PATHOPHYSIOLOGICAL INSIGHTS INTO FACIAL HYPERPIGMENTATION AND AESTHETIC TREATMENT MODALITIES

Facial hyperpigmentation, including melasma and post-inflammatory hyperpigmentation, poses a significant dermatological and psychosocial challenge. These conditions arise from a complex interplay of genetic factors, hormonal influences, and environmental exposures (UV, VL, IR), with management particularly challenging in skin of color. This narrative review synthesizes current insights into the pathophysiology of hyperpigmentation—emphasizing the roles of MC1R, tyrosinase, and related enzymes in melanogenesis—and evaluates both established and emerging treatment modalities. A systematic literature search up to February 2025 identified studies addressing topical, oral, laser, and combination therapies. Topical treatments, such as a 5% alpha-arbutin and 2% kojic acid cream, demonstrated efficacy comparable to triple combination formulations but with lower recurrence (p = 0.004). Low-dose tranexamic acid, delivered orally or via mesotherapy, significantly reduced modified Melasma Area Severity Index (mMASI) scores (p = 0.02) and improved quality of life (p = 0.03). Laser therapies—including picosecond Nd:YAG and 755-nm lasers—produced significant mMASI reductions (p < 0.001), with a nonablative 1,927-nm fractional laser achieving a 43% improvement in pigmentation among darker skin types (p < 0.0001). Adjunctive procedures, such as glycolic acid peels, supramolecular salicylic acid with niacinamide, and microneedling, further enhanced clinical outcomes (p < 0.05–p = 0.001). Preliminary evidence also supports acupuncture as a promising complementary approach. In summary, an individualized, multimodal treatment strategy is essential for optimal management of facial hyperpigmentation. Further controlled studies are warranted to refine these protocols and enhance long-term therapeutic efficacy.