The results of the in‐vitro experiment showed that 3 µM of chloroquine was the Effective Concentration to reduce viral replication of HPV by 50% (EC50) and that 28 µM of chloroquine was the Effective Concentration to reduce viral replication of HPV by 90% (EC90).

Source: Anecdotal Off-Label Trials of Chloroquine Formulations as Topical Anti-Human Papillomavirus Treatments for High- and Low-Risk HPV-Derived Disease Justice Obi, M.D., James K. Bashkin, D. Phil.
I just saw the presentation about off-label usage of Chloroquine and there's a doctor in New York who makes anti-HPV compounds.
This information might be useful for people with very long, persistent HPV infections:

• http://www.realhpvcure.com/
  
• https://www.genitalwartcure.com/
  

At the same time, the Chinese company Hybribio is conducting clinical trials of its Chloroquine gel.

From the abstract:
Off-label, non-blinded clinical studies were performed with formulations of the API chloroquine, a well-known antimalarial for which we discovered strong anti-HPV activity. The anti-HPV activity was confirmed in cell culture studies in three independent laboratories, including at the National Institutes of Health. We present before and after data from patients with a range of high- and low-risk HPV infections. Successful treatment includes patients with Bowen’s disease, oral papillomas, CIN grades I and II, and genital warts. In certain cases, DNA tests were run by independent labs and these showed no HPV after treatment with chloroquine formulations. Chloroquine and related molecules have been found to reactivate p53 expression in tumors, leading to tumor shrinkage by autophagy and related processes, and this has led the antimalarial class to be studied as anticancer drugs in eight or more clinical trials, some in Phase III. We suspect that importance of eliminating p53 as part of the HPV lifecycle, as carried out by the viral E6 oncoprotein by ubiquitination of p53, and the documented recovery of p53 expression by chloroquine, play a role in the observed anecdotal results. Patient data will be shown after the ten day to two-week topical treatment course via a cream, douche, or mouthwash.
Source:
https://www.itmedicalteam.pl/proceedings/anecdotal-offlabel-trials-of-chloroquine-formulations-as-topical-antihuman-papillomavirus-treatments-for-high-and-lowris-64538.html
Note:
I know there was one study on mice:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175579/

and one case study:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969705/

but I am looking for more reports of Chloroquine use on humans.
UPDATE #1:
It seems that Chinese company Hybribio patented Chloroquine phosphate gel:

• http://hybribio.com/news/shownews.php?id=1333

and is doing some clinical trials in China. For example: "[Translation]A randomized, double-blind, placebo-controlled, multicenter phase II clinical study evaluating the safety and efficacy of chloroquine phosphate gel in the treatment of condyloma acuminatum and flat wart".

Hey-Oh! So, I see some form of this question multiple times per day in various skin and personal care subs: How do I deal with my hyperpigmentation? I also asked myself this question a few years ago. See, I'm prone to freckles and a little melasma and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern, especially among people in their 30s. This started as a small post about my routine and ballooned into a massive book about hyperpigmentation. I hope it's helpful!
DISCLAIMERS:

• I use the term "brightening" instead of "lightening" which is a subtle distinction. None of the ingredients or methods I recommend bleach your skin as "lightening" would suggest, but they can reduce the appearance of hyperpigmentation. "Brightening" tends to be a confusing term in skincare, but for the purposes of this post, I use it as a descriptor for anything that helps prevent or reduce melanin in hyperpigmented skin.
• I will use the term "hyperpigmentation" ad nauseam as a catch-all term for excess pigmentation in the skin including freckles, melasma, PIH and dark spots. This does not encompass moles which are different. This is also different from redness, which is a whole other post.
• Speaking about hyperpigmentation requires some sensitivity to very real issues around it including cultural implications. This post is not intended to moralize hyperpigmentation nor is it intended to alienate the normal melaninization of skin across various tones. Hyperpigmentation refers to excess melanin production on the skin in the form of spots that are darker than the surrounding skin. It's not bad or wrong, nor does it speak to anyone not "doing a good enough job" of taking care of themselves.
• I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
• I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't have any products I've formulated myself to promote. This is going to get long because I wanted to cover everything re:hyperpigmentation. But for your reading pleasure and ease, I have divided this post up so you can get whatever information you need:

Table of Contents

1. Types of Hyperpigmentation
2. What Causes Hyperpigmentation?
3. How To Treat Hyperpigmentation Part 1: The Ingredients
4. How to Treat Hyperpigmentation Part 2: The Routine and Recommendations
5. Body Hyperpigmentation
6. Nuclear Options

Let's get to it!
Types of Hyperpigmentation
Hyperpigmentation refers to excess melanin production in the skin, but it can actually take a couple different forms. Knowing the type of hyperpigmentation you're experiencing is key to understanding if and how it can be treated.
Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.

What Causes Hyperpigmentation?

There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:
Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:

• Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors. People with darker skin are also more prone to melanin production in the form of hyperpigmentation.
• Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
• Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
• Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.

Sun (UV) Exposure. In addition to genetic determination of melanin production, UV exposure is the leading environmental cause of hyperpigmentation and the formation of dark spots. Melanin is the pigment that provides color to our skin, hair, and eyes. It acts as a natural sunscreen (but don't treat it like natural sunscreen!!! This isn't the point of the exercise), absorbing UV radiation to protect the skin from damage.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots. One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure. For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:

• Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
• Hormonal medications: Hormonal medications, such as birth control pills and estrogen replacements, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
• Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Isotretinoin aka accutane when taken for acne can cause hyperpigmentation due to the increase of cell turnover and exposing delicate new skin cells to UV rays before they have shored up.

If using these medications is necessary for your livelihood, it is not recommended to stop their use without the recommendation of your doctor.

