Treating Hyperpigmentation on Indian Skin

Indian skin is particularly susceptible to hyperpigmentation. Most people in India have a skin tone ranging from Type III to Type VI on the Fitzpatrick scale, although Type II is also seen in the northernmost regions of the country. The general recommendations on reducing hyperpigmentation in people with darker skin are not alway set in stone when it comes to South Asian skin.

Something that will work in African American skin might not work as well in Indian skin. On a side note, South Asians tend to have substantially more body hair than other ethnicities, so laser hair removal is extremely popular in the subcontinent. Lasers that work well on the fairer skinned Indians (skin Type III or even lighter).

Treating Hyperpigmentation in Indian Skin

If you have Indian skin, you must check out the clinics and doctors that are listed in the India country section in my page on top clinics for dark skin laser treatments. Not only are these clinics experienced at treating darker skin, they almost entirely specialize in treating Indian patients.

Most of them have years of experience in using lasers to treat Indian skin. Whether for hair removal, hyperpigmentation treatment, acne scar revision, moles and skin tag removal and much more. And they all use the latest available technologies that work on South Asian dusky skin tones.

The depth of hyperpigmentation is also an important factor when it comes to treatment strategy. Epidermal hyperpigmentation is on the upper layers of the skin and hence easier to treat. In contrast, dermal pigmentation runs much deeper and requires more intensive treatments.

Vogue India has a good summary of recommendations in treating dark spots in Indian skin. According to Dr. Lara Devgan, if done too agressively, lasers, chemical peels, and microinfusion microneedling for fading darkness can make dark spots worse in peple with olive and darker skin tones.

The Ageless Clinic in India in Mumbai has a useful page that discusses pigmentation issues in Indian skin. Below is an image from the clinic’s instagram that shows a before and after result in removing hyperpigmentation from an Indian person.

Hyperpigmentation Indian Skin
Before and after hyperpigmentation in Indian skin. Treatment from Ageless Clinic.

The clinic’s owner is Dr. Harsha Bijlani. According to her, once the issue causing your pigmentation is under control (whether hormonal, due to injury or excessive sun exposure), peels and lasers are the most common ways to prevent and fight pigmentation. Inititial treatment will usually consist of skin lightening creams that are more suitable for darker skin.

At the Ageless Clinic, hyperpigmentation treatment consists of the following options:

  • PicoSure®.
  • Clear Skin Laser™.
  • Cosmelan™.
  • AgeLess Diamond Skin Resurfacing™.
  • Dermaroller with Lightening Agents.
  • Mesotherpy with Lightening Agents.
  • Skin-brightening Super-Medi Facials.
  • AgeLess Stem Cell Face Treatment™.
  • Chemical Peels.

A Common Skin Concern

Hyperpigmentation is a common skin concern for individuals with Indian skin tones. It can be caused by various factors, including sun exposure, inflammation, hormonal changes, and genetics. Here are some general recommendations for treating hyperpigmentation on Indian skin:

  1. Sun Protection:
    • Sun exposure can exacerbate hyperpigmentation. Use a broad-spectrum sunscreen with a high SPF (at least 30) every day, even on cloudy days. Reapply sunscreen every two hours, especially if you are outdoors.
  2. Topical Skin Lightening Agents:
    • Ingredients such as hydroquinone, kojic acid, niacinamide, alpha arbutin, and licorice extract can help lighten hyperpigmented areas. These ingredients may be found in over-the-counter products or prescribed by a dermatologist.
  3. Retinoids:
    • Retinoids, such as retinol or prescription-strength tretinoin, can promote skin cell turnover and help fade hyperpigmentation. Start with a lower concentration to minimize irritation, and gradually increase if tolerated.
  4. Vitamin C:
    • Vitamin C is an antioxidant that can help brighten the skin and reduce hyperpigmentation. Look for serums containing stabilized vitamin C (ascorbic acid) for maximum effectiveness.
  5. Chemical Peels:
    • Chemical peels, including glycolic acid or salicylic acid peels, can help exfoliate the skin and reduce hyperpigmentation. However, these should be done under the supervision of a dermatologist to avoid complications.
  6. Microneedling:
    • Microneedling involves the use of tiny needles to stimulate collagen production and improve skin texture. It can be effective in treating hyperpigmentation when performed by a trained professional.
  7. Prescription Medications:
    • Dermatologists may prescribe stronger medications, such as topical steroids or combination creams, depending on the severity of hyperpigmentation.
  8. Avoid Irritants:
    • Avoid harsh skincare products and treatments that can irritate the skin, as inflammation can worsen hyperpigmentation in individuals with Indian skin tones.
  9. Hydration:
    • Keep your skin well-hydrated. Moisturizing regularly helps maintain the skin barrier and can contribute to an overall healthier complexion.
  10. Consult a Dermatologist:
    • If hyperpigmentation is persistent or severe, it’s essential to consult a dermatologist. They can assess your skin, determine the underlying causes, and recommend a personalized treatment plan.

