Expert Consensus on the Management of Hyperpigmentation Disorders in India: A Modified Delphi Study by the Pigmentary Disorders Society

Hyperpigmentation disorders are prevalent in individuals with skin of color and are associated with considerable psychosocial impact. Clinical heterogeneity, chronic relapsing course, and limited evidence often result in suboptimal outcomes. This consensus aimed to develop evidence-informed, expert consensus recommendations for the diagnosis and management of common hyperpigmentation disorders in the Indian context. A modified Delphi study was conducted by Indian experts of the Pigmentary Disorders Society (PDS) between August 2025 and January 2026. Twelve dermatologists with expertize in pigmentary disorders participated. An exploratory round identified four priority conditions: melasma, acquired dermal macular hyperpigmentation, post-inflammatory hyperpigmentation, and periorbital hyperpigmentation. A broad literature review informed the development of the statements. Two rounds of anonymous voting using a 5-point Likert scale and a virtual meeting were undertaken. Consensus was predefined as high (≥ 75%), moderate (55%-74%), or low (< 55%). In Round 1, 34 statements were evaluated; 21 achieved high consensus, 9 moderate, and 4 low. Following the virtual discussion and refinement, 11 revised statements were revoted on in Round 2, resulting in 32 final high-consensus statements. Key recommendations emphasized proactive prevention and relapse minimization in Fitzpatrick skin types III-VI, the use of dermoscopy and Wood's lamp for aiding diagnosis, and the use of histopathology when indicated. Overall, the consensus favored combination approaches targeting melanogenesis, inflammation, and photoprotection. The panel also outlined preferred topical, oral, and procedural options based on existing evidence and clinical experience. Overall, this consensus provides contextualized guidance for major hyperpigmentation disorders, emphasizing individualized and multimodal management.