How To Treat Hyperpigmentation Part 1: The Ingredients

When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, curb melanin production, and block harmful UV rays. A lot of these things overlap with treatments for other conditions like acne and general anti-aging, but I've noted ones that specifically work on the mechanisms controlling melanin production. Now, this is an extensive list, but I know it doesn't have everything. I've included the ingredients that had the most compelling evidence and/or worked the best for me or people at my practice. But it's also not necessarily a shopping list. You don't have to have all of these things to treat hyperpigmentation, but I'll get to that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets hyperpigmentation based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:
Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem. Arbutin is a Tyrosinase Inhibitor that blocks melanin production.
Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over. Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production.
Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin. Licorice Extract is a plant extract that inhibits melanin production.
Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.

How To Treat Hyperpigmentation Part 2: The Routine and Recommendations

This is adapted from numerous comments, posts and DMs I've written on the topic and also comprises a large portion of my own personal routine and routines we recommend to patients. This is a generalist routine meaning it targets all the forms of hyperpigmentation I've mentioned; freckles, melasma, PIH, and age spots though it can be tweaked to address these individually more specifically. This is really my jumping off point for people to get a good idea of what they can achieve as a baseline with OTC ingredients before fine tuning or enlisting the help of a dermatologist. For a lot of people, this is enough to fully resolve, but even if it gets you part of the way there, this should give you a good idea of reactivity. A few caveats:

• Freckles cannot ever be 100% eradicated. You can however reduce their appearance and prevent them from getting darker. It's important to have realistic goals and understand that sometimes our genetics will overrule any routine we have.
• This routine and any hyperpigmentation routine will not address moles. Moles are a totally different thing that can only be eradicated through removal by a medical practitioner. Moles can be raised or not, but no amount of topicals will get rid of them.
• Melasma is a beast. Sometimes it can be treated with OTC topicals, sometimes it requires prescription strength topicals like hydroquinone, sometimes you need in-office procedures like fractal lasers or IPL. Again, this routine is a jumping off point to see what you can accomplish at home before going down that road.
• You'll notice I don't mention products with all the ingredients I listed above. This is because the more you put on your face, the greater your risk of causing irritation. Again, you can adjust and tweak by switching out products with these ingredients or add/subtract as it suits your personal needs.
• If you're struggling with hyperpigmentation while pregnant or breastfeeding, these recommendations may need to be paused.

Alright, let's get to it!
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:

• Azelaic acid
• Alpha Arbutin
• Vitamin C serum
• Moisturizer
• SPF

The combo of C+AZ+AA+SPF is an absolute powerhouse for healing existing hyperpigmentation and preventing new hyperpigmentation from forming. It makes your SPF more effective, it inhibits the production of melanin from UV exposure (not your natural melanin production though), and it speeds cell turnover with dual antioxidant action and gentle chemical exfoliation. The result is brighter skin in a few months of consistent use.
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:

• Cleanse
• Buffer
• Tranexamic acid and exfoliant OR retinoid**
• Moisturize

To cleanse, I have a really basic recommendation that will remove your SPF, makeup, and any grime/sebum from your day. Start with Cetaphil gentle cleanser. This is a gentle, hydrating cleanser that will break up your SPF really effectively. Massage in and rinse. Then apply a foaming cleanser, I recommend Cetaphil daily cleanser which foams. This will sweep away anything that’s left and give you a good foundation for the rest of your routine. While this doesn't directly help hyperpigmentation specifically, it's a critical step especially for people who are acne>PIH prone. It also gives you a nice clean slate to apply the rest of your skincare. I've tried dozens of cleansers but always come back to these two as good basic options.
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer.
You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.

Body Hyperpigmentation

Ok, I need everyone to be a grownup for two seconds. These products and methods (both from the prior section and this section) should NOT be used on your genitals. First, you can cause serious irritation or infection by applying active skincare to your genitals. Second, it's really not going to do anything to change the pigmentation of the skin there. The skin on your genitals is different than your body and facial skin and it pigments in different ways for different reasons so it's not going to respond to topicals the same way the rest of your body does. Don't even try it.
To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks. Ok, now that we've got the disclaimers out of the way, let's move forward.
Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.

Nuclear Options

In general, I recommend trying OTC topical solutions for any skin concern before heading down the in-office procedure route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office procedures and RX treatments easier and more effective. Part of it is so you have a good maintenance routine in place to use after the fact to preserve the results of your in-office procedure which can sometimes be costly. Lastly, while some procedures can solve the immediate problem completely, topical skincare can be really effective at treating other adjacent conditions like redness, acne, and fine lines.
Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.

Hey-Oh! So, I see some form of this question multiple times per day in various skin and personal care subs: How do I deal with my hyperpigmentation? I also asked myself this question a few years ago. See, I'm prone to freckles and a little melasma and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern, especially among people in their 30s. This started as a small post about my routine and ballooned into a massive book about hyperpigmentation. I hope it's helpful!
DISCLAIMERS:

• I use the term "brightening" instead of "lightening" which is a subtle distinction. None of the ingredients or methods I recommend bleach your skin as "lightening" would suggest, but they can reduce the appearance of hyperpigmentation. "Brightening" tends to be a confusing term in skincare, but for the purposes of this post, I use it as a descriptor for anything that helps prevent or reduce melanin in hyperpigmented skin.
• I will use the term "hyperpigmentation" ad nauseam as a catch-all term for excess pigmentation in the skin including freckles, melasma, PIH and dark spots. This does not encompass moles which are different. This is also different from redness, which is a whole other post.
• Speaking about hyperpigmentation requires some sensitivity to very real issues around it including cultural implications. This post is not intended to moralize hyperpigmentation nor is it intended to alienate the normal melaninization of skin across various tones. Hyperpigmentation refers to excess melanin production on the skin in the form of spots that are darker than the surrounding skin. It's not bad or wrong, nor does it speak to anyone not "doing a good enough job" of taking care of themselves.
• I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
• I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't have any products I've formulated myself to promote.

