Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (
hormones) and exogenous factors (such as use of
cosmetics and perfumes, and exposure to sun radiation).
Melasma (
chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl's
melanosis, poikiloderma of Civatte,
erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations. Treatment of
melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum
sunscreens. Several hypopigmenting agents have been used with differing results. Topical
hydroquinone 2 to 4% alone or in combination with
tretinoin 0.05 to 0.1% is an established treatment. Topical
azelaic acid 15 to 20% can be as efficacious as
hydroquinone, but is less of an
irritant.
Tretinoin is especially useful in treating
hyperpigmentation of photoaged skin.
Kojic acid, alone or in combination with
glycolic acid or
hydroquinone, has shown good results, due to its inhibitory action on
tyrosinase. Chemical peels are useful to treat
melasma:
trichloroacetic acid,
Jessner's solution,
Unna's paste, alpha-
hydroxy acid preparations,
kojic acid, and salicyclic
acid, alone or in various combinations have shown good results. In contrast,
laser therapies have not produced completely satisfactory results, because they can induce
hyperpigmentation and recurrences can occur. New
laser approaches could be successful at clearing facial
hyperpigmentation in the future.