Table 2.

Management strategy for postinflammatory hyperpigmentation in skin of color

USE	THERAPY
First-line therapy	Hydroquinone 4%*
	Sunscreen
Additional treatment needed after 8–12 weeks of therapy	Combination therapy: HQ plus other depigmenting agents# OR
	Chemexfoliation Glycolic acid Salicylic acid Trichloroacetic acid^ Jessner's solution^
	Laser/light therapy Blue light photodynamic therapy Fractional photothermolysis Nd:YAG laser
First-line therapy for HQ allergy or prior long-term use	Other depigmenting agents Tretinoin Adapalene Tazarotene Mequinol Azelaic acid
	Sunscreen
Additional treatment needed after 8–12 weeks of therapy	Chemexfoliation or laser/light therapyas above

^*To avoid complications such as exogenous ochronosis, it is best to switch to a nonhydroquinone depigmenting agent after prolonged use.

^#Other agents commonly used in combination with HQ include retinoids, glycolic acid, kojic acid, ascorbic acid, and vitamin E.

^{^}Effective for melasma but clinical studies are needed for PIH.

HQ = Hydroquinone

Nd:YAG = Neodymium: yttrium aluminum garnet