This is going to get long because I wanted to cover everything re:hyperpigmentation. But for your reading pleasure and ease, I have divided this post up so you can get whatever information you need:
Table of Contents

1. Types of Hyperpigmentation
2. What Causes Hyperpigmentation?
3. How To Treat Hyperpigmentation Part 1: The Ingredients
4. How to Treat Hyperpigmentation Part 2: The Routine and Recommendations
5. Body Hyperpigmentation
6. Nuclear Options

Let's get to it!

Types of Hyperpigmentation

Hyperpigmentation refers to excess melanin production in the skin, but it can actually take a couple different forms. Knowing the type of hyperpigmentation you're experiencing is key to understanding if and how it can be treated.
Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.

What Causes Hyperpigmentation?

There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:
Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:

• Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors. People with darker skin are also more prone to melanin production in the form of hyperpigmentation.
• Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
• Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
• Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.

Sun (UV) Exposure. In addition to genetic determination of melanin production, UV exposure is the leading environmental cause of hyperpigmentation and the formation of dark spots. Melanin is the pigment that provides color to our skin, hair, and eyes. It acts as a natural sunscreen (but don't treat it like natural sunscreen!!! This isn't the point of the exercise), absorbing UV radiation to protect the skin from damage.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:

• Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
• Hormonal medications: Hormonal medications, such as birth control pills and estrogen replacements, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
• Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Isotretinoin aka accutane when taken for acne can cause hyperpigmentation due to the increase of cell turnover and exposing delicate new skin cells to UV rays before they have shored up.

If using these medications is necessary for your livelihood, it is not recommended to stop their use without the recommendation of your doctor.

How To Treat Hyperpigmentation Part 1: The Ingredients

When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, curb melanin production, and block harmful UV rays. A lot of these things overlap with treatments for other conditions like acne and general anti-aging, but I've noted ones that specifically work on the mechanisms controlling melanin production. Now, this is an extensive list, but I know it doesn't have everything. I've included the ingredients that had the most compelling evidence and/or worked the best for me or people at my practice. But it's also not necessarily a shopping list. You don't have to have all of these things to treat hyperpigmentation, but I'll get to that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets hyperpigmentation based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:
Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem.
Arbutin is a Tyrosinase Inhibitor that blocks melanin production. Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over.
Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production. Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract is a plant extract that inhibits melanin production. Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.

How To Treat Hyperpigmentation Part 2: The Routine and Recommendations

This is adapted from numerous comments, posts and DMs I've written on the topic and also comprises a large portion of my own personal routine and routines we recommend to patients. This is a generalist routine meaning it targets all the forms of hyperpigmentation I've mentioned; freckles, melasma, PIH, and age spots though it can be tweaked to address these individually more specifically. This is really my jumping off point for people to get a good idea of what they can achieve as a baseline with OTC ingredients before fine tuning or enlisting the help of a dermatologist. For a lot of people, this is enough to fully resolve, but even if it gets you part of the way there, this should give you a good idea of reactivity.
A few caveats:

• Freckles cannot ever be 100% eradicated. You can however reduce their appearance and prevent them from getting darker. It's important to have realistic goals and understand that sometimes our genetics will overrule any routine we have.
• This routine and any hyperpigmentation routine will not address moles. Moles are a totally different thing that can only be eradicated through removal by a medical practitioner. Moles can be raised or not, but no amount of topicals will get rid of them.
• Melasma is a beast. Sometimes it can be treated with OTC topicals, sometimes it requires prescription strength topicals like hydroquinone, sometimes you need in-office procedures like fractal lasers or IPL. Again, this routine is a jumping off point to see what you can accomplish at home before going down that road (and more on that at the bottom in part 6).
• You'll notice I don't mention products with all the ingredients I listed above. This is because the more you put on your face, the greater your risk of causing irritation. Again, you can adjust and tweak by switching out products with these ingredients or add/subtract as it suits your personal needs.
• If you're struggling with hyperpigmentation while pregnant or breastfeeding, these recommendations may need to be paused.

Alright, let's get to it!
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:

• Azelaic acid
• Alpha Arbutin
• Vitamin C serum
• Moisturizer
• SPF

The combo of C+AZ+AA+SPF is an absolute powerhouse for healing existing hyperpigmentation and preventing new hyperpigmentation from forming. It makes your SPF more effective, it inhibits the production of melanin from UV exposure (not your natural melanin production though), and it speeds cell turnover with dual antioxidant action and gentle chemical exfoliation. The result is brighter skin in a few months of consistent use.
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:

• Cleanse
• Buffer
• Tranexamic acid and exfoliant OR retinoid**
• Moisturize

To cleanse, I have a really basic recommendation that will remove your SPF, makeup, and any grime/sebum from your day. Start with Cetaphil gentle cleanser. This is a gentle, hydrating cleanser that will break up your SPF really effectively. Massage in and rinse. Then apply a foaming cleanser, I recommend Cetaphil daily cleanser which foams. This will sweep away anything that’s left and give you a good foundation for the rest of your routine. While this doesn't directly help hyperpigmentation specifically, it's a critical step especially for people who are acne>PIH prone. It also gives you a nice clean slate to apply the rest of your skincare. I've tried dozens of cleansers but always come back to these two as good basic options.
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer. You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.

Body Hyperpigmentation

Ok, I need everyone to be a grownup for two seconds. These products and methods (both from the prior section and this section) should NOT be used on your genitals. First, you can cause serious irritation or infection by applying active skincare to your genitals. Second, it's really not going to do anything to change the pigmentation of the skin there. The skin on your genitals is different than your body and facial skin and it pigments in different ways for different reasons so it's not going to respond to topicals the same way the rest of your body does. Don't even try it.
To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks.
Ok, now that we've got the disclaimers out of the way, let's move forward. Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.

