Post Inflammatory Hyperpigmentation and Hypopigmentation
Usually, normal skin colour will return slowly over a period of months. One should avoid further trauma to the area, e.g. frequent rubbing and sunlight exposure. In hyperpigmentation, bleaching agents such as those containing hydroquinone may be used. Occasionally a mild steroid may help.
Freckles and Lentigines
Freckles and lentigines can be reduced and lightened by avoiding sun exposure and with the regular use of sunscreens and skin lightening creams. If creams and sun avoidance still do not give satisfactory results, they can be safely removed with intense pulsed light therapy or pigment laser treatment. Most patients will require about four to six treatment sessions to obtain optimal results.
Melasma is challenging to treat as recurrence after initial successful treatment is high. Melasma is best controlled with the regular use of broad spectrum sunscreens, sun avoidance and lightening creams. Prescription-only combination creams may offer rapid initial clearance of the melasma. For difficult cases, chemical peeling, intense pulsed light therapy, oral tranexamic acid and laser treatments may offer additional benefits but the results are variable.
Medical treatment is not needed unless the skin is uncomfortable from itching. The dryness can be helped by using a moisturiser and avoiding soap. If the patches are red or itchy, a mild steroid cream (hydrocortisone) can be applied for a short period to improve symptoms. Sunscreens in summer may prevent the patches becoming more noticeable by reducing the tanning of the non-affected skin.
Drug Induced Hyperpigmentation
Skin lightening creams are usually first line treatment. The offending drug must also be discontinued if possible. Difficult cases may be treated with pigment lasers but results and variable.
Sunscreens: Areas of vitiligo will burn easily in the sun. The use of a sunscreen with a high sun protection factor (SPF) of 30 or higher to all exposed areas helps to protect skin affected by vitiligo.
Topical corticosteroids: The application of a potent or very potent corticosteroid anti-inflammatory cream or ointment to areas of vitiligo may restore some pigment. Side effects, such as thinning of the skin and stretch marks, are a risk with continued use. Short courses of oral steroids can sometimes be considered but may be associated with side effects such as weight gain, skin thinning, mood changes and cataracts.
Other topical preparations: Other types of anti-inflammatory creams and ointments, such as calcineurin inhibitors and vitamin D analogues, may also restore pigment in some patients. These topical treatments will help avoid the corticosteroid side effect of skin thinning.
Phototherapy: This involves exposing affected skin to artificial ultraviolet light. Phototherapy may be helpful in a proportion of patients with vitiligo. However, treatment often needs to be prolonged (lasting at least several months). Phototherapy may be used in combination with topical or oral corticosteroid treatments.
Laser treatment: Some areas of vitiligo have improved from treatment with a laser called the Excimer laser. Laser treatment can be used in combination with topical treatments