Depending on the type of skin pigmentation problem, and the natural color of your skin, creams may be prescribed to lighten dark areas or to darken light patches. Creams may begin to show results in as little as two weeks, but most creams require regular use for two to four months for optimum results. Some creams have a bleaching effect to lighten and even skin tone, while others are chemical peels that slowly reveal new skin and even out blotchy pigment.
Hydroquinone
Hydroquinone is used as a bleaching cream in a two to four percent concentration. DermNet NZ explains that hydroquinone works by inhibiting tyrosinase, an enzyme that helps to make melanin. Pigment cells contain melanin, which gives the skin cells their color. When applied to the darker areas of your skin, hydroquinone blocks melanin formation, gradually lightening the areas until they match your lighter skin tone. The lightening process takes several months. Hydroquinone lightening is permanent. The lightened skin must be protected from sun exposure, including tanning beds. Follow your doctor’s instructions carefully when using hydroquinone, and never use it if you are pregnant or breastfeeding.
Azelaic Acid
Azelaic acid is non-toxic, and is safe for long term use and during pregnancy. It is produced by yeast and occurs on normal skin. Azelaic acid is often used to treat acne on dark skin where scars can leave pigmented spots. Azelaic acid has antibacterial properties, and it is an anti-inflammatory agent that scavenges free radicals. It helps to return damaged skin cell growth to normal. It will not bleach normal skin. DermNet NZ cautions that patients with extremely sensitive skin should discontinue its use if redness or itching occurs.
Topical Corticosteroid
Topical corticosteroid creams, such as hydrocortisone creams, are available in many strengths to treat many conditions. According to the Mayo Clinic, mild corticosteroid creams may be prescribed for vitiligo, a pigmentation disease characterized by patches of skin that lose pigmentation. It may take as long as three months for any change in skin tone to be apparent, and treatment may need to be continued for several months for skin to be repigmented. Your doctor should monitor you closely during corticosteroid use due to side effects that may occur.
Salicylic acid
Salicylic acid is a keratolytic, which breaks down the skin protein, keratin. It is used as a chemical peel for pigmentation disorders to remove the outer layers of skin and allow new skin cells to grow, evening out skin color. It is available in strengths from .05 percent to 30 percent, and should be used only as directed with careful monitoring by your doctor. DermNet NZ advises using petroleum jelly around the area being treated to protect it from surplus application.
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