Platelet-Rich Plasma Therapy

Introduction to Hyperpigmentation

Melasma is a common facial hyperpigmentation disorder characterized by symmetrical brown patches, predominantly affecting women and darker skin types, primarily attributed to ultraviolet exposure and hormonal influences, according to the American Academy of Periodontology 1
Postinflammatory hypopigmentation (PIH) is a reactive hypomelanosis that develops following cutaneous inflammation or injury, resulting in lighter patches of skin compared to the surrounding areas, and can be caused by various factors including inflammatory skin conditions, acne, burns or trauma, infections, chemical irritants, dermatologic procedures, and certain medications 2

Initial assessment should include determination of skin phototype (Fitzpatrick scale), identification of underlying cause of hyperpigmentation, and assessment of depth of pigmentation (epidermal vs. dermal) to guide treatment decisions, with patients being monitored closely for signs of irritation or worsening pigmentation 3, 1
Understanding the specific type of hyperpigmentation is crucial for selecting appropriate treatment strategies and setting realistic expectations for patients regarding treatment outcomes 1
The Melasma Area and Severity Index (MASI) and Modified Melasma Area and Severity Index (m-MASI) are validated scales used to measure the extent of facial hyperpigmentation and assess treatment response, as recommended by the American Academy of Periodontology 1

Hydroquinone 4% cream is indicated for treating various hyperpigmentation conditions, including chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation, although evidence for axillary use is limited 4, 1
Triple combination cream, containing 4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide, is an effective treatment option, with 77-94% of patients achieving clear or almost clear skin 1
Alternative topical agents, such as azelaic acid (15-20%) and kojic acid, have less irritation potential with similar efficacy to hydroquinone 1
Non-hydroquinone formulations, including those containing epidermal growth factor, tranexamic acid, vitamin C, arbutin, and niacinamide, have shown promising results with fewer side effects 1
Oral tranexamic acid (250 mg twice daily) is a promising treatment option for moderate to severe cases resistant to topical therapy, requiring monitoring for thromboembolic risk, as recommended by the American Academy of Dermatology 1
Platelet-rich plasma (PRP) intradermal injections have been shown to be effective for treating melasma, with significantly better results seen when compared to intradermal tranexamic acid, according to the American Academy of Dermatology 1

A treatment protocol of once a month for three to five sessions is recommended for PRP therapy, although the guideline society is not specified 1
Mandatory sun protection with broad-spectrum SPF 70 or higher is crucial to prevent worsening hyperpigmentation, as inadequate sun protection is the most common reason for treatment failure, according to the American Academy of Dermatology and the Skin Cancer Foundation 1
Continuing strict sun protection indefinitely, even after clearing, and considering intermittent hydroquinone use for recurrences is recommended by the American Academy of Dermatology 1
Evaluation of response should be done every 4-6 weeks using standardized photography and assessing using Melasma Area and Severity Index (MASI) score, adjusting treatment if no improvement after 8-12 weeks, as advised by the American Academy of Dermatology 1

Chemical peels, such as glycolic acid or salicylic acid, can be considered after 8-12 weeks of unsuccessful topical therapy, with 3-4 sessions spaced one month apart, as recommended by the American Academy of Dermatology 1
Photodynamic therapy (PDT) can be considered for resistant cases of facial hyperpigmentation, with caution due to the risk of post-inflammatory hyperpigmentation and higher risk of complications in darker skin types, as recommended by the British Journal of Dermatology 5
Laser therapy should be used with caution, especially in darker skin types, due to the risk of worsening hyperpigmentation and causing atrophic scarring, according to the American Academy of Dermatology 3, 6

Hydroquinone has been associated with carcinogenesis concerns, which remain debated but have led to restrictions in many countries, according to the British Journal of Dermatology 4
Ochronosis (blue-black discoloration) can occur with prolonged use of hydroquinone beyond 6 months, emphasizing the importance of careful treatment planning and patient education 1
Aggressive treatments, such as high-concentration peels or laser treatments, can worsen hyperpigmentation, and discontinuing treatment too early can lead to recurrence, highlighting the need for careful consideration of treatment options and patient follow-up 1