Nuclear Options

In general, I recommend trying OTC topical solutions for any skin concern before heading down the in-office procedure route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office procedures and RX treatments easier and more effective. Part of it is so you have a good maintenance routine in place to use after the fact to preserve the results of your in-office procedure which can sometimes be costly. Lastly, while some procedures can solve the immediate problem completely, topical skincare can be really effective at treating other adjacent conditions like redness, acne, and fine lines.
Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.

Estive pensando numa maneira de contribuir com a participação do Atila, caso seja chamado como testemunha na CPI. Até agora, os argumentos da defesa (do governo) são voltadas muito no atraso da comunicação da OMS, pra justificar possíveis atrasos ou não cumprimento das medidas sanitárias.
Pensado nisso, resolvi compilar links que coletei ao longo dos meses desde quando soube dos primeiros casos já na China, em janeiro de 2020. Tem outro guardados no Flipboad que, talvez, possam ajudar como complemento.
Já aviso que não sei como o Reddid lida com lista de links.
Janeiro 2020
Para contextualizar, em janeiro ouve a demissão do Roberto Alvim do ministério da cultura

• 24 de Janeiro - Matéria do The Washington Post - Scientists are unraveling the Chinese coronavirus with unprecedented speed and openness
• 27 de janeiro - o Google disponibilizou Coronavírus - Google My Maps
• 28 de janeiro - compartilhei este site tbm com dados sobre casos e morte COVID-19
• 28 de Janeiro - Matéria do Uol - Ministro confirma caso suspeito de coronavírus em MG

Março de 2020

• 12 de Março - Materia neste Site - Why Britain’s Coronavirus Strategy is Literally One of the Most Insane Things in Modern History (fontes: NYTime - As Europe Shuts Down, Britain Takes a Different, and Contentious, Approach; Reuters - Keep calm and carry on: what is the logic behind Britain's coronavirus bet?)

[...]I didn’t used to be such a person — a cynic, conspiratorially minded, suspicious. But I have to confess: watching the British government actually want their nation to come down with Coronavirus is doing a pretty good job of making me one. How stupid do you have to be to want your entire nation to fall ill with a deadly virus? I can’t believe anyone’s that dumb, really. I can only believe that they know exactly what they are doing, and why.

• 14 de março - Postagem no Medium - Coronavírus: Por Que Você Deve Agir Agora **(**Infelizmente, por algum motivo foi deletado). Mas, segue o texto que copiei

Alguns recortes, mas vale a pena ler tudo. Tudo baseado em modelo matemático
"[...]O controle de doenças da China perguntou aos doentes quando eles começaram a sentir os sintomas.
[...]No dia 21 de janeiro o número de casos oficiais (laranja) começaram a explodir: cerca de 100 novos casos. Mas na realidade, existiam cerca de 1.500 casos surgindo naquele dia, crescendo exponencialmente. Mas as autoridades não sabiam disso. O que eles sabiam era que existiam 100 casos de uma nova doença.
Dois dias depois, as autoridades fecharam Wuhan. Nessa altura, o número de casos diagnosticados era próximo de 400. Note esse número: eles decidiram fechar a cidade com apenas 400 novos casos em um dia. Na realidade, existiam 2.500 casos nesse dia. Mas eles não sabiam disso.
[...]uma nota sobre a Coréia do Sul: o país provavelmente é uma exceção. O coronavírus foi contido nos primeiros 30 casos. Mas o paciente 31 foi um super-transmissor que passou o vírus para milhares de pessoas. Porque o vírus é transmitido antes de apresentar sintomas, no momento que as autoridades perceberam, o vírus já estava espalhado. Agora estão pagando o preço desse único caso. Seus esforços de contenção começam a aparecer: Itália e Irã já ultrapassaram o número de casos da Coréia do Sul.
[...]Washington State é a Wuhan americana. O número de caos ali cresceu exponencialmente. No início de março eram cerca de 140.Mas uma coisa interessante aconteceu logo cedo. O índice de mortalidade foi altíssimo. Num determinado momento, existiam 3 casos e uma morte.Sabemos por outros lugares que a taxa de mortalidade do coronavírus varia de 0,5% a 5% (mais comum o primeiro). Como a taxa de mortalidade pode ser de 33%?
[...] Sabemos aproximadamente quantos dias leva, em média, para uma pessoa ser contaminada até sua eventual morte (17,3 dias). Isso significa que a pessoa que morreu em 29 de fevereiro em Washington, foi contaminada por volta de 12 de fevereiro.
[...]Agora, use a média de dobro do tempo para o coronavírus (tempo que leva para dobrar os casos, na média), de 6,2 dias. Significa que nos 17 dias que passaram até que esse doente morresse, os casos teriam multiplicado por 8 (=2^(17/6). Significa que, se você não está diagnosticando todos os casos, uma morte hoje representa 800 casos reais nesse dia.
O Estado de Washington tem hoje 22 mortes. Com essa conta rápida, são aproximadamente 16.000 casos reais de coronavírus hoje. Mais do que os casos na Itália e Irã somados.
Se você olhar no detalhe, vamos ver que 19 dessas 22 mortes ocorreram numa área, num grupo, específico, que pode não ter espalhado demais o vírus. Então, se considerarmos essas 19 mortes como apenas uma, o número de mortes no estado, ao invés de 22 seria 4. Atualizando o modelo com esse número, ainda temos aproximadamente 3.000 casos hoje. [...]"

