What is hyperpigmentation?

Our skin gets its color from a pigment called melanin. It’s produced by special cells in the skin. Melanin is usually evenly spread across our skin, but some people may have areas of skin that have more melanin. As a result, their skin may have brown or gray patches.

Hyperpigmentation is a condition in which certain areas of skin get darker in color compared to the surrounding skin because of extra melanin. It’s harmless on its own but can be a symptom of a more serious condition in addition to being emotionally distressing. 

There are several different types of hyperpigmentation. 

Age spots are also known as liver spots or sun spots, while doctors use the term lentigines. These are flat oval spots that usually appear on skin regularly exposed to the sun, such as on the face and back of the hands. They tend to first appear during middle age and increase in number with time.

Melasma is a type of hyperpigmentation that usually occurs on the face, including the forehead, chin, nose, and cheeks. It occurs more in women than in men and is common during pregnancy

Hyperpigmentation can develop because of skin injuries. This is known as post-inflammatory hyperpigmentation. These injuries include burns and cuts, or inflammation of the skin because of acne or lupus

Some medication can cause hyperpigmentation on the face. These include antibiotics such as tetracyclines and sulfonamides, non-steroidal anti-inflammatory medication, and barbiturates. Once the drugs are stopped, the hyperpigmentation is likely to fade slowly.

Hyperpigmentation can also be the result of conditions like Addison disease, which occurs when your adrenal glands don’t make enough hormones. It can also be the result of hemochromatosis, a genetic abnormality that causes excess iron in the body. 

Both Addison and hemochromatosis, along with other diseases in which hyperpigmentation is present, can cause dangerous symptoms, which is part of why it’s important to get hyperpigmentation looked at by a medical professional.

While hyperpigmentation can affect people of all different skin colors, it’s more severe and frequent in those with darker skin.

Diagnosis for hyperpigmentation

A dermatologist is able to determine the underlying cause of most hyperpigmentation by looking at your skin and asking about your medical history and any other symptoms you may be experiencing. In some cases, a small skin biopsy may be needed. 

Some doctors may recommend a Wood’s Lamp skin examination. This special lamp emits black light and allows the healthcare provider to find out how deeply the hyperpigmentation has penetrated. 

Treatments for hyperpigmentation

Healthcare providers will first treat the underlying cause of hyperpigmentation. Treating post-inflammatory hyperpigmentation early can help prevent more darkening of the skin. 

Some cases of hyperpigmentation may fade on their own — for example, melasma during pregnancy or drug-related hyperpigmentation. 

Medications

Some medications can help with hyperpigmentation. They may be used alone or combined, which may be more effective. Some of these treatments may take several months to show improvement. 

Hydroquinone is one of the most common medications for hyperpigmentation. It works by slowing down the enzyme needed to make melanin. It comes in creams, lotions, and gels, some of which may not need a prescription. However, hydroquinone is not effective on sun spots.

Topical retinoids are creams, lotions, and gels that have medication derived from Vitamin A. They can be used alone or combined with other medications to treat hyperpigmentation.

Azelaic acid is produced by a type of yeast that lives on skin. It comes as a gel, cream, and foam. It works by slowing down tyrosinase, an enzyme needed to make melanin, as well as inhibiting the growth of abnormal melanocytes, the cells that make melanin.

Another medication used for hyperpigmentation is kojic acid. It’s produced by some fungi during fermentation. It slows down the formation of melanin and can be used together with hydroquinone and glycolic acid.

Ascorbic acid is topical Vitamin C. In addition to lightening skin, it’s also anti-inflammatory and helpful in cutting down on molecular damage caused by sunlight.

Home care

As sunlight can cause hyperpigmentation to darken, an important part of treatment is daily use of broad-spectrum sunscreen with a sun protection factor of at least 30. Those with hyperpigmentation should also try to avoid the sun and wear protective clothing, hats, and sunglasses. Doctors say a day’s worth of excess sun can undo months of treatment. 

Healthcare providers also suggest using cosmetics to hide hyperpigmentation. Covering up can help with the emotional distress caused by the skin’s appearance without the expense or risk of adverse effects associated with other treatments.

Surgery

Chemical peels remove skin cells with excess melanin. A solution is applied to the skin and this causes it to exfoliate and peel off. There are three types of chemical peels:

  • Superficial peel. This uses a mild acid like alpha-hydroxy acid to peel off the outer layer of skin.
  • Medium peel. Glycolic or trichloroacetic acid is used to remove skin cells in the outer and middle layers of skin.
  • Deep peel. Trichloroacetic acid or phenol deeply penetrate the middle layer of skin to remove skin cells.

Laser therapy can also be used to remove pigment. This uses a beam of light to cut, burn, or destroy tissue.

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Possible complications and side effects

Chemical peels and laser therapy can result in irritation of the skin, which can worsen the hyperpigmentation or lead to new hyperpigmentation or scarring.

Some medications may cause irritation, stinging, and redness. If the area swells, discolors, or itches severely, stop using these medications and talk to your doctor. Some medications shouldn't be used in pregnancy or breastfeeding.

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Medically Reviewed on 3/25/2021
References
American Academy of Dermatology Association: “Melasma: Diagnosis and Treatment.”

American Osteopathic College of Dermatology: “Hyperpigmentation.”

American Society for Dermatologic Surgery: “Chemical Peels.”

DermNet NZ: “Hydroquinone.”

Journal of Clinical and Aesthetic Dermatology: “Postinflammatory Hyperpigmentation: A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color.”

Lasers in Surgery and Medicine: “Analysis of hyperpigmentation and hypopigmentation after Er:YAG laser skin resurfacing.”

Merck Manuals: “Addison Disease.”

Merck Manuals: “Hemochromatosis.”

Merck Manuals: “Hyperpigmentation.”

StatPearls: “Postinflammatory Hyperpigmentation.”

The Australasian College of Dermatologists: “Post-inflammatory hyperpigmentation.”