Treatment of Hyperpigmentation in Black Women

First-Line Topical Therapy

The American Academy of Dermatology recommends triple combination formulations containing hydroquinone, tretinoin, and corticosteroids as the most effective topical regimen for hyperpigmentation 1, 2
Tretinoin can be used alone or combined with hydroquinone for enhanced efficacy 1
Azelaic acid is particularly helpful for patients with darker skin types due to its lightening effect on dyspigmentation and should be considered as an alternative or adjunct 3

The American Academy of Dermatology recommends applying broad-spectrum sunscreen with minimum SPF 30 (preferably SPF 50+) daily, reapplying every 2-3 hours during sun exposure 1
Sun protection is the foundation of any hyperpigmentation treatment regimen and must be maintained throughout therapy 1, 2

Oral tranexamic acid 250 mg twice daily is an evidence-based option for refractory melasma or persistent hyperpigmentation 2, 4
Topical niacinamide may provide additional benefit, though evidence for acne-related use is insufficient in current guidelines 5

Platelet-rich plasma (PRP) injections have demonstrated significant improvement in hyperpigmentation within 6 weeks as measured by modified MASI scores 1, 4
Microneedling may be more effective than intradermal PRP injections for delivering treatments to hyperpigmented skin 1, 4
PRP combined with oral tranexamic acid demonstrates higher efficacy compared to tranexamic acid alone with lower recurrence rates 4

Measure treatment efficacy using the Melasma Area and Severity Index (MASI) or modified MASI (mMASI) to objectively track improvement 1, 2
Hyperpigmentation should be managed as a chronic condition requiring regular follow-ups and maintenance therapy 1
Counsel patients to avoid smoking, as this can impair treatment outcomes 1

Do not use clascoterone for hyperpigmentation—it is a topical antiandrogen indicated only for acne vulgaris and has no role in treating melanocyte dysfunction 2, 4
Avoid prolonged use of topical corticosteroids beyond 2 months due to risk of skin atrophy 6, 7
Recognize that genetic factors and hormonal influences may limit treatment success in some patients, requiring realistic expectations 1