• 14 de março - Materia washingtonpost - Why outbreaks like coronavirusspread exponentially, andhow to “flatten the curve”
• 15 de março - soube deste subgrupo - subreddit coronabr
• 15 de março - Globo News - Ministério da Saúde vai convocar médicos cubanos para trabalhar na pandemia do novo coronavírus (sendo bem sincero, não sei se sequer foram convocados esses médicos)
• 15 de março - Observable - Don't be Italy ou Quarantine Now
• 16 de março - Canal no Youtube Ministério da Saúde atualiza a situação do Coronavírus
• 16 de março - (atualizado dia 20 de março) Reuters Graphics - The Korean clusters - How coronavirus cases exploded in South Korean churches and hospitals (sobre o paciente 31)
• 17 de março - postei uma frase (acho que postaram aqui)

"Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate." - Michael O. Leavitt, U.S. Secretary of Health and Human Services, 2007.

• 17 de março - Soube de um grupo de pessoas dispostas a ajudar com demandas com a eminência de escassez de suprimentos médicos Grupo Facebook Open Source COVID19 Medical Supplies
• 17 de março - Site português - Folding@Home ou como transformar o seu computador numa arma contra o Covid-19 (acredito que isso ajudou e muito a acelerar as pesquisas no início)
• 17 de março - Teve uma correria danada para comprar de muitos Álcool Gel (poucos sabiam, ou foram informados, que água e sabão também serviam para esterilizar as mãos)
• 18 de março - Postei um vídeo do Youtube do canal Khan Academy - Estimating actual COVID 19 cases (novel corona virus infections) in an area based on deaths
• 18 de março - Matéria do Vox - How soap kills the coronavirus e do Mark Robert - How To See Germs Spread Experiment (Coronavirus)
• 19 de março - Hemobanco pede por doações de sangue em Curitiba
• 20 de março - Medium - Prevendo o crescimento de casos de COVID-19 (coronavírus) no Brasil com análise de dados, gráficos e equações! — Parte 1
• 20 de março - Globo Bem Estar - Brasileira cria rede para imprimir em 3D equipamentos de UTI usados no tratamento contra o coronavírus
• 20 de março - Live do Atila - O que o Brasil precisa fazer nos próximos dias. Foi aquela live, pesada, que, até hoje, cobram ele por uma informação "exagerada" tirada da Imperial College (revisada posteriormente). Ps.: Quero deixar um elogio, pela contribuição que essa live trouxe, mesmo que o governo tenha feito tudo de errado
• 21 de março - Youtube - Visualization of air spread when coughing 😷
• 23 de março - GizmodoBR - Drones capturam vídeos de cidades em quarentena nos EUA - Gizmodo Brasil
• 24 de março - GizmodoBR - Homem morre e esposa está em condições críticas após tomarem cloroquina para se prevenirem contra coronavírus
• 24 de março - Matéria The Intercept - Exclusivo: Bolsonaro ignora alerta da Abin sobre 5,5 mil mortos por coronavírus
• 24 de março - IFLScience Coronavirus Found On Quarantined Cruise Ship's Surfaces Up To 17 Days After Being Vacated (Caso do Navio cruzeiro)
• 24 de março - Youtube Planalto - Pronunciamento do Presidente da República, Jair Bolsonaro (24/03/2020)
• 25 de março - Publiquei um print do Worldometers . Estávamos com 440.145 casos no mundo, nesse dia. Em resumo: era um gráfico pra saber quanto dias íamos de 580 até 1.000 casos (2 dias), de 1.000 pra 10.000 (7 dias), de 10 mil pra 100mil (35 dias), de 100mil pra 200mil (12 dias), de 200mil pra 300mil (3 dias) e de 300mil pra 400mil (três dias)
• 26 de março - Youtube NYT ‘People Are Dying’: Battling Coronavirus Inside a N.Y.C. Hospital NYT News
• 27 de março - Exame - Bolsonaro: Eu tenho o poder de interferir e vou continuar interferindo
• 27 de março - Facebook Prefeito de Florianópolis faz pronunciamento - Atenção! Em Florianópolis, a quarentena será mantida até 8 de abril. Para mais detalhes do que pode e o que não pode neste período
• 29 de março - Facebook/Twitter - A história do primo do porteiro
• 29 de março - Bem Paraná - Paraná tem 16 novos casos da Covid 19 em apenas um dia. Estado soma 152 casos confirmados
• 29 de março - Compartilhei este site aatshb covid trends
• 30 de março - Youtube Roda Viva - No Roda Viva desta segunda-feira, o convidado é o biólogo e pesquisador Atila Iamarino.
• 31 de março - G1 Politica - OMS nega ter sido contra medidas de isolamento social; Tedros Ghebreyesus diz que cobrou políticas sociais para atender quem perdeu renda por causa do combate ao coronavírus

