Global consensus on the management of melanin hyperpigmentation disorders

Melanin hyperpigmentation disorders (MHD) are among the most prevalent dermatologic concerns globally, affecting individuals across all skin phototypes and geographies. Despite their widespread impact on quality of life-including stigmatization, anxiety and depression-comprehensive, unified and practical clinical guidelines are lacking. This global consensus project convened 10 leading dermatologists and pigmentary disorder experts from Africa, Asia, Europe and the Americas to develop an evidence-based, internationally applicable framework for the management of common MHD, including melasma, post-inflammatory hyperpigmentation, acquired dermal macular hyperpigmentation, periorbital hyperpigmentation, chronic hyperpigmentary photodamage, freckles/ephelides and hyperpigmentation of the folds. Based on a comprehensive literature review and a structured Delphi process, the expert panel formulated consensus statements and tailored treatment algorithms that account for skin type, photobiological behaviour, disease severity and regional access to therapies. Special emphasis was placed on the role of broad-spectrum photoprotection and the challenges of tinted sunscreen availability in diverse populations. Treatment options ranged from topical lightening agents and systemic therapies (e.g. oral tranexamic acid) to procedural interventions (e.g. chemical peels, lasers and IPL) stratified by disease subtype and pigmentation depth. Notably, the consensus highlights that effective MHD management must address not only melanocytes but also the surrounding skin microenvironment, including fibroblasts, mast cells and vascular components. This consensus provides a globally adaptable clinical guide for the diagnosis and management of MHD, emphasizing a personalized approach that bridges scientific rigour with real-world applicability across diverse populations and health systems.