Hyperpigmentation on Skin: Causes and Treatments
Medically reviewed by Deeptej Singh, MDMedically reviewed by Deeptej Singh, MDHyperpigmentation refers to spots or patches on the skin that are darker than the surrounding skin. It can occur anywhere on the body but is most common on the face. Sun exposure, hormonal changes, skin inflammation or trauma, as well as certain medications, can cause the skin to produce too much melanin (pigment), leading to an uneven complexion. Hyperpigmentation may fade over time or persist for months or years.While hyperpigmentation is harmless, it can be cosmetically bothersome for many people and impact their self-esteem. Fortunately, several effective treatments can help decrease melanin production and promote a clearer complexion.
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Hyperpigmentation Skin Changes Hyperpigmentation develops when melanocytes—specialized skin cells responsible for producing melanin—start producing more melanin than usual. Overactive melanocytes and increased melanin can lead to dark spots or patches on the skin.Several factors can contribute to the development of hyperpigmented skin, including: Sun exposure: Ultraviolet (UV) rays from the sun trigger melanin production, making the skin more pigmented to shield it from the sun’s rays. This process can sometimes lead to hyperpigmented skin on the face, hands, and other skin areas frequently exposed to the sun. Hormonal changes: Hormonal fluctuations, specifically changes in estrogen and progesterone levels during pregnancy, menopause, and when taking hormonal birth control, can trigger or worsen melasma. Skin inflammation: Inflammation from injuries or inflammatory skin conditions, such as acne and eczema, can cause post-inflammatory hyperpigmentation (PIH), where dark spots develop as the skin heals.Stress: Stress increases cortisol (stress hormone), which can stimulate melanin production and trigger or worsen hyperpigmentation. Certain medications: Some medications can cause hyperpigmentation, including antibiotics, chemotherapy drugs, antimalarials, tricyclic antidepressants, and hormonal birth control pills. How Hyperpigmentation LooksMelasmaMelasma typically appears as freckle-like spots or blotchy, flat patches of hyperpigmented skin on the face, including the cheeks, forehead, chin, and upper lip. Melasma is usually symmetrical, meaning you’ll notice matching patches on both cheeks or evenly developed spots across your forehead. Depending on your skin tone, these hyperpigmented areas may appear tan, brown, grayish-brown, or bluish-gray.
Reproduced with permission from © DermNet New Zealand www.dermnetnz.org 2023.
Sun SpotsAlso known as solar lentigines, age spots, or liver spots, sun spots generally appear as small, flat, oval-shaped dark spots on sun-exposed areas like the face, hands, shoulders, tops of feet, and arms. Depending on your skin tone, these discolored spots may appear light brown to black.
CRISTINA PEDRAZZINI/SCIENCE PHOTO LIBRARY / Getty Images' title='Sunspots hyperpigmentation on an elderly woman's skin'>
CRISTINA PEDRAZZINI/SCIENCE PHOTO LIBRARY / Getty Images
Post-Inflammatory Hyperpigmentation (PIH)PIH varies in size, shape, and location depending on where the skin experiences injury or inflammation. It typically appears in small, darkened patches or spots that may look dark brown or blue-gray in darker skin tones and purplish in lighter skin tones. Acne can leave hyperpigmented spots on the face and trunk, and skin injuries like cuts, scrapes, insect bites, and burns more commonly cause hyperpigmentation on the arms and legs.
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Susceptible Body PartsHyperpigmentation can develop anywhere on the body, but it is more common in areas frequently exposed to the sun, including the following: Face, including the cheeks, forehead, chin, and upper lip ForearmsNeckShouldersUpper back Hyperpigmentation is also more common in body areas that experience repeated friction, such as skin rubbing on skin or clothing, including the inner thighs, underarms, feet, and knees. Does It Fade?Hyperpigmentation often fades over time, but some skin discoloration may require treatment to diminish its appearance. How long hyperpigmentation lasts and the likelihood of it fading depend on the underlying cause, type, and severity of hyperpigmentation and your natural skin tone. Generally, superficial hyperpigmentation, where excess melanin is closer to the skin's surface, may fade more quickly, typically within six to 12 months. However, deeper pigmentation, which involves the lower layers of the skin, can take years to fade and may require professional treatments to diminish.For example, melasma that develops during pregnancy tends to fade after childbirth, and medication-related hyperpigmentation gradually fades after you stop taking the medication. Post-inflammatory hyperpigmentation typically fades within several months as the skin heals, though hyperpigmented spots on the legs may not disappear without treatment.How to Minimize the Effects You can take several steps at home to reduce the visibility of dark spots and patches and prevent worsening hyperpigmentation, such as:Sun protection: Apply a broad-spectrum, water-resistant sunscreen with a sun protection factor (SPF) of 30 or higher to sun-exposed skin areas daily to help prevent further darkening and fade existing hyperpigmentation. Apply sunscreen to all exposed areas of skin, even on cloudy days.Choose gentle skin care products: Opt for gentle, noncomedogenic skin care products free from harsh chemicals and fragrances that irritate the skin and worsen dark spots.Camouflage with makeup: Concealers and foundations can help cover up hyperpigmentation and boost self-confidence when visible hyperpigmentation is bothersome. Consider over-the-counter (OTC) products: OTC skin-lightening creams containing azelaic acid, vitamin C, kojic acid, retinoids (e.g., retinol, tretinoin), or glycolic acid may help reduce the appearance of hyperpigmentation. These ingredients can help fade existing spots and may help slow melanin production to prevent new hyperpigmented areas from developing. When to Consider Treatment Options If hyperpigmentation persists despite at-home treatments or it is impacting your self-esteem, consider seeing a healthcare provider to discuss professional treatment options. Dermatologists—doctors specializing in diagnosing and treating skin conditions—can accurately determine the underlying cause, diagnose the type of hyperpigmentation, assess its severity, and recommend effective treatments. Your dermatologist may recommend one or more treatments, including the following: Prescription topical medications: Skin care formulas with higher concentrations of active skin-lightening ingredients, such as hydroquinone, tretinoin, and corticosteroids, can help reduce melanin production and decrease excess pigment in the skin. Chemical peel: Treatments that involve applying a chemical solution to hyperpigmented areas to exfoliate the top layer and reduce the appearance of dark spots. Laser therapy: Procedures that use lasers (light) can target and break down excess melanin in the skin, improving results in people when used in combination with topical medications.Microneedling: A minimally invasive procedure that involves creating tiny holes in the skin to stimulate collagen production, helping improve skin texture and tone. Platelet-rich plasma (PRP): This procedure involves extracting a small blood sample, placing it into a machine to separate the platelets, and injecting the concentrated platelet-rich plasma into the affected areas to promote a more even complexion. Summary Hyperpigmentation develops when sun exposure, hormonal changes, or skin inflammation cause excess melanin production, leading to dark spots or patches on the skin. Self-care and at-home treatments, including applying daily sunscreen application, using gentle skin care products, and wearing makeup to camouflage dark spots, can help minimize hyperpigmented skin. While some hyperpigmentation may fade over time, persistent or bothersome dark spots may require professional treatment, especially if they seem to be worsening or are affecting self-esteem. A dermatologist can recommend effective treatments, including topical medications or specialist procedures, such as laser therapy or microneedling, to help hyperpigmented areas fade and restore natural skin tone. Read the original article on Verywell Health.
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