TW: mention of abuse and eating disorders
I’ve decided to make a bullet point list of all the messed up things my abusive ex said/did that haunt me to this day, in no particular order.
For context, we broke up a few years ago and were both in our 20’s. Life is good now, but I’m still suffering every day from the trauma he caused. I don’t want to vent to ppl who know me irl so here I am. I’m not here for advice, validation or pity, I’m just hoping this will give me some kind of closure so I can finally move on and heal.
Without further ado, here are some of the things my ex did that still haunt me:
-He often got angry at mobile games and would even hit his phone out of anger. When I asked him to stop he mocked me and said I don’t let him express his emotions and he feels like he’s walking on eggshells around me.
-I wanted to go to a concert on the same day as a party a mutual friend threw. He changed his mind when we were there. After the 3rd time of me asking if we could go, he got angry, tossed his keys across the room towards me and told me to go by myself. It was not gentle, my friends were shocked.
-I got angry at a rude remark he made in front of a mutual friend. We were on a trip. I started giving him the silent treatment and ignoring him when he tried to talk to me, which is a bit childish but it resulted in me being yelled at for a few hours. I went home early from that trip.
-He asked me to go on a walk with him at around 3am, we started chatting about women’s rights. He disagreed that women get harassed more than men, an argument started. He then left me and I had to walk back home alone for 20 minutes.
-I suffered from an eating disorder when I was young (which he was aware of) and I had started to relapse. After weeks of gathering the courage to tell him so I can get support to seek help, he said “you look fine to me” and didn’t even bother telling me to go seek professional help. Later I mentioned this to him and he apologized. But the day after, he forced me to go have lunch with him and get pizza despite me not wanting to. I got called selfish for that.
-On the same note, I struggled to go to social functions or even go out because of my ED. I got called selfish for that as well, in fact he insisted (yelled) that I make everything about myself and should think about how my insecurities affect him.
-I offered to tutor him for his chemistry exam, one which he had failed once and I had passed with stellar grades. I told him a trivial thing that he disagreed on, he refused to take my word. He googled it, saw that I was right, refused to acknowledge it and asked to move on in an angry tone. When he passed said exam, he insisted that I only helped a little and he could have done it by himself. Note that we were classmates at the time, I am now doing a phd and he is (to my knowledge) still stuck in the same semester of undergrad.
-I like to ask questions about people’s interests, no matter how simple the question, to let them know I care. In his case, he constantly responded in a high and mighty tone, insinuating that I’m stupid. This also rubbed off on all other topics, even ones I knew more about. It got so bad that my friends remarked on it.
-He once said that I would be one point higher on the 1-10 attractiveness scale if I didn’t have acne. When I told him how shitty that was, he got defensive and said that I have less acne now so it should not matter.
-He got furious at me for declining to hang out on a weekend where I had planned to spend time for myself. He insisted that I never have time for him. I apologized and offered to hang out at his place the next day. He ended up inviting his friend over (or the friend came uninvited idk) and played video games with him for a few hours while I sat there doing nothing.
That’s all I can remember for now. At least for the worst ones. Maybe I will add more to the list at some point. We broke up when the mental abuse started showing signs of getting physical. Perhaps what hurt the most is that he had told mutual friends that I blocked him out of nowhere. I have no doubt that he thinks he was in the right, so he will never face his actions and I have to be okay with that.
I know I shouldn’t, but I check his socials sometimes, hoping that he becomes a better person and dates someone else, but he’s still alone and miserable, which is what scares me. I get paranoid sometimes, thinking that he’ll hurt me for being happier without him.
These days, I often get intrusive flashbacks of the things he did and get overwhelmed with disgust, anger and shame. I know a person’s value does not diminish when they are intimate with someone but remembering the fact that I let him be with me in that way makes me feel impure and dirty, even gets me nauseous sometimes.
If you relate to any of this, please try to evaluate your relationship dynamics. None of this was sudden, the decent into this gaslighting and abuse was gradual. These moments were often laced in between happy and normal ones.
If you see this behavior in a friend’s partner, please make it your business and tell them kindly. I only started noticing his terrible behavior when my friends told me, and if they had said something sooner, I could have gotten out faster.
To conclude, healing from this has been challenging to say the least. I’ve had immense difficulty with learning to express myself again and speak out when I disagree with something. I’m now in a drama-free loving relationship and my career has thrived post-breakup, which are what should matter the most, but alas, here we are.

