Dr. Heather Woolery-Lloyd recaps her lecture on What's New in Skin of Color on Thursday, November 9, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

Dr. Woolery-Lloyd walks through several new alternatives to hydroquinone for melasma. She points to thiamidol, which has been compared to hydroquinone and works well in her practice (available as a serum plus day and night creams for maintenance), as well as lotus sprout extract in synergistic combinations and other new technologies. Her key advice when evaluating these products is to check the study demographics: a product tested only in skin types one through three isn't necessarily ineffective in darker skin, but she wants studies that include darkly pigmented patients—types four through six, who complain of hyperpigmentation the most—before interpreting results.

She also addresses central centrifugal cicatricial alopecia (CCCA), noting a strong genetic component with an autosomal dominant inheritance pattern, and the PADI3 gene now implicated in the condition—a reason to decouple blame from patients' hairstyling practices. Finally, she flags kratom, an over-the-counter, opioid-like analgesic and sedative sold online, as an unexpected culprit for photo-accentuated, photo-distributed hyperpigmentation worth adding to the differential.

  • Hydroquinone remains the gold standard for melasma, but alternatives like thiamidol, lotus sprout extract combinations, and newer technologies have been compared to hydroquinone and shown to be effective.
  • When evaluating any pigment product, check the study demographics—ideally look for representation of skin types four through six before interpreting results for darker-skinned patients.
  • CCCA has a strong genetic component, appears to follow an autosomal dominant pattern (and can occur in men), with the PADI3 gene implicated—a reason to move away from blaming patients' hairstyling.
  • Consider kratom, an over-the-counter opioid-like analgesic and sedative, as a culprit in new-onset, photo-distributed, photo-accentuated hyperpigmentation.