What Is Hyperpigmentation?

Hyperpigmentation is a general term that describes different types of skin discoloration. This happens when the cells that give your skin its color are triggered to start overproducing pigment—causing skin darkening in patches.1 A variety of factors can cause this trigger, including sun exposure, hormone changes, certain health conditions, genetics, and more.

Some people may choose to treat the skin discoloration with over-the-counter (OTC) or prescription topical medications and in-office skin resurfacing procedures. Knowing what might be causing your hyperpigmentation can also help you prevent it from happening.

Types of Hyperpigmentation

Hyperpigmentation is classified into several different types. The most common include:2

• • Melasma: This is a common skin condition that leads to patchy or blotchy discoloration. It usually appears on the face, though some people may experience it on the neck, arms, or other parts of the body. These patches are generally darker than your natural skin tone and can look like freckles or cover a larger area.3 Melasma often develops during pregnancy or while taking birth control pills, so it tends to impact women more frequently.4
  • Post-inflammatory hyperpigmentation: This type describes spots or patches of discolored skin that develop after some type of skin trauma. These triggers can include an acne breakout, skin wound, irritation, hormonal changes, certain medications, or another skin condition.5 People with medium to dark skin tones may be more susceptible to experiencing post-inflammatory hyperpigmentation due to the amount of melanin present in the skin.6
  • Age spots: Sometimes referred to as liver spots, age spots are flat, dark, smaller marks that typically develop after age 40. You’ll usually notice them on parts of the body that see the most sun, like the face, backs of the hands, shoulders, or forearms. 7 Age spots by themselves are harmless, and they tend to run in families.8

Causes of Hyperpigmentation

Hyperpigmentation is caused by an over-production of melanin, which is the pigment that gives your skin its color. This can happen as a result of several factors.9

Sun exposure prompts an overall darkening of the skin in most skin types. That’s because the sun’s UV rays drive pigment cells to overproduce, which in turn leads to dark spots.10

Hormonal changes, which include hormonal forms of birth control, pregnancy, and menopause, commonly lead to hyperpigmentation. In particular, a fluctuation of female sex hormone levels (estrogen and progesterone) can trigger skin discoloration conditions like melasma.11

Skin trauma or inflammation in any form can also lead to hyperpigmentation. This can include an acne breakout, cut, wound, friction, bug bite, or a skin condition like eczema—which all prompt inflammation. As a result, melanin cells start over-producing, leading to a darker spot after the trauma has healed.12

Stress might trigger skin discoloration by activating cortisol (a stress hormone) levels, according to some research.11 Experts theorize that releasing an excess amount of this hormone can prompt an overdrive of melanin, leading to hyperpigmentation.

Some types of drugs can also lead to hyperpigmentation. These include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), antimalarials, anti-seizure medications, hormonal birth control pills, and medications that increase your skin’s sensitivity to sunlight—like retinoids and some blood pressure medications.1211

Risk Factors

Certain circumstances can make it more likely for some people to develop hyperpigmentation. For example, genetics and having certain health conditions may increase your risk.

Researchers have identified more than 100 genes that are responsible for regulating melanin, which ends up impacting skin color.13 Some studies suggest people who experience melasma often have at least one family member with the same condition.11

A rare condition known as Addison’s disease that impacts the adrenal system has been known to trigger hyperpigmentation by impacting melanin production.14 Plus, some skin conditions like acne, eczema, and psoriasis can also be factors for developing dark spots.5

Treatments for Hyperpigmentation

The most effective treatment for hyperpigmentation depends on the cause of the discoloration.

A healthcare provider can diagnose and treat any root causes of your hyperpigmentation. Before recommending specific treatments, they’ll consider factors like your skin tone, how far the hyperpigmentation has affected the layers of your skin, and any hyperpigmentation triggers or risk factors you may have.15

From there, they may recommend one or a combination of different hyperpigmentation treatment options, including:161715

