Hydroquinone To Treat Post-Inflammatory Hyperpigmentation Caused By Acne Vulgaris

Hydroquinone Therapy for Post-inflammatory Hyperpigmentation Secondary to Acne: Not Just Prescribable by Dermatologists.

Chandra M, Levitt J, Pensabene CA.

Acta Derm Venereol. 2011 Oct 17. doi: 10.2340/00015555-1225.

• In darker skin phototypes (Fitzpatrick IV and above), post inflammatory hyperpigmentation (PIH) following active inflammatory acne lesions (papules, pustules) is an issue and very common cause of emotional distress. As a complaint, it is even more often a concern than the active lesions.
• Prevention of active lesions is important and in our experience it is effective to give a low dose of cyclines instead of starting with topical antibiotics and/or benzoyle peroxyde.
• However, the lesions of PIH, additionally to sun protection are often treated with hydroquinone.
• The authors mention the utility of associating topical hydroquinone at a concentration of 4% associated with a mild steroid and retinoid. The hydroquinone treatment is done twice daily for up to 6 months. Retinoids and steroids are used twice daily for 2 weeks then on weekends only.
• The authors report irritation only. However one must be aware that hydroquinone is a phenolic compound which has been banned in Europe from prescription drugs due to toxicology concerns.
• Because PIH is spontaneously resolving with sunprotection doing no treatment is a possibilty. However patients do not accept that and speeding up the return to a normal skin is an understandable request. Therefore treatment should be risk free (appart from the possibility of a slight irritation, but this can happen with any cream).