Dr. Dover points out that PIH is particularly difficult to treat because there is a risk of making it worse; he too opts for topical treatments to err on the side of safety. “For the most part, hydroquinone is marginally effective, as is Kligman’s formula,” he says. “High energy Q-switched lasers and IPL sometimes produce temporary improvement but in the end can make this condition worse. Low fluence Q-switched lasers, especially the Q-switched Nd:YAG laser, have shown some early promise.”
Dr. Nikolaidis is reluctant to use laser treatments for PIH because overshooting means starting over, which is especially frustrating—for both the patient and the provider—as laser- or peel-related PIH typically resolves on its own. “What you’re doing with topical agents in those cases is shortening the duration of what would happen naturally,” he says. “The main thing that I’ve learned over the last 15 years is that patience is a virtue. Try not to move the needle too quickly with hyperpigmentation; it’s more about slow improvement over time rather than trying to get an immediate, drastic reduction.”
Laura Beliz is the associate editor of MedEsthetics.
Photo copyright Getty Images.