Your Complete Guide to Hyperpigmentation (and How to Finally Fix it)
Main image – Dianevilladsen/Stocksy
If you’ve ever experienced dark spots or patches on your skin but you don’t know why or what they are, it could be that your skin is prone to hyperpigmentation. But with so many different types, it can definitely be confusing to know which one you have, and how you can treat it.
Here, I ask GP and aesthetician Dr Ahmed El Muntasar, dermatologist and cosmetic surgeon Dr Nathan Newman, dermatologist Dr Shereene Idriss, and skin experts Nina Prisk and Shawnda Dorantes, to explain once and for all about the different types and causes of hyperpigmentation, as well as the treatments you can try to navigate it a little more smoothly.
Image – adobe
What is hyperpigmentation?
According to Dr Newman, there are four main types of hyperpigmentation.
- Melasma
“Also known as chloasma it is a skin condition characterised by darker skin-coloured patches on your skin,” he says. What does it look like? “These patches are usually brown or grey-brown and appear on the face, particularly on the cheeks, forehead, nose, and upper lip,” he explains.
- PIH (Post Inflammatory Hyperpigmentation)
“PIH can affect any skin type but is more common in olive skin tones,” says Dr Newman. “Left untreated, the discoloration may take months to years to fade.”
- Acanthosis Nigricans
“It is characterised by dark, velvety discolouration and thickening of the skin, usually in body folds such as the neck, armpits and groin,” he says.
- Sunspots
“Also known as solar lentigines, liver spots, or age spots, these are flat, brown spots that appear on sun exposed areas of the skin, such as the face, hands, shoulders, and arms,” Dr Newman explains. “They are more common in older adults and are generally harmless.”
Image – adobe
What causes hyperpigmentation?
Each type of hyperpigmentation has a different cause.
- Hormones
With melasma, it’s hormonal changes. “Melasma is more common in women, especially during pregnancy (also known as “the mask of pregnancy”) or with the use of oral contraceptives, due to hormonal influences,” Dr Newman explains.
Hormonal changes during the menopause can also have an impact, according to Prisk.
- Lifestyle
“Sun exposure can darken these patches as UV light stimulates melanin production, deepening the pigmented patches,” says Dr Newman.
“Failure to wear SPF is another cause, as is exposure to pollution, which can enter the skin and trigger reactions that lead to pigmentation,” according to Prisk. “Skin injury, and certain medications can also be a cause,” she adds.
Dr Newman confirms that damage to the skin to cause PIH. He explains that this type of pigmentation can be triggered by inflammatory episodes, “such as acne, eczema, or an injury, and this is due to increased melanin production as a response to skin inflammation.”
- Health conditions
Dr Newman explains that health conditions can bring on Acanthosis Nigricans. “It’s often associated with insulin resistance, obesity, hormonal disorders, or certain medications,” he explains. “Although it’s generally benign, Acanthosis Nigricans can sometimes signal underlying health issues, particularly metabolic disturbances like diabetes.”
Prisk adds, “Over 100 genes are known to affect skin pigmentation and these, along with hormones, are responsible for regulating the skin’s melanin production.
“Genes can impact the levels of eumelanin or pheomelanin the skin cells produce, as well as how well they function. This can cause a change in skin pigment over time.”
The topical treatments for hyperpigmentation
Image – Irina/adobe
Dr Muntasar says even regular moisturising can help reduce the appearance of hyperpigmentation. “Sometimes little wins like just hydrating the skin, especially with darker skin tones, really helps with brightening up pigmentation,” he says.
There are many ingredients you can introduce into your regime that can help reduce your hyperpigmentation too. “Exfoliating acids like glycolic and lactic acid help clear dead skin cells, while pigment-reducing agents such as alpha arbutin, kojic acid, and tranexamic acid inhibit melanin production for a brighter complexion,” says Dr Idriss.
