In this video blog, Vaneeta Sheth, MD, discusses highlights from her lecture, Cosmeceutical Updates in Skin of Color, on July 26, 2024, during the inaugural Elevate-Derm Alliance

In this video

With 2% hydroquinone pulled from the market, Dr. Sheth explains she has had to "get creative" and take a deeper dive into alternatives she once reserved for sensitive-skin patients, acne with post-inflammatory changes, and widespread hyperpigmentation that was hard to spot-treat. She now points patients toward azelaic acid — available over the counter in concentrations up to 15% — and niacinamide, both of which she describes as gentle, effective, well tolerated, and easy to find. She frames melasma much like a chronic inflammatory disease: treat it down with active, prescription-strength products, then cycle off to over-the-counter maintenance, with plenty of "hand holding" to set expectations that it "is going to be a journey" and almost always comes back.

She also breaks down why epidermal versus dermal pigment matters, since deeper pigment responds less to topicals. A Wood's lamp exam — which she reaches for mainly in non-responders — helps identify deep dermal pigment, and she cautions patients against rushing to lasers, calling them a last-line option best done by someone experienced in deeper skin tones who knows how to pre- and post-treat to reduce PIH risk. For sun protection, she now recommends tinted sunscreens almost exclusively, favoring brands that offer broader shade ranges rather than a single "universal" shade.

  • After the loss of 2% hydroquinone, azelaic acid (now OTC up to 15%) and niacinamide are Sheth's go-to actives for sensitive skin and broad-surface hyperpigmentation.
  • Treat melasma like a chronic inflammatory disease — bring it down with active/prescription treatments, then maintain with gentler OTC options, and prepare patients that it tends to recur.
  • Deeper (dermal) pigment responds less to topical treatment; a Wood's lamp exam is especially useful in non-responders to determine whether pigment is too deep to reach.
  • Lasers are a last-line option for melasma, not a first move — results are unpredictable and should be done by someone experienced in deeper skin tones with proper pre- and post-treatment to limit PIH.
  • Recommend tinted sunscreens, and choose brands offering multiple shades rather than a single 'universal' shade that rarely matches all skin tones.