Hyperpigmentation is one of the most common dermatological concerns and affects people of all ages and skin tones. It has many triggers with genetics, inflammation, hormonal changes and long-term sun exposure chief amongst them. Whilst treatable, hyperpigmentation can take a long time to fade and depending on the cause may recur. To date, prescription treatments such as Hydroquinone remain the most powerful way to fade hyperpigmentation. However, not everyone has access to them and you can not use them indefinitely. Over the counter skincare, can help bridge this gap and there are a number of ingredients that may help. Cysteamine is one such ingredients that is becoming increasingly popular as a gentle but effective way to tackle hyperpigmentation. In this article, we explore what cysteamine is, how it works and the best way to use it to fade dark marks and even out skin tone.
What is Cysteamine & How Does it Work?
Cysteamine is a naturally occurring compound that forms in the body when it breaks down an amino acid called cysteine. In skincare, its synthetic form is an active ingredient in products aiming to help fade hyperpigmentation due to melasma, inflammation or sun damage. Cysteamine has been studied for many years and can be safe for use on most skin types and tones. This includes even some people with reactive skin conditions who struggle with stronger treatments.
Melanin is the pigment that gives skin its colour and is produced by specialised cells called melanocytes. When the skin has exposure to sunlight, hormonal change or inflammation, these cells release enzymes that drive pigment production. Excess pigment can deposit in different layers of the skin to form dark spots or patches. The main way cysteamine works is by slowing the activity of the enzymes that drive melanin production. It also acts as an antioxidant, by binding excess copper or iron particles and increasing glutathione production. This helps neutralise the oxidative stress that triggers excess pigmentation. Because it acts on several points within the pigment pathway, cysteamine can treat a range of hyperpigmentation concerns.
How Does Cysteamine Compare with Other Hyperpigmentation Treatments?
As cysteamine acts at more than one stage of pigment formation, it behaves differently to most other topical treatments. Here’s how cysteamine compares to the most common hyperpigmentation skincare treatments:
- Hydroquinone: The main way this prescription only medicine works is by very effectively blocking the key enzyme (tyrosinase) involved in pigment production. If used correctly, hydroquinone can tackle even severe hyperpigmentation and initial results may be visible within weeks. However, it can irritate the the skin and if used inappropriately or for too long may even cause rebound hyperpigmentation or ochronosis. Some small clinical studies show that cysteamine can achieve a similar reduction in mild hyperpigmentation to hydroquinone but with fewer side-effects. As such, cysteamine might be a gentler over the counter alternative for mild hyperpigmentation or useful for maintenance during hydroquinone breaks.
- Tranexamic acid: You can find this compound in both over the counter and prescription hyperpigmentation tretaments. It mainly targets the inflammatory and hormonal signals that stimulate pigment production. As such tranexamic acid is particularly helpful for melasma. Whilst most people can tolerate it well, progress tends to be slower and more modest. Cysteamine acts both through antioxidant actions as well as more directly on reducing melanin formation. There is evidence that combining these two ingredients can offer a gentle and effective way to improve the appearance of melasma.
- Azelaic acid: This exfoliating acid also has an anti-inflammatory ingredient with mild pigment-lightening effects. It’s safe for long-term use and usually gentle enough for use in sensitive or acne-prone skin. Whilst it can be an effective anti-hyperpigmentation treatment especially at higher prescription strengths, azelaic acid is usually not enough on its own to fade dark spots. There isn’t much in the way of scientific research directly comparing azelaic acid with cysteamine. However, use of both can amplify their benefits due to the different ways they work.
- Retinoids: Derivatives of retinol and in particular prescription compounds like tretinoin and adapalene, don’t inhibit melanin directly but they do speed up skin cell turnover. This helps to shed pigment more quickly and can be effective by themselves for mild hyperpigmentation. They also enhance the penetration of other actives such as hydroquinone. Again, it’s not possible to compare them with cysteamine due to the different actions, however strong retinoids can complement cysteamine’s effects.
Who Can Benefit from Cysteamine?
