Hyperpigmentation Management Perspectives: A Nationwide Survey of Indian Dermatologists

Objective: Hyperpigmentation is a prevalent dermatological concern in India, with melasma and Post-Inflammatory Hyperpigmentation (PIH) being the most common presentations and more than 80% of the Indian population exhibits facial pigmentation heterogeneity. These disorders significantly affect individual’s quality of life. This survey study aimed to assess the clinical practices, treatment preferences and perceptions of Indian dermatologists in managing hyperpigmentation. Methods: A pan-India survey was conducted in 2024 among 409 dermatologists using a 21-question online questionnaire. Key findings: Melasma (50.2%) and PIH (49.8%) were the most frequently encountered hyperpigmentation types. Sun exposure (59.2%) was identified as the leading etiological factor, followed by hormonal changes (26.4%) and acne (14.4%). Hydroquinone combinations (45.5%) were the preferred first-line agent, while kojic acid (45.5%) and azelaic acid (30.9%) were commonly used as second-line options. The Cleanse, Treat, Moisturize and Protect (CTMP®) regimen was followed by 86.3% of dermatologists. Hyperpigmentation relapses were commonly attributed to poor sun protection (34.7%) and treatment non-compliance (32.8%). Agents such as azelaic acid (25%), tranexamic acid (21.9%), niacinamide (21.9%) were the most accepted new depigmenting agents in clinical practice. Ferulic acid, glycolic acid, salicylic acid and mandelic acid were commonly accepted exfoliating agents. The most recommended sunscreen types were broad-spectrum SPF 50+, PA++++, tinted (60.2%), followed by broad-spectrum SPF 50+, PA++++, non-tinted (35.2%). Conclusion: This pan-India survey study highlights the significant burden of hyperpigmentation and reinforces the importance of a holistic skincare regime (CTMP®) as the foundation of management. Incorporating newer depigmenting agents along with appropriate cleansing, moisturization and broad-spectrum sunscreens use offers more effective, safer, holistic and sustainable outcomes compared to traditional therapies alone in hyperpigmentation management.