Abril de 2020

• 01 de Abril - Folha de São Paulo - Compra em massa pelos EUA cancelou aquisição de equipamentos para o Brasil, diz Mandetta
• 02 de abril - Reddit CoronaBR - Por que o Brasil não consegue produzir reagentes para teste de covid-19 em massa?
• 02 de Abril - G1 Bem Estar - Ministério da Saúde cadastra médicos veterinários e mais 13 categorias para combater coronavírus
• 03 de Abril - Folha de São Paulo - China cancela compra de respiradores pela Bahia, e carga fica retida nos EUA (Nessa época o governo não demonstrou interessem em ir atrás de ventiladores/respiradores diretamente com o governo da China)
• 04 de Abril - Folha de São Paulo - Bolsonaro faz chamado para jejum religioso neste domingo contra coronavírus
• 08 de Abril - Museu do Holocauto de Curitiba publicou uma nota de repudio, mais uma, contra uma apresentador de tv
• 14 de Abril - Ifl Science - Branch Of Small Chloroquine Trial Halted Due To Heart Complications In Patients
• 14 de Abril - Ifl Science - High Levels Of SARS-CoV-2 Discovered In Urban Wastewater System
• 15 de Abril - G1 Política - Bolsonaro diz a ministros que ele é o presidente, comanda ações e foca na economia
• 17 de Abril - Embaixada da Alemanha Brasília - A chanceler alemã, Angela Merkel, explicou em menos de 2 minutos a seriedade da situação do coronavírus e como um pequeno aumento no número de novos casos de COVID-19 pode afetar o sistema de saúde.
• 17 de Abril - Uol - Bolsonaro: Abrir comércio é risco que corro. Se piorar, vem para o meu colo
• 17 de Abril - Secretaria de Estado da Saúde do Paraná - Sesa abastece regionais de saúde com cloroquina e reafirma importância do isolamento social, é possível encontrar a notícia no Google
• 22 de Abril The Guardian - Trump stops hyping hydroxychloroquine after study shows no benefit
• 23 de Abril - G1 Bem Estar - Curva de mortes de Covid-19 no Brasil está mais rápida que a da Espanha, dizem universidades
• 23 de Abril - G1 Bem Estar - CFM diz a Bolsonaro que não recomenda hidroxicloroquina, mas libera receita em 3 casos
• 23 de Abril - Fast Company - American billionaires have gotten $280 billion richer since the start of the COVID-19 pandemic
• 23 de Abril - Youtube Canal do Pirulla - É PURO ALARMISMO? (#Pirula 328.5)
• 28 de Abril - G1 Mundo Trump diz que acompanha 'de perto' o 'surto sério' de novo coronavírus no Brasil e sugere suspender voos
• 29 de Abril - G1 Política - Políticos criticam declaração de Bolsonaro sobre recorde de mortos por coronavírus no país (do "E daí? Lamento. Quer que eu faça o quê? Eu sou Messias [referência ao próprio nome], mas não faço milagre", disse Bolsonaro a jornalistas quando questionado sobre o assunto. ")
• 29 de Abril - G1 Política - Bolsonaro diz que cobrança sobre mortes por coronavírus precisa ser feita a governadores e prefeitos ( Num outro vídeo - sso dia antes, ou horas antes - ele disse que poderia colocar na conta dele)
• 29 de Abril - G1 Política - Datafolha: 52% defendem isolamento social amplo; 46% são a favor de volta ao trabalho de pessoas fora do grupo de risco
• 29 de Abril - Museu do Holocausto de Curitiba - Condena o comentário do chanceler brasileiro Ernesto Araújo comparando o isolamento social com campos de concentração nazistas
• 29 de Abril - Veja - Associação judaica dos EUA exige desculpas do chanceler Ernesto Araújo

Maio de 2020
*continuarei a atualizar depois. Quem quiser contribuir é só postar os links nos comentários

Le post d’hier est ici.
Le bilan chiffré et les cartes d’hier sont ici
Merci pour tous les messages hier, et aujourd’hui !
Si vous connaissez des liens pour proposer des services d’aides aux personnes âgées et fragiles, aux soignants, aux personnes qui travaillent, est-ce que vous pourriez les poster en lien que je fasse une liste?
Il y a actuellement 199 000 cas dans le monde. Le nouvel épicentre de l’épidémie est l’Europe, et notamment la vieille Europe. Edit: il est 14 heures et il y a maintenant plus de 204 000 cas. Edit: il est 22h30, et il y a maintenant 217 000 cas recensés.
Hier, la Belgique a aussi décidé de son confinement. D’après les rumeurs, New York sera confinée d’ici 48 heures. Les casinos ont fermé à Las Vegas.
En Italie, les chiffres sont toujours très impressionnants: 31 506 cas (+3526) et 2503 décès (+345). La situation est catastrophique à Bergamo, où les hôpitaux sont saturés. Il y a pourtant une bonne nouvelle: dans les régions où le confinement a été mis en place de manière précoce, le nombre de nouveaux cas diminue. Au niveau national, même si c’est occulté par l’énormité des chiffres, on peut voir que cela commence à se tasser aussi. L’Italie est en bonne voie. Il faut savoir qu’ils publient plein de données, et aident vraiment à comprendre le phénomène, donnent plein d’infos précieuses aux autres pays. J’espère que personne ne l’oubliera.
En Espagne, la situation est aussi difficile. Il y avait hier 11178 cas (+1236) et 491 décès (+149).
En France, la situation est catastrophique dans le Haut-Rhin. Des patients commencent à être évacués vers d’autres hôpitaux. Il semble qu’un tri ait été mis en place. Depuis hier la réa est saturée.
Il y a plus de cas détectés en Île de France que dans le Grand Est. Hier, l’exode des parisiens (et dans d’autres métropoles) a continué. Les gares ont été prises d’assaut.
Chez moi, le confinement, c’est pas gagné : il y a un jardin non visible depuis la rue, je n’y ai jamais vu autant de monde (gamins, famille qui joue au badminton, gars qui font des étirements, petites vieilles qui lisent sur les bancs...) qu’hier après-midi. Si les images des hôpitaux du Haut-Rhin fuitent, les gens prendront peut-être conscience de ce qui se passe. Incroyable ces comportements alors qu’on a conscience de ce qu’il se passe en Italie!
Niveau traitement, beaucoup de buzz autour de la chloroquine. Des infos que j’ai, le traitement marche et est utilisé avec succès en Chine, où il a bien fait chuter le taux de mortalité. Il y a cependant des ajustements à faire sur les dosages, à cause des effets secondaires chez certains patients.
De nouveaux députés ont été testés positifs. Je laisse cet article de la Provence ici, je conseille à chacun de le lire afin de se rendre compte de l’égalité des chances à la française.
Vous pouvez avoir des infos sur l’étude sur laquelle s’est appuyé le conseil scientifique pour rendre son avis ici .
Concernant la durée du confinement, personne ne croit aux 15 jours. Les optimistes parlent de 45 jours, les pessimistes jusqu’à l’été. De mon côté, l’info que j’ai est un pic prévu dans trois semaines si aucune mesure de confinement n’était mise en place. La donne a changé en positif avec la mise en place du confinement, en négatif après les débilités des citadins de ce week-end suivi de leur exode. Edit : la donne a changé sur le taux de mortalité, pas sur la durée du confinement comme on me l’a fait remarquer. Je m’égare à vouloir que ça dure le moins longtemps possible...
Au Royaume-Uni, Boris Johnson a annoncé que s’il y avait 20 000 morts ou moins, ce serait un bon résultat.
Partout dans le monde, des plans de soutien massifs à l’économie sont lancés. Il faut dire qu’entre les usines fermées, les gens au chômage, les compagnies aériennes qui menacent de faire faillite en mai, les inquiétudes sont grandes.
Au Japon, ils s’acharnent encore à vouloir organiser les JO (voir le communiqué ici ).
Aujourd’hui :
— Important et à communiquer à tous les inconscients qui laissent leurs gamins jouer en pensant qu’ils ne craignent rien: une nouvelle étude montre que 6% des enfants développent des symptômes sévères.