After 7 months of Tretinoin my acne has all cleared up. I’ve been doing microdermabrasion and microneedling treatments for a few months now, particularly 2 microneedling treatments thus far and another 3rd one planned.
While my skin is way smoother and I don’t notice any deep scarring, my redness from the acne scars are there, almost like red marker dots all over my face. The 2 microneedling treatments lightened these a bit but not much.
What treatment can I get after my 3rd microneedling treatment to solve this? I don’t want to waste anymore money on microneedling because my deep scarring has all subsided.

After 7 months of Tretinoin my acne has all cleared up. I’ve been doing microdermabrasion and microneedling treatments for a few months now, particularly 2 microneedling treatments thus far and another 3rd one planned.
While my skin is way smoother and I don’t notice any deep scarring, my redness from the acne scars are there, almost like red marker dots all over my face. The 2 microneedling treatments lightened these a bit but not much.
What treatment can I get after my 3rd microneedling treatment to solve this? I don’t want to waste anymore money on microneedling because my deep scarring has all subsided.

I woke up one morning when I was 20 with a huge red cystic pimple with a head on my chin. I thought ugh, but I’ve gotten a white head here in there through my teenage years so I popped it (gasp) and went about my day. The next day I had another one, and the next day I had another one. They were only on my chin and jaw line. And I’ve had them in some capacity ever since. I am 27 now. Guys…I’m at my wits end. During the last 7 years I feel like I’ve tried everything, from hippy dippy crunchy granola “homemade” remedies (I do not recommend, I did this right when this started when I was young and stupid) to going vegan to various forms of BC to just about every topical. Nothing can get rid of it. My skin has definitely gotten better in the last 2-3 years since I realized I need to stop overdoing the actives, but fundamentally I still get horrible cystic pimples. Below is a list of some (since I’ll probably forget at least a couple) that I have tried. Is there any hope for me? Anything else I can do? I feel like I’m going to hate my skin for the rest of my life.
Lifestyle/Supplements -going vegetarian -going vegan -cutting out sugar -spearmint tea/supplements -DIM supplements -omegas -getting on hormonal BC -getting off hormonal BC
Topical scripts -adapalene gel (different while it was still prescription + epiduo) -azelaic acid -clindamycin -currently on tret for about 2 months but it makes me purge SO bad
Common acne treatments -BHA -AHA -mandelic acid -benzoyl peroxide -niacinamide
I don’t know what else to do. I’m pretty fucking scared of spiro or accutane, for a variety of reasons. Not to mention any derm I have had has basically told me they wouldn’t prescribe it for my issues because it would be overkill. I have nearly perfect skin that has not gotten a pimple in the last 5-10 years everywhere other than my chin/jaw line that is constantly red and inflamed no matter what I do. There are times when I can’t help but cry looking in the mirror. Is there anything else anyone can suggest? I don’t want to spend my whole life suffering from this.
Current routine (I don’t think anything in the routine is the cause as this has been totally revamped through the years but the acne has persisted), including just in case. AM: cleanse w water, kiehl’s vit c + HA, caudalie sensitive moisturizer, eucerin oil control spf 50 PM: micellar water, softymo deep cleansing oil, dr jart ceramidin liquid OR dr jart aha/bha toner (2x a week when I don’t have big inflamed flare ups), purito tiger grass serum, dr jart ceramidin cream, Laneige water sleeping mask on nights that I used the acid toner ⁱⁿ the last 2 months, the acid toner has been replaced by tret

Ok so I’m dealing with some texture and very mild small-bumps-acne, and I’m thinking i’ll either use just differen (adapalene) or epiduo (adapalene + benzoyl peroxide)

• I can use only one or I can incorporate both
  
• I can do whichever one i’m using with short contact therapy or by buffering
  
• if I do use BP, would it only be as a spot treatment, or over the whole area? Because i’m targeting my cheeks and I have tiny slightly raised bumps that might be hard to spot treat individually
  

For those with dehydrated, acne prone skin, what products have you found to help? I'm needing something to treat the acne, but need to repair the moisture barrier and get my skin balanced again. I have naturally dry skin, but too many treatments from the dermatologist have caused my skin to become very dehydrated. My acne is only on my chin and jawline.

Let me give you an insight of my situation. So for months I’ve been on 50mg of spiro and it hasn’t done much for my face tbh. I decided to go back to a derm and the dr put me on dapsone gel and adaplene cream and told me I can’t take spiro anymore as I need to have blood work done and they need to examine it. So 6 weeks go by and all my cystic acne is gone and my face is completely clear. However about 2 weeks ago I started getting back cystic acne and the topicals I was using dried out my skin until it felt like sand paper.
Last week I decided to change my derm to someone new, this new dr gave me a few injections and upped my spiro to 100mg no hesitations as she said 50mg is basically nothing and that I don’t need blood work for spiro. I come home to find out that the spiro, benzoyl treatment and wash will not be filled by my pharmacy leaving me no choice but to buy my spironolactone. I left out the benzoyl treatment and wash.
Okay so did you acne clear with just spiro alone or did you incorporate any topicals or face wash?

