TREATMENT RECOMMENDATIONS FOR ACNE-ASSOCIATED HYPERPIGMENTATION: RESULTS OF A DELPHI CONSENSUS PROCESS AND LITERATURE REVIEW.

Overview

Acne vulgaris can be associated with hyperpigmentation, particularly in individuals with skin of color. This acne-induced macular hyperpigmentation (AMH), also called post-inflammatory hyperpigmentation or PIH, is often long-lasting and negatively impacts quality of life. Large-scale randomized controlled clinical trials regarding treatment of acne and AMH are lacking. For this reason, evidence-based treatment recommendations cannot be made. Yet AMH is a common condition, and it is important for clinicians to have guidance on management strategies. The authors, a group of 10 board-certified dermatologists, conducted a modified Delphi consensus process to reach consensus on first-line therapy for AMH and whether therapeutic choices may change in different patient sub-groups. We reached consensus that most patients with acne and AMH should receive early and efficacious acne treatment with a topical retinoid and benzoyl peroxide. Therapies aimed at addressing AMH - including hydroquinone, azelaic acid, chemical peel, or antioxidants - may also be considered to enhance the effect of the treatment regimen on acne and pigmentation. Chemical peels may be used as adjunctive or second-line therapy. This publication details the results of the Delphi process, reviews relevant literature in providing recommendations for AMH and discusses appropriate treatment options.