What can be done to minimize the appearance of pigmented lines and wrinkles on my knuckles and elbow crease? (photos)

You will likely have the best result from a combination of treatments. You can consider peels or laser treatments to start. This can be augmented by using prescription lightening creams. Daily you can begin now by keeping your skin moisturized, following a healthy diet, and using sunscreen every day.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

First, I’d focus on exfoliation and moisturizing as well as being very strict about using sunscreen even for minor exposure to the sun. If this is not enough, you can consider a light chemical peel to the area or prescription hydroquinone cream, which suppresses natural pigment formation.