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Cosmoderma Patna takes pride in maintaining a patient-centric approach. Our dermatologists not only focus on treating the skin condition but also prioritize your overall well-being. They provide guidance on proper skincare routines, lifestyle modifications, and preventive measures to help you achieve long-term skin health.
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This is the product I use with 2% salicylic acid, but I'm wondering if 2% is too strong and drying out my skin more than I want and making my oily skin/acne even worse. Would dropping to a 0.5% product be easier on my skin does the % not really impact the 'drying'?

30 mg 8 weeks 60 mg 14 weeks(current). Acne has gotten way worse since before starting accutane I had less severe acne prior to starting treatment. Am I a non responder to my current dosages?

Mostly we get acne around aroud cheeks and the jaw and leaves some pretty bad scars. I had severe acne and it left me with some pretty bad scarring i tried different treatments but nothing seemed to work. When i was around 18 i was so much depressed and was always in my room. Rn i am 24 and i thought of growing a beard and now i cannot see a single scar on my face.ah thankgod i grow beard :)

I've had rosacea for maybe eight years, diagnosed by doctors. Worse in the last four. I feel it makes me sleepy mostly. That's the most annoying part about it.
Has anyone else experienced some improvement when applying niacinamide and zinc serum topically? I'm a little confused because my rosacea seems to be not blooming much this summer and it shouldn't be able to go to sleep, or should it? Not that I am complaining. But I do wonder if it suddenly comes back full on and this sudden pause in activity is due to something I haven't figured out. I started the niacinamide treatment almost two months ago for acne and it works ok for that along with other types of treatments + sunscreen. But sunscreen alone hasn't done much to improve rosacea during other summers.
I've spent time in the sun for almost two weeks now, daily, and I still look normal, am not too sleepy and only have minor outbreaks. Like a tiny red dot on my left cheekbone and a small pimple on my chin. Last night I even forgot one of my daily two skincare routines and I'm still not red or itchy today.
The tingly feeling was there last night when I fell asleep and I expected to look horrible today.
I don't think I've experienced any side effects except for maybe a little burning sometimes when the niacinamide is applied.

I did microneedling back in 2013-2015, probably 10~12 treatments at a medi spa and had great results, especially with my cystic acne scars. Had a couple of flares in 2019-2021 and have some scarring so thinking about doing it again. Searched the sub and didn’t see much about self microneedling but I see some of the pens on the sites. Anybody do their own and have recommendations? Also, what cleanser and numbing agent because I don’t see anything like that anywhere. Appreciate you suggestions :)

Hey-Oh! So, I see some form of this question multiple times per day in various skin and personal care subs: How do I deal with my hyperpigmentation? I also asked myself this question a few years ago. See, I'm prone to freckles and a little melasma and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern, especially among people in their 30s. This started as a small post about my routine and ballooned into a massive book about hyperpigmentation. I hope it's helpful!
DISCLAIMERS:

• I use the term "brightening" instead of "lightening" which is a subtle distinction. None of the ingredients or methods I recommend bleach your skin as "lightening" would suggest, but they can reduce the appearance of hyperpigmentation. "Brightening" tends to be a confusing term in skincare, but for the purposes of this post, I use it as a descriptor for anything that helps prevent or reduce melanin in hyperpigmented skin.
• I will use the term "hyperpigmentation" ad nauseam as a catch-all term for excess pigmentation in the skin including freckles, melasma, PIH and dark spots. This does not encompass moles which are different. This is also different from redness, which is a whole other post.
• Speaking about hyperpigmentation requires some sensitivity to very real issues around it including cultural implications. This post is not intended to moralize hyperpigmentation nor is it intended to alienate the normal melaninization of skin across various tones. Hyperpigmentation refers to excess melanin production on the skin in the form of spots that are darker than the surrounding skin. It's not bad or wrong, nor does it speak to anyone not "doing a good enough job" of taking care of themselves.
• I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
• I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't have any products I've formulated myself to promote.

This is going to get long because I wanted to cover everything re:hyperpigmentation. But for your reading pleasure and ease, I have divided this post up so you can get whatever information you need:
Table of Contents

1. Types of Hyperpigmentation
2. What Causes Hyperpigmentation?
3. How To Treat Hyperpigmentation Part 1: The Ingredients
4. How to Treat Hyperpigmentation Part 2: The Routine and Recommendations
5. Body Hyperpigmentation
6. Nuclear Options

Let's get to it!

