The Role of Cysteamine Cream in Hyperpigmentation Disorders: A Review

Abstract

Hyperpigmentation is a skin pigmentation disorder caused by increased melanin production or deposition. Hydroquinone remains the first-line topical therapy, but long-term use is limited by the risk of side effects. Cysteamine is a multitarget depigmenting agent with potential as an effective and safe alternative therapy. To examine the mechanism of action, effectiveness, safety, and potential use of cysteamine cream in various hyperpigmentation disorders. A literature review of articles from PubMed, NCBI, and Google Scholar published in the last 10 years was conducted. This included randomized controlled trials (RCTs), systematic reviews, and meta-analyses using the keywords cysteamine cream and hyperpigmentation. The literature review showed that cysteamine 5% cream is effective in reducing hyperpigmentation, especially melasma, with comparable effectiveness to hydroquinone 4%. The mechanisms include inhibition of tyrosinase, peroxidase, and melanogenesis, as well as increased antioxidant activity. Reported side effects are generally mild, such as erythema, burning sensation, pruritus, and local irritation, with no risk of toxicity to melanocytes with long-term use. Evidence regarding its effectiveness in post-inflammatory hyperpigmentation (PIH) and other forms of hyperpigmentation is limited. Cysteamine 5% cream is an effective, safe, and potentially effective depigmentation therapy as an alternative to hydroquinone, although further research is needed, particularly in PIH and other forms of hyperpigmentation