Hyperpigmentation in Skin of Color

In her session, “Management of Hyperpigmentation in Skin of Color,” Oyetewa Asempa, MD, FAAD, highlighted not only the clinical complexity of this condition, but also the profound psychosocial toll it can take.

“Hyperpigmentation is among the top dermatologic concerns in skin of color [and] causes significant psychosocial distress,” she emphasized.

From acne scars to melasma, lichen planus pigmentosus, and drug-induced pigmentation, Dr Asempa walked attendees through the most common culprits of pigmentary disorders affecting Fitzpatrick skin types III–VI. Notably, she reminded APPs that post-inflammatory hyperpigmentation (PIH) “can take months to years to resolve” and is often more distressing than the initial condition that caused it, particularly in acne.

Dr Asempa did not shy away from the emotional burden these patients often carry. “PIH is often the most distressing aspect of acne for patients with skin of color,” she explained, citing studies linking hyperpigmentation to self-esteem issues, social anxiety, and long-term emotional strain.

Her approach emphasized both empathy and precision. Diagnosis is largely clinical, but treatment must be carefully chosen and patient-specific, avoiding exacerbation.

Dr Asempa reviewed a range of treatment strategies:

• Hydroquinone remains the gold standard for melasma, particularly in triple-combination therapy.
• Azelaic acid is safe during pregnancy and preferred for patients wary of skin-lightening agents.
• Topical or oral tranexamic acid (TXA) has gained traction, with oral TXA offering “clinically meaningful improvement in moderate-to-severe melasma,” although proper screening is essential due to rare thrombotic risk.

She also discussed newer options like cysteamine, thiamidol, and flutamide cream, as well as procedural interventions, including chemical peels, fractional lasers, and microneedling—each with their own risks and ideal indications.

Dr Asempa closed with actionable insights: Use tinted SPF with iron oxides for visible light protection, always pre-treat inflammatory conditions, and do not forget to educate patients on behavior modification, such as avoiding scratching or picking, which can worsen pigmentation. “Just SPF is not enough, you need SPF with iron oxides.”

Reference

Asempa OB. Management of hyperpigmentation in skin of color. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.