Types of Hyperpigmentation

Hyperpigmentation refers to excess melanin production in the skin, but it can actually take a couple different forms. Knowing the type of hyperpigmentation you're experiencing is key to understanding if and how it can be treated.
Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.

What Causes Hyperpigmentation?

There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:
Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:

• Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors. People with darker skin are also more prone to melanin production in the form of hyperpigmentation.
• Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
• Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
• Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.

Sun (UV) Exposure. In addition to genetic determination of melanin production, UV exposure is the leading environmental cause of hyperpigmentation and the formation of dark spots. Melanin is the pigment that provides color to our skin, hair, and eyes. It acts as a natural sunscreen (but don't treat it like natural sunscreen!!! This isn't the point of the exercise), absorbing UV radiation to protect the skin from damage.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:

• Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
• Hormonal medications: Hormonal medications, such as birth control pills and estrogen replacements, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
• Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Isotretinoin aka accutane when taken for acne can cause hyperpigmentation due to the increase of cell turnover and exposing delicate new skin cells to UV rays before they have shored up.

If using these medications is necessary for your livelihood, it is not recommended to stop their use without the recommendation of your doctor.

How To Treat Hyperpigmentation Part 1: The Ingredients

When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, curb melanin production, and block harmful UV rays. A lot of these things overlap with treatments for other conditions like acne and general anti-aging, but I've noted ones that specifically work on the mechanisms controlling melanin production. Now, this is an extensive list, but I know it doesn't have everything. I've included the ingredients that had the most compelling evidence and/or worked the best for me or people at my practice. But it's also not necessarily a shopping list. You don't have to have all of these things to treat hyperpigmentation, but I'll get to that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets hyperpigmentation based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:
Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem.
Arbutin is a Tyrosinase Inhibitor that blocks melanin production. Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over.
Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production. Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract is a plant extract that inhibits melanin production. Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.

How To Treat Hyperpigmentation Part 2: The Routine and Recommendations

This is adapted from numerous comments, posts and DMs I've written on the topic and also comprises a large portion of my own personal routine and routines we recommend to patients. This is a generalist routine meaning it targets all the forms of hyperpigmentation I've mentioned; freckles, melasma, PIH, and age spots though it can be tweaked to address these individually more specifically. This is really my jumping off point for people to get a good idea of what they can achieve as a baseline with OTC ingredients before fine tuning or enlisting the help of a dermatologist. For a lot of people, this is enough to fully resolve, but even if it gets you part of the way there, this should give you a good idea of reactivity.
A few caveats:

• Freckles cannot ever be 100% eradicated. You can however reduce their appearance and prevent them from getting darker. It's important to have realistic goals and understand that sometimes our genetics will overrule any routine we have.
• This routine and any hyperpigmentation routine will not address moles. Moles are a totally different thing that can only be eradicated through removal by a medical practitioner. Moles can be raised or not, but no amount of topicals will get rid of them.
• Melasma is a beast. Sometimes it can be treated with OTC topicals, sometimes it requires prescription strength topicals like hydroquinone, sometimes you need in-office procedures like fractal lasers or IPL. Again, this routine is a jumping off point to see what you can accomplish at home before going down that road (and more on that at the bottom in part 6).
• You'll notice I don't mention products with all the ingredients I listed above. This is because the more you put on your face, the greater your risk of causing irritation. Again, you can adjust and tweak by switching out products with these ingredients or add/subtract as it suits your personal needs.
• If you're struggling with hyperpigmentation while pregnant or breastfeeding, these recommendations may need to be paused.

Alright, let's get to it!
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:

• Azelaic acid
• Alpha Arbutin
• Vitamin C serum
• Moisturizer
• SPF

The combo of C+AZ+AA+SPF is an absolute powerhouse for healing existing hyperpigmentation and preventing new hyperpigmentation from forming. It makes your SPF more effective, it inhibits the production of melanin from UV exposure (not your natural melanin production though), and it speeds cell turnover with dual antioxidant action and gentle chemical exfoliation. The result is brighter skin in a few months of consistent use.
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:

• Cleanse
• Buffer
• Tranexamic acid and exfoliant OR retinoid**
• Moisturize

To cleanse, I have a really basic recommendation that will remove your SPF, makeup, and any grime/sebum from your day. Start with Cetaphil gentle cleanser. This is a gentle, hydrating cleanser that will break up your SPF really effectively. Massage in and rinse. Then apply a foaming cleanser, I recommend Cetaphil daily cleanser which foams. This will sweep away anything that’s left and give you a good foundation for the rest of your routine. While this doesn't directly help hyperpigmentation specifically, it's a critical step especially for people who are acne>PIH prone. It also gives you a nice clean slate to apply the rest of your skincare. I've tried dozens of cleansers but always come back to these two as good basic options.
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer. You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.