Cysteamine is often marketed as an over the counter ingredient that sits between prescription treatments and cosmetic brightening ingredients. Obviously a lot of this is marketing hype but it is an effective ingredient due to its multi-actions on hyperpigmentation. The main people who can benefit from using cysteamine for hyperpigmentation include those with:
- Melasma: Its antioxidant and pigment suppressing effects are helpful for hyperpigmentation triggered by hormones or sun exposure.
- Post-inflammatory hyperpigmentation (PIH): This is the dark marks that can occur due to inflammation after acne, eczema or injury.
- Sunspots: Cysteamine can help fade spots or patchy uneven tone due to prolonged sun exposure.
- Sensitive or reactive skin: It is fairly gentle even for long-term use.
- Hydroquinone-free protocols: It’s also a good option for anyone who cannot tolerate hydroquinone or who wants a maintenance product to keep hyperpigmentation from returning after stronger treatments.
How to use Cysteamine in Skincare
Cysteamine works gradually, so the approach needs to be slow and steady. Rushing frequency or strength is neither helpful nor safe. Improvement depends on regular use and sun protection rather than how quickly you increase frequency. Here are some of our top tips for introducing it into your skincare routine:
- Frequency: Start slowly by using cysteamine two to three evenings a week. Only increase this when your skin is comfortable. Keep the rest of your routine simple while you introduce it and adjust based on how your skin feels.
- Application: Cleanse then wait until the skin is completely dry before applying cysteamine on in thin even layer.
- Contact time: You usually apply creams directly on to clean, dry skin for a short contact time before rinsing. However, some newer formulas may allow you to leave them on the skin. If it is a rinse-off product, you normally need to leave them on for 15–30 minutes before removing. If it is a leave-on formula, then you can usually apply a light moisturiser on top. Read the instructions carefully to check which one yours is!
- Layering: Avoid using exfoliating acids and retinoids initially on cysteamine nights to reduce irritation.
- Pairing: Use with a gentle cleanser and a hydrating moisturiser to support the skin barrier. If you’re building up your routine, try to introduce one new active at a time after your skin has adjusted to cysteamine.
- Photoprotection: Apply a broad-spectrum sunscreen with at least SPF 30 every morning and reapply during the day. Tinted/iron-oxide sunscreens add useful visible-light protection for melasma and PIH.
- Maintenance: Once hyperpigmentation has improved, most people maintain results by using cysteamine a few nights a week alongside consistent sunscreen.
Risks, Side-effects & Precautions
Topical cysteamine is usually well tolerated, but like anything in life there are potential risks. Many of these side effects are temporary and tend to settle as the skin adjusts. However, users should be aware of the following:
- Irritation: Mild redness or tingling is common during the first few uses and usually settles within a few days or weeks. Applying after a moisturiser, shortening contact time or using it on alternate nights can help if the skin feels sensitive or dry.
- Allergic or inflammatory reaction: Persistent redness, itching, peeling or darkening isn’t expected. Seek medical help urgently and stop the treatment as it may be a sign of allergy or extreme irritation.
- Broken skin: Avoid applying cysteamine to inflamed, broken or recently exfoliated areas as this can increase irritation.
- Pregnancy & breastfeeding: It is best to avoid cysteamine during pregnancy or breastfeeding unless specifically advised by a doctor as there is little data on safety during these periods.
Used correctly and alongside daily sunscreen, cysteamine is well tolerated and suitable for long-term or maintenance use. If you have an existing skin or medical condition then it is best to check with your doctor first to ensure it is safe and appropriate for you.
Cysteamine can be a safe and effective treatment for mild to moderate hyperpigmentation. It works gradually to reduce melanin overproduction and can be used safely for extended periods. It also works well with many other skin evening treatments. This makes it a valuable option for those unable to use hydroquinone or seeking long-term maintenance. However, as with all things in medicine and life, results depend on patience and consistency.
At City Skin clinic, we are passionate about personalised skincare. Our online skin clinic offers safe and effective custom skin treatments. Where appropriate our doctors use ingredients such as Tretinoin and Hydroquinone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
