The general goal of treating hyperpigmentation includes inhibiting the formation of melanosomes and the proliferation of melanocytes, thereby reducing melanin production. This process will often involve compounds that inhibit the tyrosinase enzyme responsible for catalyzing melanin synthesis inside melanosomes. Currently, there are several treatments used for reducing melanin formation, however, a great many of them are too abrasive and undesirable for the already compromised and delicate immune system of most oncology clients. Research has shown that common topical applications – such as combinations of hydroquinone, retinoids, glycolic acid, salicylic acid, or kojic acid – already pose a hazard to healthy individuals, let alone vulnerable patients.

Paradoxically, the treatment options that serve to reduce melanin formation also compromise the skin's ability to protect itself against ultraviolet damage; in the case of an individual undergoing chemotherapy, their skin is already highly photosensitive. Therefore, safe and gentle treatments, such as products containing niacinamide, non-denatured soy, magnesium ascorbyl phosphate, lactobacillus ferment, pumpkin enzyme, and yeast extract, are more suitable, but there is still limited data describing the efficacy of these options for oncology clients. Studies suggest that health practitioners also educate their clients on becoming proactive in skin-protective behaviors prior to anti-cancer therapy in order to minimize dermatological side effects.

Proactive behaviors include extensive sun protection, which is essential pre-, during, and post-cancer treatment. Using safe and simple emollients to protect the skin's moisture barrier should also become a daily habit. The most overlooked aspects of preventing and managing hyperpigmentation is adequate internal hydration and a fortified nutrition plan that includes antioxidants and anti-inflammatory compounds. Research confirms that antioxidants can inhibit the oxidation and formation of tyrosinase. Anti-inflammatory compounds that are taken internally or applied topically also address the aspects of hyperpigmentation related to inflammation. Some examples include mulberries, pomegranates, licorice, and vitamin E. Overall, the key aspects to managing hyperpigmentation in oncology clients is using safe and simple products, maintaining the moisture barrier, and exercising prevention. This type of treatment plan encompasses a holistic approach to maintaining healthy skin and may prove to be the most beneficial in combating hyperpigmentation and other challenging side effects of cancer treatments.

References
Leyden, J., & Wallo, W. (2011). The mechanism of action and clinical benefits of soy for the treatment of hyperpigmentation. International Journal of Dermatology, 50(4), 470-477.
Lynch, T. J., Kim, E. S., Eaby, B., Garey, J., West, D. P., & Lacouture, M. E. (2007). Epidermal Growth Factor Receptor Inhibitor-Associated Cutaneous Toxicities: An Evolving Paradigm in Clinical Management. The Oncologist, 12(5), 610-621.
Kambil, S., Bhat, R., & Pavey, R. (2015). Dermatological adverse reactions to cancer chemotherapy. Indian Journal of Dermatolog, Venereology, and Leprology, 81(4), 434.
Ra, H., Shin, S., Kim, J., Lim, H., Cho, B., & Roh, M. (2012). The impact of dermatological toxicities of anti-cancer therapy on the dermatological quality of life of cancer patients. Journal of the European Academy of Dermatology and Venereology, 27(1), e53-e59.