Remember that consistency is key when treating hyperpigmentation, and results may take time. Additionally, protecting your skin from further sun damage is crucial to preventing the recurrence of hyperpigmented areas. Always patch test new products and introduce them gradually to avoid potential irritation. Individual responses to treatments may vary, so consulting with a dermatologist for personalized advice is recommended.

Cosmelan Peel for Depigmentation: Benefits and Reviews

For people with darker skin, chemical peels are not always safe. One needs to be especially careful with deeper high TCA peels that go beyond the epidermis and penetrate the upper layer of the dermis. In this post, I will cover the Cosmelan peel, which is relatively safe and popular with people of color.

The company that makes Cosmelan® is mesoestetic. You can purchase the home use product from Amazon, where it currently has an average rating of 4.5 out of 5 stars based on 207 reviews.

Cosmelan Peel
Cosmelan 2 peel for melasma and dark spot treatment.

How does Cosmelan Peel work?

The Cosmelic peel treatment is used to treat melasma, brown spots and hyperpigmentation on the face. It can also be used in other body areas, although the face is the most common region. Note that one should try using skin lightening and bleaching creams first before proceeding to the more intensive peels.

There are two steps to the peel process.

  • Cosmelan Phase 1: An intense depigmentation process that should be undertaken at a clinic or salon under the supervision of a trained aesthetic professional. After application of the Cosmelan 1 mask, the customer goes home and allows it to act for between 8 and 12 hours. Usually, only one clinic visit is required as long as you adhere to the at-home aftercare regimen.
  • Cosmelan Phase 2: This is a home cream for use on the face to improve skin pigmentation imperfections. Cosmelan 2 is a maintenance product that needs to be used on a set schedule. A consistent treatment regimen will help regulate the overproduction of melanin for lasting results. One dermatologist (see video below) recommends using this product three times daily in the first month; twice daily in the 2nd and 3rd months; and once a day from the 4th month onwards.

Mesoestetic also sells a couple of other products to use afterwards. These include a soothing and melan recovery cream for sensitive skin, and a sun protection lotion. See more on their official Instagram account.

The Bombay Skin clinic has some great before and after photos of patients who got the Cosmelan Peel treatment. They classify this process as an:

Advanced medium depth peel treatment that is free from hydroquinone and steroids, thereby making it a safe peel.


Cosmelan contains multiple products that help with pigment removal. Cosmelan 1 contains azelaic acid, kojic acid, phytic acid, retinoic acid, ascorbic acid, arbutine, licorice extract, salicylic acid, retinol palmitate, tocopherol, bisabolol, allantoin, nicotinamide, aloe vera and titanium dioxide. Cosmelan 2 contains titanium dioxide, kojic acid, phytic acid and ascorbic acid.

Side Effects

As with any chemical peels, there can be some side effects with Cosmelan. According to the American Academy of Dermatology (AAD), among the potential side effects of chemical peels include persistent redness that may last for months; temporary darkening of the skin; lighter skin color; and, very rarely, scarring. In the hands of experienced dermatologists, such side effects are rare and usually transient.

The below video shows a full demo of the Cosmelan peel process on two African American brothers:

What Types of Hyperpigmentation can Cosmelan Treat?

Among the hyperpigmentation problems that can be treated with Cosmelan include the following:

  • Melasma.
  • Sun spots.
  • Age spots.
  • Acne scarring.
  • Post-Inflammatory hyperpigmentation (PIH).
  • Uneven skin tone.
  • Dark patches on knees, elbows and other areas of the body.

One darker skinned person even used this product for her undereye discoloration and dark circles. Her unbiased review on YouTube is worth a watch.

