Corticosteroids hyperpigmentation treatment

When a peel causes localized inflammation that visibly develops into hyperpigmentation, even with sun protection and avoidance, a corticosteroid (preferably a fluoro-corticosteroid) should be applied. It should be applied twice a day locally to the erythema before it develops into hyperpigmentation and should not be used long term (1 week at the most), to avoid the side-effects associated with corticosteroids. This treatment should of course be combined with sun protection/avoidance measures and a topical depigmenting agent. 

Azelaic acid is a newer treatment for hyperpigmentation, primarily for post-inflammatory hyperpigmentation. It works by blocking the activity of tyrosinase and does not cause photosensitivity of the skin or residual changes in the skin. There is decreased incidence of allergic reactions associated with azelaic acid. Corticosteroids also block the activity of tyrosinase. Corticosteroids are used in combination with other drugs to minimize the side effects. The combination of azelaic acid and hydrocortisone acetate (10%) may also be useful in the treatment of post-inflammatory hyperpigmentation of skin... 

Topical treatments for melasma usually include tyrosinase inhibitors, with or without tretinoin or one of its precursors. Azelaic acid is also a viable treatment option. A corticosteroid can be combined with it to counter any potential active inflammation. Lasers, intense pulsed light (IPL), dermabrasion and microdermabrasion have also been suggested, but often cause post-inflammatory hyperpigmentation. TCA can be an excellent treatment for melasma it eliminates the melanin stored in the papillary dermis and epidermis (Figure 13.8). Mesotherapy has been recently reputed as an effective treatment of melasma. ... 

The histological features of melasma and chloasma are discussed elsewhere in this book. The standard recommendations for treatment often only mention topical applications of tretinoin, hydroquinone and other tyrosinase inhibitors corticosteroids and peels are considered as a last resort because of their potential to turn melasma into post-inflammatory hyperpigmentation (PIH). Conventional peels require conscientious pre-peel preparation to avoid this danger. Easy TCA (ETCA), in combination with appropriate post-peel care, can be used to treat melasma without the constraints of pre-peel preparation (Eigures 16.1-16.5). 

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