Hyperpigmentation Review Examines Treatment Strategies and Evidence Gaps in Skin of Color
Key Takeaways
- A literature review of hyperpigmentation disorders emphasized ultraviolet and visible-light exposure, inflammatory signaling, hormonal influences, and dermal changes as contributors to pigmentation and treatment resistance.
- The authors described multimodal management approaches incorporating photoprotection, topical therapies, selected systemic treatments, and procedures tailored to the disorder and patient characteristics.
- The review identified gaps in clinical trials, diagnostic tools, and outcome measures for people with Fitzpatrick skin types III to VI.
A literature review presented at the 2026 Fall Clinical Dermatology Conference examined mechanisms and treatment strategies for hyperpigmentation disorders, emphasizing persistent gaps in evidence involving patients with skin of color.
Susan Taylor, MD, of the University of Pennsylvania, and colleagues reviewed English-language literature indexed in PubMed and MEDLINE from 2000 through 2026, prioritizing randomized trials, meta-analyses, epidemiologic studies, and consensus statements. Conditions discussed included melasma, postinflammatory hyperpigmentation (PIH), solar lentigines, drug-induced pigmentation, and acquired dermal macular hyperpigmentation.
The authors described pigmentation as a multifactorial process involving ultraviolet radiation, visible-light signaling through opsin-3, inflammation, hormonal pathways, and changes in the dermal microenvironment. In melasma, basement-membrane disruption and dermal senescence may contribute to persistence and treatment resistance.
Treatment Approaches and Representation Gaps
The review identified visible-light photoprotection and multimodal topical regimens as important components of management. Its treatment summary included hydroquinone, triple-combination therapy, azelaic acid, retinoids, cysteamine, thiamidol, and tranexamic acid, with selection dependent on indication and evidence. Procedural approaches included chemical peels, microneedling, and laser-based treatments, with particular attention to the risk of PIH in darker phototypes.
The authors also noted that oral tranexamic acid requires patient-specific risk assessment and that procedural outcomes and recurrence vary. The poster synthesized existing literature rather than reporting new patient-level outcomes or a pooled effect estimate.
“Closing the evidence gap for skin of color is the next priority in treatment of hyperpigmentation and will require inclusive trial design, validated diagnostic tools, and standardized outcome measures,” the authors concluded.