic Surgery Times with insight into three topical agents for the treatment of hyperpigmentation in darker skin. Each contains hydroquinone and other differing active ingredients.
Rather than recommending one agent over another, she advises clinicians to become familiar with current research for each bleach, and the risk/benefit panel for each.
"Know the benefits, the side effects," she suggests. "There is efficacy with every product. You have to have experience with each one and decide, 'This is my favorite.'"
However, some cases may require a different approach.
"For severe post-inflammatory hyperpigmentation, none of these may work. You still may end up doing extemporaneous compounding of a bleach."
Tri-Luma Although the FDA has approved Tri-Luma (Galderma) as a combination bleach to treat melasma, Dr. Grimes routinely uses it off label to treat hyperpigmentation in darker skin types. Tri-Luma contains hydroquinone 4 percent, fluocinolone acetonide 0.01 percent and tretinoin 0.05 percent.
"Tri-Luma has become the leading topical bleaching agent for hyperpigmentation," she says. "But the worst mistake a physician can make is to keep a patient on it indefinitely, because it contains a fluorinated steroid."
"The longer a patient stays on Tri-Luma, the greater the risk of atrophy, steroid-induced rosacea or steroid-induced telangiectasia," she explains.
Tri-Luma's quick onset of action makes it a good choice for hyperpigmentation.
EpiQuin Micro Also quick to produce results is EpiQuin Micro (SkinMedica), which contains hydroquinone 4 percent and retinol 0.15 percent in a microsponge vehicle, says Dr. Grimes.
"This is significant because treatment of post-inflammatory hyperpigmentation commonly takes several months," says Dr. Grimes, adding that EpiQuin is a good first-line therapy for mild-to-moderate cases.
She and colleagues conducted a 12-week, open-label study of EpiQuin and found it to be safe and effective. Twenty-five subjects applied the bleaching cream to their entire face once in the morning and again in the evening, with sunscreen also applied 15 minutes after the morning application.