Editing Hyperpigmentation (section)

==Treatment==
There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.<ref name=Gupta2005rev>{{cite journal|last1=Gupta|first1=AK|last2=Gover|first2=MD|last3=Nouri|first3=K|last4=Taylor|first4=S|title=The treatment of melasma: a review of clinical trials.|journal=Journal of the American Academy of Dermatology|date=December 2006|volume=55|issue=6|pages=1048–65|pmid=17097400|doi=10.1016/j.jaad.2006.02.009}}</ref>

Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.<ref name=":0">{{Cite web|url=https://www.aad.org/media/news-releases/variety-of-options-available-to-treat-pigmentation-problems|title=Variety of options available to treat pigmentation problems {{!}} American Academy of Dermatology|website=www.aad.org|access-date=2017-02-12}}</ref>

===Topical treatments===
Many topical treatments disrupt the synthesis of melanin by inhibiting the enzyme [[tyrosine hydroxylase]].<ref name="Kim Kang 2015 pp. 607–612"/>

Several are prescription only in the US, especially in high doses, such as [[hydroquinone]], [[azelaic acid]],<ref>{{Cite journal|last1=Mazurek|first1=Klaudia|last2=Pierzchała|first2=Ewa|date=2016-09-01|title=Comparison of efficacy of products containing azelaic acid in melasma treatment|journal=Journal of Cosmetic Dermatology|volume=15|issue=3|pages=269–282|doi=10.1111/jocd.12217|issn=1473-2165|pmid=27028014|s2cid=25303091}}</ref> and [[kojic acid]].<ref>{{Cite journal|last1=Monteiro|first1=Rochelle C.|last2=Kishore|first2=B. Nanda|last3=Bhat|first3=Ramesh M.|last4=Sukumar|first4=D.|last5=Martis|first5=Jacintha|last6=Ganesh|first6=H. Kamath|date=2013-03-01|title=A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma|journal=Indian Journal of Dermatology|volume=58|issue=2|pages=157|doi=10.4103/0019-5154.108070|issn=1998-3611|pmc=3657227|pmid=23716817 |doi-access=free }}</ref> Some are available without prescription, such as [[niacinamide]],<ref>{{Cite journal|last1=Hakozaki|first1=T.|last2=Minwalla|first2=L.|last3=Zhuang|first3=J.|last4=Chhoa|first4=M.|last5=Matsubara|first5=A.|last6=Miyamoto|first6=K.|last7=Greatens|first7=A.|last8=Hillebrand|first8=G.G.|last9=Bissett|first9=D.L.|date=2002-07-01|title=The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer|journal=British Journal of Dermatology|volume=147|issue=1|pages=20–31|doi=10.1046/j.1365-2133.2002.04834.x|pmid=12100180|s2cid=39489580}}</ref><ref>{{Cite news|url=https://www.futurederm.com/spotlight-on-niacinamide/|title=Spotlight On: Niacinamide - FutureDerm|date=2007-10-30|newspaper=FutureDerm|access-date=2017-02-12|language=en-US}}</ref> {{sm|l}}-[[ascorbic acid]],{{cn|date=March 2022}} retinoids such as [[tretinoin]],<ref name="Callender Baldwin Cook-Bolden Alexis pp. 69–81">{{cite journal |last1=Callender |first1=Valerie D. |last2=Baldwin |first2=Hilary |last3=Cook-Bolden |first3=Fran E. |last4=Alexis |first4=Andrew F. |last5=Stein Gold |first5=Linda |last6=Guenin |first6=Eric |date=2021-11-09 |title=Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice |journal=American Journal of Clinical Dermatology |publisher=Springer Science and Business Media LLC |volume=23 |issue=1 |pages=69–81 |doi=10.1007/s40257-021-00643-2 |issn=1175-0561 |pmc=8776661 |pmid=34751927}}</ref> or [[cysteamine hydrochloride]].<ref>{{Cite journal|last1=Mansouri|first1=P.|last2=Farshi|first2=S.|last3=Hashemi|first3=Z.|last4=Kasraee|first4=B.|date=2015-07-01|title=Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial|journal=The British Journal of Dermatology|volume=173|issue=1|pages=209–217|doi=10.1111/bjd.13424|issn=1365-2133|pmid=25251767|s2cid=21618233}}</ref><ref>{{Cite news|url=http://www.scientispharma.ch/product/cysteamine-cream/|title=Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment|newspaper=Scientis Pharma|access-date=2017-02-12|language=en-US|archive-date=2016-12-24|archive-url=https://web.archive.org/web/20161224031421/http://www.scientispharma.ch/product/cysteamine-cream/|url-status=dead}}</ref> Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,<ref>{{Cite journal|last=Draelos|first=Zoe Diana|date=2007-09-01|title=Skin lightening preparations and the hydroquinone controversy|journal=Dermatologic Therapy|volume=20|issue=5|pages=308–313|doi=10.1111/j.1529-8019.2007.00144.x|issn=1529-8019|pmid=18045355|s2cid=24913995|doi-access=free}}</ref> and the use of it became more regulated in several countries and discouraged in general by [[World Health Organization|WHO]].<ref>{{Cite book|title=Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization|hdl = 10665/39218|isbn = 9789241571579|publisher = World Health Organization|year = 1994}}</ref> For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.<ref>{{Cite web|url=https://echa.europa.eu/information-on-chemicals/evaluation/community-rolling-action-plan/corap-table/-/dislist/details/0b0236e1807e3dff|title=Hydroquinone - Substance evaluation - CoRAP - ECHA|website=echa.europa.eu|language=en-GB|access-date=2017-02-12}}</ref>