• OTC topical medications: These products often include ingredients like azelaic acid, kojic acid, glycolic acid, and vitamin C that work to fade dark spots. They may also help slow down the melanin production that’s behind hyperpigmentation. Check with a healthcare provider if you have any questions about the safety or quality of skincare products purchased in drugstores.5
• Prescription topical medications: These ointments are stronger alternatives to the OTC topicals, and are available through a healthcare provider. They should be used exactly as directed since prescription medications have the potential to cause a reaction or sensitivity due to their strength.7 Standard options include:
• Hydroquinone: This works to lighten and even out the skin tone and is commonly used in melasma treatment.
• Retinoids and corticosteroids: These are sometimes used together to help reduce discoloration by targeting inflammation and skin cell turnover.
• Triple combination cream: This topical contains all three ingredients (hydroquinone, retinoid, corticosteroid) to combat discoloration from all angles.
• Chemical peels: This in-office procedure involves removing excess pigment from the skin by applying a layer of a (safe) chemical solution. It can help resurface the overall skin and lighten up any dark patches.
• Microdermabrasion: Another dermatological procedure, microdermabrasion involves using a device to buff off an outer layer of the skin. It can help treat uneven skin tone and also allow other topical medications to absorb into the skin more easily.
• Microneedling: This procedure uses a device with tiny needles to create microscopic wounds in the skin, which helps stimulate collagen production in the skin. As these tiny tears heal, a more even skin tone overall can develop, reducing the look of discoloration.
• Laser and light therapy: This treatment can help improve uneven skin tone. It is important for people to use sun protection and a prescription treatment for their hyperpigmentation after laser therapy. Some temporary side effects, like a short-term darkening of age spots or other discoloration, can happen before results appear.

Depending on the cause of your hyperpigmentation and how severe your case is, some treatment options can take anywhere between three months to one year to show results.15

Preventing Hyperpigmentation

Hyperpigmentation isn’t always completely preventable. But there are a few ways to help manage current dark spots from worsening—and potentially stop new patches from forming.

To start, sun protection is key for all types of hyperpigmentation. Because exposure to the sunlight can cause the skin to produce more pigment, you’ll want to routinely apply sunscreen and consider using sun-blocking clothing if needed to prevent this from happening.15 Some other sun-protective tips include using a hat while outdoors and avoiding direct sunlight during peak hours (generally 10:00 am to 2:00 pm).18

Skin trauma or injury can also lead to hyperpigmentation and acne, so try to limit picking or scratching at any spots, bites, or wounds on your skin. This can prevent dark spots from forming in the first place, and also help any existing hyperpigmentation to fade.5

Skincare Tips for Hyperpigmentation

Identifying the cause of your hyperpigmentation and treating it are solid first steps. Next, experts recommend developing a skincare routine that’s specifically tailored for hyperpigmentation and implementing some other lifestyle habits to support overall skin health. These tips include:19

• Protect your skin from the sun. Even if you already take precautions against sun exposure, adding a tinted sunscreen to your routine can further help protect against visible light for people with hyperpigmentation. This may be particularly helpful for people with dark skin tones.
• Choose gentle products. When selecting skin care products, look for gentle and fragrance-free options. Skin care products that burn or sting when applied can cause skin irritation that may make dark spots worse.
• Use makeup as needed while treatments work. You’re not alone if the appearance of your skin discoloration is bothersome, or impacting your self-esteem.20As hyperpigmentation treatments start working, you might consider using makeup to help reduce the appearance of dark spots.
• Apply your skincare products in an effective order. The way you layer skincare products makes a difference when you’re treating hyperpigmentation. Experts generally recommend applying any OTC or prescribed topical medication first and then following up with sunscreen before applying camouflage makeup (if desired).15
• Maintain a healthy diet. Research shows some skin conditions can be triggered by your diet. While there’s no one-size-fits-all or quick fix when it comes to diet, eating nutrient-rich foods like fruits, veggies, whole grains, and heart-healthy fats that support the whole body’s function may be helpful for your skin health, too.21
• Reduce stressful triggers. Studies have found that stress can prompt skin conditions like acne to develop and flare up. Avoiding unnecessary stress may help manage these conditions and avoid hyperpigmentation.22

When to See a Healthcare Provider

Hyperpigmentation isn’t always simple to treat. Some dark spots may fade on their own over time, while others may be more stubborn and require professional assistance.5

If you’ve tried OTC hyperpigmentation remedies and aren’t seeing any improvement in your dark patches after several weeks, it might be time to check with a healthcare provider. Whether it’s your general practitioner or a dermatologist (a healthcare provider who specializes in treating skin, hair, and nail conditions), they might recommend prescription-strength treatment or in-office medical procedures to help.

Here’s what you might expect at an in-office visit:15

• Questions about your medical history, symptoms, when the dark spots began to develop, and any medications you may be taking
• A skin care examination, where a healthcare provider may use a specialized UV light device known as a Wood’s lamp to look closely at the pigmentation in the top layers of your skin
• A skin biopsy, which involves removing a tiny piece of the affected skin if the hyperpigmentation is suspected to be another skin condition

A Quick Review

Hyperpigmentation describes patches of skin that are darker than the surrounding skin. It happens when melanin (the substance that gives our skin color) is overproduced. Genetics, skin damage, sun exposure, and hormones can impact your skin pigmentation and cause it to darker. Treatment options vary depending on what’s causing your hyperpigmentation, but might include topical medications, chemical peels, laser resurfacing, and sun protection.