Cosmelan in Dark Skin

Here are some considerations for Cosmelan peel in individuals with dark skin:

  1. Consultation with a Professional: Before undergoing any skin treatment, especially for individuals with dark skin, it’s essential to consult with a dermatologist or skincare professional who has experience with darker skin tones. They can assess your skin type, address any concerns, and determine whether Cosmelan peel is a suitable option for you.
  2. Patch Test: Darker skin tones can be more sensitive, and there is a risk of post-inflammatory hyperpigmentation. A patch test can help assess how your skin will react to the peel before applying it to a larger area.
  3. Customized Treatment Plan: The concentration of active ingredients in the Cosmelan peel can be adjusted to meet individual needs. A customized treatment plan based on the specific skin concerns and skin type is important to minimize the risk of side effects.
  4. Pre-Treatment Care: Proper pre-treatment care is crucial for individuals with dark skin undergoing a peel. This may include the use of specific skincare products to prepare the skin and reduce the risk of complications.
  5. Post-Treatment Care: After the peel, it’s important to follow a strict post-treatment care routine, including avoiding sun exposure, using sunscreen, and using gentle skincare products to minimize the risk of hyperpigmentation.

Cysteamine Cream (Cyspera) for Hyperpigmentation

During the last several years, dermatologists have been increasingly prescribing cysteamine cream to treat melasma and other hyperpigmentation conditions. The most well known brand is Cyspera, which Dr. Corey Hartman really likes. He states that it is his:

First choice for patients dealing with hyperpigmentation, especially patients of color.”

In February 2022, Practice Update concluded that stabilized topical cysteamine can be considered a first-line non-hydroquinone option for patients with various hyperpigmentation related conditions. This includes melasma, postinflammatory hyperpigmentation, lentigines, and dyschromia related to facial aging.


Cysteamine (not to be confused with cystamine) is a naturally occurring amino acid (via cysteine or cystine) in the human body.

Since Cysteamine is a natural antioxidant compound, it usually results in no major long-term side effects in skin. In contrast, the gold standard popular hydroquinone treatment can cause permanent skin damage, especially in people of color.

One 2020 case report found that topical Cysteamine 5% cream significantly improved a person’s chronic postinflammatory hyperpigmentation (PIH). Moreover, this patient with skin type 5 saw no results from using a popular triple combination cream (containing hydroquinone, topical corticosteroids, and retinoids). The skin lightening effect was noted by a reduction in the melanin index.

A 2014 study from Iran found Cysteamine 5% cream to show significant efficacy in the treatment of melasma.


Cyspera cream with Cysteamine
Cyspera cream with Cysteamine.

The main product that is currently available on the market is Cyspera pigment correction cream. The manufacturer Scientis Pharma (Switzerland) has an Instagram page with some good before and after photos. They sell the product in a three can combo called The Cyspera Intensive System™. It costs $285 on their website, but is not currently sold on Amazon. The system consists of:

  • Cyspera Intensive™ (30 ml / 1 fl oz).
  • Cyspera Neutralize™ (50 ml / 1.75 fl oz).
  • Cyspera Boost™ (30 ml / 1 fl oz).

The main ingredient is referred to as Cysteamine Isobionic-Amide Complex™.

Dr. Alexis Stephens has a useful video covering this cream. Board certified dermatologist Dr. Dray (Andrea Suarez) reviewed Cyspera in an unbiased manner in 2020. American Academy of Dermatology President Dr. Seemal Desai is a fan of this product.

Also see the below video from Dr. Sheila Nazarian at the Skin Spot:

It used to be too difficult to compound a 5% cysteamine based topical cream that was stable, but Cyspera managed to overcome this challenge. One minor issue with this product is its strong rotten egg (sulfur) smell according to some reviewers.

How Does it Work?

According to Dermnetz, Cysteamine cream works via the following hypothesized mechanisms:

  • The inhibition of tyrosinase and peroxidase.
  • Scavenging of dopaquinone.
  • Chelation of iron and copper ions.
  • Increase of intracellular glutathione.

How do you Apply Cysteamine Cream?

According to Dr. Nazarian, during the first 16 weeks, you will need to apply the cream once per day. Thereafter, during the maintenance phase, you will just need to apply it two times a week.

Other Cysteamine Based Creams

A number of other companies seem to be selling cysteamine based creams. I will try to update this post as I find more that seem legitimate.

US based Senté makes a Cysteamine based pigment and tone corrector cream. It also includes a patented Heparan Sulfate Analog (HSA). The cream evens out complexion in all skin tones and improves the appearance of dark spots. Moreover, it is hydroquinone-free and safe for long-term use in those with sensitive skin. The cost of one tube is pretty significant at $149.

Note that Cysteamine is not a photosensitizer. This means that it can be applied at any time of the year, regardless of sun intensity.