• France :

— Le DGS dit que la situation s’aggrave rapidement. 4000 tests aujourd’hui, 42 500 tests depuis le début de l’épidémie. 9134 cas (+1404), 3600 personnes hospitalisées , 931 cas graves. 264 (+89) décès - don’t 7% touché des personnes de -de 65 ans. Le bilan par région est ici . Il y a maintenant 2693 cas en Île de France, 2163 dans le Grand Est. Les autres régions sont sous les 1000 cas. La moitié des patients en réa ont moins de 60 ans.
— Il y a un projet de loi d’Etat d’Urgence Sanitaire . D’après l’AFP: « Le projet de loi d'urgence pour faire face au #covid_19 prévoit d'autoriser la déclaration d'un "état d'urgence sanitaire", permettant notamment de restreindre certaines libertés, selon ce texte obtenu par l' #AFP de source parlementaire. L'état d’urgence sanitaire "donne pouvoir au Premier ministre de prendre par décret pris sur le rapport du ministre chargé de la santé, les mesures générales limitant la liberté d’aller et venir, la liberté d’entreprendre et la liberté de réunion et permettant de procéder aux réquisitions de tout bien et services nécessaires afin de lutter contre la catastrophe sanitaire", détaille le texte. »
— Castaner au 20h de TF1.
— La Chine nous envoie un million de masques et du matériel médical (source)
— Je pense qu’on peut dire adieu aux marchés en plein air sous peu vu ce qu’il se passe à Barbès.
— Au niveau confinement : y’a pas plein de monde, mais il y a quand même des gens dans la rue (ca en fait beaucoup pour jogging/je vais bosseje vais faire les courses).Je vois passer les flics régulièrement. C’est simple: mis à part une voiture qu’ils ont contrôlée ce matin, je ne les vois contrôler personne. Je sais pas si chest spécifique à mon quartier, où bien ils ne contrôlent que quand il y a attroupement.
— Olivier Veran déclare qu’on peut espérer un ralentissement dans une douzaine de jours.
— Jean-Paul Hamon, le président de la fédération des médecins de France , est contaminé. Il explique la situation difficile dans son cabinet, car il n’est pas le seul à avoir été testé positif.
— Ricard va fournir de l’alcool pour produire les gels hydro alcooliques. LVMH a effectué ses premières livraisons aux hôpitaux.
— comme dans d’autres pays, il commence à y avoir des mutineries dans les prisons. Il y a eu un début à Grasse hier. . La situation est inquiétante à Fresnes, qui est surpeuplée et où cinq cas ont été détectés. En Italie, il y a eu des morts et des fugitifs. En Iran, pour éviter la propagation, 85 000 prisonniers ont été relâchés.

• Espagne: 13 716 cas (+1890), 533 décès (+25)
  
• Iran: 17 361 cas(+1192), 1135 deces(+147).
  
• Italie: 35 713 cas (+4207), 2978 décès (+475). L’Italie a publié des données sur les cas (âge, comorbidites etc...). Le pdf est ici .
  
• Allemagne: alors que l’Allemagne se rapproche des 10 000 cas, elle ne compte que 26 décès. C’est vraiment une anomalie par rapport aux autres pays, y compris la Corée qui a énormément testé. J’essaie de comprendre un peu pourquoi.
  
  • Royaume-Uni : les écoles vont fermer. Il y a des achats panique là-bas aussi.
• Singapour: 47 nouveaux cas aujourd’hui...ils avaient réussi à endiguer l’épidémie, mais ça repart à la hausse...
  
• Aux Etats-Unis, les choses s’accélèrent (confinement etc...) . Donald Trump a invoqué le Défense Production Act . La bourse de New York fermé pour une semaine dans sa forme « physique » et passe tout en électronique.
  

Études: voici l’avis de Nassim Nicholas Taleb sur l’étude utilisée par le conseil scientifique pour conseiller le gouvernement.
Voici un lien vers une discussion reddit intéressante sur la chloroquine. Tout n’est pas pertinent mais il y a pas mal d’infos et d’arguments.
Un autre traitement, le favipiravir, est considéré comme prometteur. . Ça ne marche que sur les cas sévères par contre.
Pour les traitements, je manque malheureusement de connaissances médicales...quand il y a pas mal de sources d’infos et un peu de recul je peux dire un peu ce qu’il en est, mais pas pour le reste désolée...
Article avec les chiffres sur les différences entre les régions mise en quarantaine très tôt en Italie et les régions avoisinantes non mise en quarantaine.
Edit: ceci est un fake , c’est d’un goût douteux, mais j’ai pas pu m’empêcher de me marrer.

