Global Consensus and Practical Treatments for Pigmentary Disorders in Skin of Color

Conclusions

• Pigmentary disorders are highly prevalent worldwide and can substantially impair quality of life, especially in darker phototypes.
• Effective management of pigmentary disorders depends first on rigorous photoprotection, including UVA, UVB, and high-energy visible light protection.
• Visible light, especially blue/violet wavelengths, is a real driver of hyperpigmentation and can prolong melanin production through melanocyte signaling pathways.
• Ambient light alone can be enough to trigger or worsen post-inflammatory hyperpigmentation, so even indoor window exposure may matter.
• Tinted, iron-oxide-containing sunscreens are generally the most effective way to prevent visible-light-induced pigmentation, although matching them to darker skin tones remains a major unmet need.
• When tinted products are not feasible, some active ingredients such as 2-MNG or broad-spectrum formulas with adjunctive agents may reduce pigmentation, but they are less effective than true visible-light protection.
• For melasma, combining UVB, UVA, and visible-light protection reduces relapse better than UVA/UVB protection alone.
• Melasma is a complex photoaging disorder involving not only melanocytes but also vascular, dermal, and inflammatory components, so therapy must be multimodal.
• Non-hydroquinone options such as thiamidol can match or outperform older hydroquinone-based triple therapy while improving tolerability and quality of life.
• Treatment of melasma should be stepped by severity, with topical agents first for mild disease and escalation to oral agents and procedures only if needed.
• Tranexamic acid appears useful for melasma, mainly through vascular effects, and may help prevent PIH, but its preventive evidence remains preliminary.
• For PIH, the best strategy is to suppress inflammation, treat the underlying dermatosis, and use photoprotection plus topical lightening agents early.
• Procedures such as lasers can help some pigmentary disorders but carry a real risk of worsening pigmentation, so test spots and caution are important.
• For acquired dermal macular hyperpigmentation, oral isotretinoin can produce meaningful improvement, particularly in reticular erythematous mucinosis and localized, shorter-duration disease, but complete clearance is uncommon.