![]() All age groups are equally affected, and there is no difference between genders however, PIH is more likely to develop in patients with darker skin types (7). Acne vulgaris is one of the most common inflammatory skin disorders that results in hypermelanosis (2). PIH frequently develops secondary to cutaneous inflammation or injury (7). Because exposure to UVA and UVB light leads to melanocytic growth and increased transfer of melanosomes to keratinocytes, broad-spectrum sun-blocks are an essential adjunct to any treatment regimen for hyperpigmentation (8). Even minimal sunlight sustains melanocytic activity. ![]() The most important risk factor in the development of all hypermelanotic conditions is ultraviolet (UV) irradiation from sun exposure, although in acne, inflammation plays an equal if not more important role. Hyperpigmentation disorders usually result from an increase in melanin production, and less commonly, from an increase in the number of active melanocytes (7). The quantity, melanin content, and distribution of these melanosomes determine the various hues of human skin color (7). This process occurs within specialized intracellular vesicles called melanosomes, which are then transferred to keratinocytes and sent to the epidermal surface. In normal skin, melanocytes (specialized dendritic cells located at the dermal–epidermal junction) convert tyrosine into melanin via the enzyme tyrosinase. PATHOPHYSIOLOGY OF post-inflammatory hyperpigmentation This paper aims to make the physician more comfortable with hydroquinone therapy by delineating how to use hydroquinone for PIH secondary to acne, as well as the drug’s mechanism of action and safety profile. Indeed, from November 2009 to November 2010, a total of 470,964 hydroquinone prescriptions were written in the USA (excluding in-office dispensing), out of which 252,066 were written by dermatologists, 72,346 by primary care physicians, and another 146,552 by other specialty physicians (6). However, the majority of hydroquinone prescriptions written in the USA are done so by dermatologists. Adolescents are among those affected by acne, and a significant subset of these patients will experience related PIH. OTC hydroquinone 2% preparations are typically less effective than the prescription 4% preparations. Hydroquinone has been produced in various over-the-counter (OTC) and prescription formulations in the USA for over 55 years, with only exceedingly rare adverse reactions reported (5). It is indicated for patients age 13 years and up. Hydroquinone, a skin-bleaching cream, is the gold-standard for treating PIH and other disorders of hyperpigmentation, such as melasma and solar lentigines (4). Post-inflammatory hyperpigmentation due to acne in a dark skin-type. It is important for physicians to recognize the negative impact that acne and PIH can have on a patient’s emotional health (causing anxiety and depression), as well as on his or her social interactions, self-esteem, self-confidence, and even employment opportunities (3).įig. Many patients find the persistent PIH more psychologically disturbing than their original acne lesions (2). The skin discoloration, which is due to excess melanin, may persist for several months or even years. Clinically, PIH presents as localized or diffuse brown macules at sites of former acne papules and pustules (Fig. Post-inflammatory hyperpigmentation (PIH) often develops secondary to either the acne itself or to damaged skin caused by overly aggressive treatment. E-mail: 50 million Americans have acne vulgaris each year (1), making it one of the most commonly encountered conditions in primary-care and dermatology practices nationwide. Mekhala Chandra, Department of Dermatology, The Mount Sinai School of Medicine, 135 W 96 th Street, Apt 11C, New York, NY 10025, USA. Key words: hydroquinone acne adolescent post-inflammatory hyperpigmentation. Physicians should feel comfortable to use hydroquinone without consulting a dermatologist. Safety concerns with hydroquinone consist only of occasional irritation, which can be suppressed with topical steroid or a short drug holiday. If post-inflammatory hyperpigmentation consists of many lesions, field therapy is favored. If post-inflammatory hyperpigmentation consists of a few lesions, spot therapy is useful. Because steroids should not be applied to the face for prolonged periods, care should be taken when a hydroquinone cream containing a steroid is chosen. Combination creams help with compliance, but often lack the strongest individual ingredients. ![]() The efficacy of this treatment can be enhanced by using a retinoid nightly and a mid-potent steroid, which is applied twice daily for 2 weeks, then at weekends only. Hydroquinone, a tyrosinase inhibitor, in a 4% cream can be used safely twice daily for up to 6 months to treat post-inflammatory hyperpigmentation. Post-inflammatory hyperpigmentation after acne can be as troublesome as the acne itself.
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