What Is Hyperpigmentation? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Hyperpigmentation can show up in different ways, from freckles on your nose and cheeks to darker patches of skin that show up during pregnancy. While common, hyperpigmentation can be bothersome, even lowering self-esteem.
Learn what causes hyperpigmentation, who it typically affects, and which treatments and prevention strategies experts recommend.
What Is Hyperpigmentation?
Hyperpigmentation is defined as patches of skin that are darker than the surrounding skin.The skin condition occurs when melanocytes, which are pigment-producing cells in the skin, produce too much pigment.
Typically, hyperpigmentation falls into three categories, says Mona Mislankar, MD, a board-certified dermatologist and the founder of Cincinnati Skin Center in Ohio. These include:
Age spots or freckles: Age spots (lentigines) occur as a result of frequent and prolonged ultraviolet (UV) exposure. Freckles are small, flat pigmented spots that are often genetic and can become darker in the summer months when there’s more sunlight.
Melasma: Melasma is a skin condition that frequently occurs during pregnancy and other times of hormonal changes. It’s marked by areas of darker patches and spots, often on the forehead, bridge of the nose, cheeks, and upper lip.
Post-inflammatory hyperpigmentation: Skin inflammation or injury can cause pigmentation that lightens over time, though this can take years. It can occur from fungal infections, contact dermatitis (an itchy rash triggered by an allergic reaction), eczema (atopic dermatitis, a skin condition that causes dry, itchy skin), bug bites, psoriasis (an immune-related skin disorder), burns, chemical peels, acne, and more. Post-inflammatory hyperpigmentation tends to be more common and severe in people with darker skin tones.
“Hyperpigmentation describes anything that is darker than your normal skin tone,” says Rebecca Kazin, MD, a board-certified dermatologist with ICON Dermatology & Aesthetics in North Bethesda, Maryland. It can look like darker spots or freckle-like patches on more exposed areas of skin, such as the face, neck, and arms. These spots appear darker than your natural skin tone, such as brown (in lighter skin) or bluish gray (in darker skin).
Since hyperpigmentation is more of an umbrella term, many things can cause areas of your skin to darken, says Marie Leger, MD, PhD, a board-certified dermatologist with Entiere Dermatology in New York City and a member of the American Academy of Dermatology.
Common causes of hyperpigmentation include:
Inflammation: Inflammatory reactions in the skin, such as acne, cuts, bug bites, and eczema can cause hyperpigmentation.
Genetics: Freckles are common in families.
Sun damage: UV rays can darken freckles, trigger melasma, and cause age spots.
Hormonal changes: Pregnancy, puberty, and oral contraceptives can create hormonal changes that make hyperpigmentation more likely. Melasma, for example, is most common during pregnancy because of increased levels of estrogen and progesterone.
Medications: Oral contraceptives and drugs that cause the skin to become more sensitive to light (including retinoids, antibiotics, and blood pressure medications) can cause patches of darkened skin.
Hyperpigmentation is a description — not a diagnosis, says Dr. Kazin. But conditions related to hyperpigmentation, such as melasma, can be diagnosed via a visual exam. “Dermatologists can determine what’s going on by looking at the distribution of pigmentation,” says Kazin.
To confirm a diagnosis of skin conditions such as eczema, infection, and psoriasis — or to rule out skin cancer — your doctor may order a skin biopsy (a procedure that removes a small sample of skin that’s viewed under a microscope). Once your doctor determines the cause of your hyperpigmentation, they can develop an appropriate treatment plan.
Dr. Mislankar estimates that most topical medications require at least three months of use before results are seen, while some in-office procedures can produce improvement within one month. The key to seeing results is to treat the underlying cause of hyperpigmentation, too.
It’s important to avoid the sun and use sunscreen during and after treatment. “We often discuss that [hyperpigmentation] is a chronic condition and there’s no quick fix,” says Mislankar. “A condition such as melasma could recur very quickly if you’re not taking appropriate precautions against the sun and heat.”
Avoiding the sun is the best thing you can do. “Hyperpigmentation will lighten on its own if you completely block exposure,” says Kazin. Protect your skin by wearing a wide-brimmed hat, seeking shade, and avoiding excessive heat, Mislankar says.
Apply sunscreen routinely. “Sunscreen is the most important at-home treatment for hyperpigmentation,” says Leger.
Consider over-the-counter (OTC) topical treatments with ingredients like adapalene, a retinoid that’s approved by the U.S. Food and Drug Administration (FDA) to treat melasma and post-inflammatory pigmentation.Azelaic acid, an ingredient often used to treat acne and rosacea, can also be helpful. In addition, skin products containing vitamin C may reduce excess pigmentation and even out skin tone.
Medication Options
Kazin often recommends prescription or medical-grade skin care to her patients. “Most over-the-counter products are not powerful enough to truly lighten hyperpigmentation. Many of these products’ claims are overstated,” she explains.
