Hyperpigmentary disorders: a therapeutic challenge in the dermatological practice



Hyperpigmentary disorders have an increasing prevalence in the dermatological practice. This is based on the recent common life style with increased UV exposure and broad usage of hormones for contraception or hormone replacement therapy. In addition a democratization of cosmetic procedures leads to higher risk to develop post-inflammatory hyperpigmentation.

Therapeutic challenges for hyperpigmentation disorders occur as a result of the highly individualized condition of each patient, the treatment resistance of hyperpigmented lesions, the high prevalence of reappearance and the necessity to balance between effective treatment and a low risk of adverse events. The individuality of each case which results out of an individually associated cause and clinical type of hyperpigmentation requires that medical professionals have a deep knowledge in hyperpigmentation causalities and therapy options. Resistance to treatments and the high prevalence of reappearance demand an individual combination of long-term treatment options which focus not only on an initial bleaching but also on a persistent depigmentation. A multitude of professional procedures, technical devices and topical agents are used with different outcomes where the expected result is not always predictable. This challenges not only the medical professional but also the compliance of the patient. In addition, the expectation to show immediate and longlasting depigmentation without adverse events such as post-inflammatory hyperpigmentation, confronts the dermatologist with a huge responsibility and pressure in his daily work.

New research findings show that there are even more factors playing a role in the pathogenesis of hyperpigmentation, which are not considered in current treatment options. Nevertheless, there is one commonality in each hyperpigmented lesion independent of cause and clinical type: increased levels of melanin because of increased activity of the human enzyme tyrosinase. This suggests one key treatment option: the inhibition of tyrosinase.