Viêm khớp thái dương hàm hay còn được gọi là rối loạn khớp thái dương hàm là một căn bệnh rất phổ biến hiện nay. Người bệnh bị viêm khớp thái dương hàm sẽ bị ảnh hưởng rất nhiều đều các hoạt động ăn, nhai, nói và nuốt thường ngày. Vậy nguyên nhân viêm khớp thái dương hàm là gì. Cách điều tri bệnh như thế nào.
Nguyên nhân viêm khớp thái dương hàm là gì?
Bệnh viêm khớp thái dương hàm có rất nhiều nguyên nhân gây ra. Điển hình có thể kể đến một số nguyên nhân sau đây:

• Do các khớp bị mỏi vì làm việc quá sức, thường xuyên phải nhau, nghiến chặt hoặc mài rang vào nhau
• Do độ tuổi: Bệnh viêm khớp thái dương hàm thông thường xảy ra ở độ tuổi 30-50 nhất là ở phụ nữ.
• Do cơ hàm bị mỏi vì siết chặt hoặc mài rang
• Do bệnh : bệnh viêm khớp thái dương hàm thường xuyên gặp phải ở những người bệnh viêm khớp dạng thấp. Những người bị hội chứng mệt mỏi mãn tính hay rối loạn giấc ngủ.

Biểu hiện viêm khớp thái dương hàm
Khớp thái dương hàm nối giữa hộp sọ và xương hàm.
Nếu khớp và cơ hàm của bạn có sự sai lệch, rối loạn khớp thái dương hàm sẽ xảy ra. Các chấn thương và viêm ở hàm như viêm khớp thường dẫn đến chứng rối loạn khớp thái dương hàm.
Dưới đây là một số triệu chứng bạn dễ dàng nhận thấy:

• Đau khi nhai
• Đau ở bên trong tai, mặt, hàm và cổ
• Phát ra âm thanh lạo xạo khi mở hoặc đóng hàm
• Cảm giác nhức đầu

<<< Xem thêm : Các phương pháp điều trị viêm khớp thái dương hàm >>>
Viêm khớp thái dương hàm uống thuốc gì
Đa số những người bị viêm khớp thái dương hàm thường lựa chọn phương pháp điều trị bằng thuốc khám viêm, giảm đau, giãn cơ.
Tùy thuộc vào nguyên nhân của bệnh như thế nào và mức độ của người bệnh sẽ được bác sỹ chỉ định cụ thể. Điển hiển có thể chỉ định như sau:

• Rối loạn khớp thái dương hàm nhiễm khuẩn: sử dụng thuốc kháng sinh penicillin G, oxacillin hoặc những cephalosporin thế hệ 1, 2, 3 khác. Phối hợp thuốc chống viêm không có chưa steroid điển hình như diclofenac, aspirin, meloxicam,… Uống thuốc giảm đau đơn thuần như paracetamol hoặc paracetamol + codein nếu như đau thường xuyên.
• Viêm đau khớp thái dương hàm sau khi gặp phải chấn thương cấp như nhổ răng khôn: sử dụng chống viêm không chứa steroid dưới dạng uống, tiêm hoặc chế phẩm dạng gel bôi tại chỗ. Sử dụng thuốc giảm đau paracetamol hoặc paracetamol + codein.
• Viêm khớp thái dương hàm do bệnh viêm khớp dạng thấp: Dùng thuốc chống viêm không steroid (aspirin, diclofenac…) hoặc kháng viêm corticoid (prednisolon, hydrocortison…) đường toàn thân; thuốc giảm đau paracetamol; thuốc chữa trị cơ bản như methotrexat, chloroquin, salazopirin, entanercept,…

Ngoài ra còn có rất nhiều phương pháp điều trị khác. Trên đây là những thông tin liên quan đến nguyên nhân viêm khớp thái dương hàm. Hy vọng những thông tin này sẽ giúp ích cho bạn.

So I've been trying to see changes in plasmid DNA supercoiling with my treatments but having a hard time interpreting those types of gels.
I followed a protocol from open wetware:

1. Miniprepred plasmids from E. coli with QIAGEN kit (all treatments were done in vivo)
2. Loaded 1-1.5ug of DNA on 1% agarose (in 2xTBE) + 5ug/ml Chloroquine diphosphate salt
3. Ran for 16h at 3 V/cm in the same 2xTBE with 5ug/ml Chloroquine
4. Rinsed well with water and stained with Ethidium bromide

Here's my gel picture. It doesn't look quite like in other publications with these types of experiments. First 2 lanes have plasmids isolated after novobiocin (ignore the spelling error please) treatment and it makes sense that I see mostly positively supercoiled topoisomers and all in the area between 'b' and 'c'.
I understand that more supercoiled DNA would migrate faster and that chloroquine relaxes negatively supercoiled DNA.
Could bands in area 'a' of untreated sample be negatively supercoiled DNA that was separated by chloroquine? I haven't seen such pattern in other publications. Is 'b' an open circle plasmid? And would 'c' be the positively supercoiled DNA? I'm lost here...
The ultimate goal is to be able to see topoisomers after Topoisomerase I inhibition but right now I'm not even confident that I can interpret my controls.
​
Any suggestions would be appreciated! Thank you!

Hey friends, I have a couple of questions about chloroquine agarose gels. I'm kind of merging protocols from a couple places (here mainly). So I made 0.8% agarose gel, adding 0.5 ug/mL chloroquine to the agarose once it had cooled. My main concern is that I forgot to add the chloroquine to the running buffer in the rig. The rig is huge (~2L of buffer), but that'd still only be 1 mg of chloroquine. Is there a way to know how big of a difference that could make?
Also, does anyone have disposal information for these? I'll be washing in 0.5 NaCl to remove the chloroquine. Can that used solution be poured down the sink? The final staining will be done with EtBr so gel disposal will be according to SOP.