Hydroquinone (a prescription skin-lightening ingredient) is considered the gold-standard treatment for hyperpigmentation. It has become controversial in recent years because some manufacturers sell OTC skin-lightening products containing hydroquinone that aren’t FDA-approved. Reported side effects from these OTC products have been severe, including skin rashes, facial swelling, and skin discoloration.
Prescription hydroquinone products used under a dermatologist’s supervision, on the other hand, are very safe. “We prescribe it all the time,” Kazin says. Make sure to follow your dermatologist’s instructions and use it for a short time, then take a break. “It’s still the most effective ingredient we have,” Kazin says.
If you prefer to avoid hydroquinone, talk to your dermatologist about medical-grade skin care available through their office. These products often include ingredients like kojic acid (derived from a fungus, this acid inhibits tyrosinase, an enzyme involved in pigment production) and arbutin (a derivative of hydroquinone, it also inhibits tyrosinase activity).“I tell patients that these won’t do the heavy lifting of getting rid of hyperpigmentation, but they can slightly lighten the spot,” says Kazin.
Finally, there’s tranexamic acid, an oral medication made from the amino acid lysine, which can be combined with topical and in-office procedures. It has been found to be safe and effective for melasma. It’s not recommended for people who smoke, take oral contraceptives or anticoagulant medications, are pregnant or breastfeeding, or have heart, lung, or kidney disease.
In-Office Treatments
In-office procedures may fade pigmentation faster than topicals. Options include:
Chemical peels: This procedure involves applying a chemical solution to the skin. “Chemical peels either work by peeling off the skin that’s darkened or by delivering potent therapeutic acids into the skin to brighten,” Kazin says. There are many types of chemical peels and they can be done in three different depths: light (removes the outer layer of skin), medium (removes the outer layer and portions of the upper part of the middle layer of skin), and deep (penetrates to the lower portion of the middle layer of skin).The right chemical peel for you will depend on your skin color and what area of the body needs to be treated. Talk to a dermatologist about what they recommend so as not to cause excess irritation that makes discoloration worse.
Laser technique These devices direct concentrated beams of light to remove the outer layer of your skin and heat the underlying layer. This stimulates the growth of smoother, more evenly pigmented skin.But laser technique (also known as laser resurfacing) should be used with caution, since excess light and heat can cause or worsen hyperpigmentation. Your dermatologist may recommend a picosecond laser, which uses quick pulses of light that do not generate much heat — an advantage when you’re addressing hyperpigmentation, says Kazin.
Microneedling In a microneedling procedure, a practitioner uses tiny needles to puncture the skin and stimulate your body to make collagen (a protein that gives structure to your skin and other connective tissues), which delivers benefits such as improving acne scars, hyperpigmentation, and fine lines and wrinkles.
Not everyone is a good fit for these treatments. Skin type, past procedures, current treatments, past medical history, and pregnancy all play a role, says Mislankar. Discuss your options with your dermatologist.
Alternative and Complementary Therapies
Many people turn to natural therapies to lighten pigmentation, but some of these can worsen discoloration, says Leger. Avoid anything that burns, stings, or irritates the skin, such as lemon juice, hydrogen peroxide, and witch hazel, she says.
Consult a dermatologist before trying any alternative and complementary therapies for hyperpigmentation.
Hyperpigmentation is more likely with age, as the effects of decades of sun exposure accumulate. You can minimize or prevent hyperpigmentation by protecting your skin from UV rays as much as possible.
Wear wide-brimmed hats, sun-protective clothing, and sunscreen while outdoors. Kazin recommends using sunscreens that contain titanium dioxide and zinc oxide (known as mineral sunscreen), which form a physical barrier on skin to block light.
Treating inflammatory skin conditions such as acne, eczema, and scalp eczema (seborrheic dermatitis, which causes a rash with yellow or white scales on your scalp) is also key for preventing hyperpigmentation, says Leger. For example, acne can leave a darker spot on the skin even after it’s healed. See your dermatologist for help managing these conditions.
Hyperpigmentation is generally not dangerous, but it can have negative health effects. For one, the wrong treatment can irritate and inflame skin, making hyperpigmentation worse, says Kazin.
Research also shows that hyperpigmentation can cause psychological distress. It may also lower self-esteem. People with hyperpigmentation are often stigmatized and considered less likable or attractive than people without hyperpigmentation, per research.
Certain groups are more prone to hyperpigmentation than others. For instance, sun exposure and trauma or injury to skin are more likely to cause hyperpigmentation in people with darker skin. And, according to some estimates, up to 65 percent of people with darker skin tones experience post-inflammatory hyperpigmentation from acne.“UV and visible light can activate melanocytes to make more melanin, and patients with darker skin inherently have more melanin,” explains Kazin.
Melasma, which is often triggered by hormonal changes, predominantly affects women, with a 9-to-1 ratio of women to men.
Hyperpigmentation is a spot, blotch, or patch of skin that is darker than your normal skin tone. It can be caused by sun exposure, inflammatory skin conditions, trauma or injury, medications, and hormonal changes. Certain treatments can worsen hyperpigmentation, so it’s best to see a dermatologist to diagnose the underlying cause and develop a treatment plan that’s safe for your skin.