Body Hyperpigmentation

Ok, I need everyone to be a grownup for two seconds. These products and methods (both from the prior section and this section) should NOT be used on your genitals. First, you can cause serious irritation or infection by applying active skincare to your genitals. Second, it's really not going to do anything to change the pigmentation of the skin there. The skin on your genitals is different than your body and facial skin and it pigments in different ways for different reasons so it's not going to respond to topicals the same way the rest of your body does. Don't even try it.
To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks.
Ok, now that we've got the disclaimers out of the way, let's move forward. Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.

Nuclear Options

In general, I recommend trying OTC topical solutions for any skin concern before heading down the in-office procedure route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office procedures and RX treatments easier and more effective. Part of it is so you have a good maintenance routine in place to use after the fact to preserve the results of your in-office procedure which can sometimes be costly. Lastly, while some procedures can solve the immediate problem completely, topical skincare can be really effective at treating other adjacent conditions like redness, acne, and fine lines.
Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.

I have been prescribed 25 mg for hair loss and mild acne. I know that this dose is really low, and that the optimal dose for regrowth is a 100 mg or above, but I have low blood pressure, so my derm didn't want to up the dose.
My hormone levels (testosterone, DHEAS, DHT..) are within the normal range but towards the limit. Has anyone had success with such a low dose? or can recommend any other treatment that I might consider? I have been using topical minoxidil for over eight months with no results and oral minoxidil is not an option for me. I am concerned about the possible weight redistribution that this medication might cause.
Thank you!

Hi everyone! I'm so excited to share my 2 month update for using Elidel to treat my facial eczema. I have made previous posts in this sub-reddit detailing my journey (with photos too). I promised to make further updates since it was the type of content I would have really appreciated when first getting facial eczema and trying to navigate treatment options.
My last update was around 2 months ago and since then, alot has happened! I'm currently in maintenance mode with my eczema and with Elidel. I've gotten into a routine with using Elidel and have switched up my skincare routine slightly too.

• During my last update, I was struggling with establishing a clear routine to using Elidel long-term. After trial and error, I have found that this routine generally works best for me: apply Elidel once a day at night for 3-4 days, then don't apply for 2-3 days, then repeat.
• I don't stick to this strictly though and usually just listen to how my skin feels, but generally that's the routine that I've been following

In terms of skincare, this is the current routine I'm using:

• AM: Wash face with cool water, apply Kiehl's Ultra Facial Cream, apply Good Molecules Sheer Mineral Sunscreen SPF 30+
• PM: Wash face with Garnier Micellar Water Gel, wash face with Krave Beauty Matcha Hemp Hydrating Cleanser, apply thin layer of Elidel only on affected areas, apply Kiehl's Ultra Facial Cream

The Kiehl's Ultra Facial Cream was a product that I religiously used prior to getting eczema and since winter was coming up, I decided to add it back into my routine and luckily, it worked just as well as before! Before I started Elidel and was still getting crazy flare-ups, it stung my skin for a bit so that's why I originally stopped using it.
I'm also thinking of switching out my sunscreen to an SPF 50 one, but slightly hesitant right now in case it doesn't work out well.
Other lifestyle changes:

• I still don't drink alcohol and haven't had a drop of it for 2 months. Sober life can be boring in social settings, but I'm learning to enjoy my mocktails and not having to experience hangovers
• I have started going to a skin clinic for Hydrafacials to deal with any dryness I may have from eczema. I may also start microneedling for some PIE and acne scars on my cheeks, but will consult with my doctor first to see if it's okay
• I wear make-up on most days for work and outings - I just make sure to wash it off very well at night. I haven't made any changes to my make-up products and still use the same ones I did prior to getting facial eczema
• The skin clinic I go to also recommended checking out a naturopath to explore other long-term treatment options that don't involve Elidel or topical medications. I'm hesitant because I'm happy with where my skin is at with Elidel, but may be something I'll explore in the future too!
• I also see my doctor regularly to update her on my progress and she is also happy with the routine that I have established

Overall, my confidence has boosted so much in the past 2 months. My initial eczema flare-ups were so damaging to my self-esteem and I'm glad to have found a treatment option that works for me. I may explore the naturopath route in the future, but for now, I'm very happy.
If anyone has questions, please don't hesitate to reach out! I'll share what I can and hopefully, this post also helps someone else out :)