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  • Comprehensive Ophthalmology, Oculoplastics/Orbit

    Review of: Managing facial hyperpigmentation

    Kundu R, Aderibigbe O, Riley J. JAMA Dermatology, in press 2023

    There are currently few published clinical trials related to facial hyperpigmentation. Sunscreen may be used to help prevent this condition, while prescription creams can be used to treat it.

    Study design

    This expert opinion provides a clear and concise overview on facial hyperpigmentation, touching on the differences between melasma and post-inflammatory hyperpigmentation as well as guidelines for treating different levels of severity.


    The main pillar of therapy for facial hyperpigmentation is preventative treatment with sunscreen along with a hydroquinone 4% cream. The latter requires a prescription due to an extremely low risk of exogenous ochronosis and a theoretical risk of tumorigenesis (although this has never been reported). Due to recurrence risk, hydroquinone cream is recommended as a once-nightly regimen during the summer, then tapering to weekend-only use during the fall and a treatment holiday during the winter. Additional treatments can be considered with increasing severity.


    This is an expert opinion guide, not a systematic review, so it does not contain scientific evidence. However, as few rigorous studies exist, this is a helpful starting point.

    Clinical significance

    This “clinical insight” reminds readers that procedural interventions should be approached cautiously in patients with facial hyperpigmentation, as well as in patients with higher Fitzpatrick skin tones. Results are variable, with risk of recurrence and post-procedure hyper- or hypopigmentation.

    Financial Disclosures: Dr. Anne Barmettler discloses no financial relationships.