Skin of color patients already make up the majority of the population in California, New Mexico, and Texas. By 2050, more than 50 percent of the US population will have skin of color, according to the Skin of Color Society. The top skin concern for this patient population is pigmentation—whether it be post-inflammatory hyperpigmentation (PIH), melasma, or the presence of other pigmented lesions.

Cosmeceuticals: Current Option of Choice

Topical cosmeceuticals are the current treatment of choice for addressing pigment issues in skin of color patients. Hydroquinone (HCQ) remains the gold standard and is extremely safe. Topicals with lower doses of HCQ and/or other actives, including plant extracts, may be preferred by patients. They cost roughly the same, if not less, than generic HCQ prescription products.

Some top sellers and good performers in the cosmeceutical space include Neocutis’ PERLE Skin Brightening Cream with Melaplex, SkinMedica’s Lytera, and products from Glyderm and Glytone, to name a few.

Some of the smaller skincare companies are also looking at correcting pigment irregularities. These include Senté, whose products are powered by a bioengineered form of heparan sulfate. I think we will see additional products that address pigment from Senté this year.

Sun Protection

Sun protection and UV avoidance are crucial aspects of care for patients with pigmentary concerns. All patients must use a sunscreen daily. Again, many of the leading skincare companies offer very good products we can recommend.

Another option to consider is Heliocare, a supplement containing the antioxidant polypodium leucotomos, that offers some protection against UV exposure. There is also some evidence that the compound can prevent certain pigment issues.

There’s also some excitement about topical and oral tranexamic acid for reducing pigment, but these are not yet FDA-approved for these indications.


Dr. Gold received a lifetime achievement award at CSF 2016.

Additional Considerations

In general, treatment for pigment disorders is topical, topical, topical. If patients need chemical peels, intense pulsed light, or laser therapy, we can add that on at the back end. Some mechanical treatments, such as picosecond lasers, work exceptionally well on pigment.

Pigment is the New Wrinkle

Pigment is the new wrinkle, and dermatologists will get better and better at addressing common pigmentary conditions. We can make PIH go away, and we can do the same for some other pigment issues.

There’s room for improvement in how we treat melasma, but I am hopeful that we will see some true innovation in the coming years that will help us to keep pace with patient demand.

Based on a Presentation from Cosmetic Surgery Forum 2017. Cosmetic Surgery Forum 2018 will be held November 28 to December 1 at Cosmopolitan, Las Vegas. Information is available at

Michael H. Gold, MD, FAAD, is the founder of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center, and Tennessee Clinical Research Center located in Nashville, TN. Dr. Gold is also a Clinical Assistant Professor at Vanderbilt University School of Nursing and an Adjunct Assistant Professor at Meharry Medical College, School of Medicine, which is also in Nashville.