===Oral===
Oral medication with [[procyanidin]] plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.<ref>{{Cite journal|last=Handog|first=Evangeline|date=2009-07-20|title=A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women|journal=International Journal of Dermatology|volume=48|issue=8|pages=896–901|doi=10.1111/j.1365-4632.2009.04130.x|pmid=19659873|s2cid=28886093|doi-access=free}}</ref> Other treatments that do not involve topical agents are also available, including fraction lasers<ref>{{Cite web|url=http://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|title=Laser Skin Whitening - Advantages and Disadvantages {{!}} Skin Whitening News|website=skinwhiteningnews.org|language=en-US|access-date=2017-02-12|date=2014-04-05|archive-date=2021-09-19|archive-url=https://web.archive.org/web/20210919172154/https://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|url-status=dead}}</ref> and dermabrasion.<ref name=":0" />

===Laser treatments===
Laser toning using [[Yttrium aluminium garnet|YAG]] lasers<ref name="Kim Suh Choi Jung pp. 1599–1606">{{cite journal | last1=Kim | first1=Young Jae | last2=Suh | first2=Hyun Yi | last3=Choi | first3=Myoung Eun | last4=Jung | first4=Chang Jin | last5=Chang | first5=Sung Eun | title=Clinical improvement of photoaging-associated facial hyperpigmentation in Korean skin with a picosecond 1064-nm neodymium-doped yttrium aluminum garnet laser | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=35 | issue=7 | date=2020-04-17 | issn=0268-8921 | doi=10.1007/s10103-020-03008-z | pages=1599–1606| pmid=32300974 | s2cid=215794622 }}</ref> and [[Intense pulse light|intense pulsed light]] have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation.<ref name="Arora Sarkar Garg Arya 2022 p. ">{{cite journal | last1=Arora | first1=Pooja | last2=Sarkar | first2=Rashmi | last3=Garg | first3=Vijay K | last4=Arya | first4=Latika | title=Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation | journal=Journal of Cutaneous and Aesthetic Surgery | volume=5 | issue=2 | date=2022-01-27 | pages=93–103 | pmid=23060704 | doi=10.4103/0974-2077.99436 | pmc=3461803 | doi-access=free }}</ref>