Complications
May occur following the use of topical medicines.
Diagnosis based on clinical examination.
Treatment is discontinuation or decreased frequency of use of topical medications, especially tretinoin and hydroquinone.
May occur following chemical peels or laser treatments.
Hyperpigmentation following laser treatments can be treated with topical hydroquinone for up to 8 weeks.
Examples include: acne, rosacea, atrophy, or telangiectasias.
These effects are typically seen after several weeks to months of corticosteroid exposure, and are the reason that commercial formulations containing corticosteroids are not recommended to be used for >6 weeks continuously.
If these effects occur, corticosteroid should be discontinued.
Hydroquinone inhibits the activity of the enzyme homogentisic acid oxidase and can cause polymerisation of homogentisic acid, which is then deposited in the skin. The result is a blue-black discoloration of the skin in areas treated with hydroquinone.
This condition is seen primarily in darker-skinned people who use hydroquinone-containing preparations (usually ≥3%) for a period of months to years, and is thought to occur more commonly in those who do not use adequate photoprotection.
This complication is seen most commonly in African countries, where high-concentration hydroquinone-containing products are readily available. If the treating physician encounters this reaction, hydroquinone-containing medicines should be discontinued immediately.
This condition can slowly fade, but is permanent in some cases.[70]
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