“Additional ingredients like niacinamide, liquorice root, and vitamin C further enhance radiance and reduce dark spots,” she adds. “Retinol promotes skin renewal, making the treatment even more effective, and azelaic acid also helps with pigmentation.”
Other beneficial ingredients include:
- Peptides
- Ceramides
- Hydroquinone
- Corticosteroids
- Arbutin
These ingredients are also beneficial for when you’re preparing for a professional treatment too. “They help prevent further pigmentation and reduce the risk of post-inflammatory hyperpigmentation (PIH), which can occur after in-office procedures, especially in darker skin tones,” explains Dorantes.
“A well-prepped skin barrier helps reduce the likelihood of worsening pigmentation or scarring during laser or microneedling treatments.” Keep reading to learn more…
In office treatments for hyperpigmentation
Image – Studiofirma/Stocksy
Lasers
Best for Melasma: “There are actually a few lasers than can help, [but] it really depends on where the pigment is,” Dr Muntasar says. “Sometimes some of them are ablative and some of them are non-ablative lasers, again, depending on the sensitivity of the skin, the extent of the hyperpigmentation and where it is on the skin.”
“Fractional CO2 and picosecond lasers are top-notch,” adds Dorantes. “They target pigment deep within the skin without damaging the surface, breaking it up into smaller particles that your body can naturally eliminate. The Nd: YAG laser is another great option, especially for darker skin tones, as it targets deeper layers without causing further irritation.”
Just don’t expect lasers to do all the work though, says Dr Idriss. “Getting a laser treatment without a proper skincare routine is like getting a dental cleaning without brushing your teeth every day. It’s useless!”
IPL (Intense Pulsed Light)
Best for sunspots: “This can be effective in treating hyperpigmentation, especially for conditions like sunspots and hyperpigmentation,” explains Dorantes. “It works by emitting broad-spectrum light that targets and breaks down excess pigment in the skin, which is then gradually eliminated by the body.” However, it’s not suitable for all skin types.
“It should be avoided on darker skin tones (Fitzpatrick skin types IV–VI) because the higher melanin content in these skin types can absorb too much light energy, increasing the risk of burns or worsening pigmentation,” she warns.
“Additionally, IPL is not recommended for treating melasma, as it can potentially exacerbate the condition.”
Another word of caution about using IPL for hyperpigmentation from Dr Idriss: “Although you might think you’re noticing benefits in the first three months post-treatment, your skin and melasma may rebound worse, making it harder to treat in the long run.”
The message? Make sure to get the advice of a recommended aesthetician or dermatologist before embarking on IPL for pigmentation issues.
Microneedling
Best for PIH and Acanthosis Nigricans: “For superficial hyperpigmentation, if you use shallow micro needling, it can reduce the activity of melanocytes so it can help with the dark marks,” says Dr Muntasar.
“Microneedling works for hyperpigmentation by creating controlled micro-injuries in the skin using tiny, fine needles,” adds Dr Idriss.
“These micro-injuries stimulate the skin’s natural healing process, promoting collagen production and accelerating cell turnover. As the skin heals, new, healthier skin cells replace older, pigmented cells, gradually reducing the appearance of dark spots.”
Image – Adobe
Chemical peels
Best for a bit of everything, according to Dorantes:
- “Glycolic Acid Peels (AHA Peels) – Melasma, PIH, Sunspots, and general skin texture.
- Salicylic Acid Peels (BHA Peels) – PIH, acne-related hyperpigmentation, and sunspots.
- Lactic Acid Peels – Sensitive skin with mild hyperpigmentation, and sunspots.
- TCA Peels (Trichloroacetic Acid) – Moderate to severe hyperpigmentation, including melasma and PIH.
- Retinoid Peels (Retinol/Retinoic Acid Peels) – Acanthosis nigricans, PIH, and overall skin renewal.
- And peels such as the Perfect Derma Peel, Vi Peel, and ZO Skin Health 3 Step Peel have a combination of the above ingredients.”
“Chemical peels work for hyperpigmentation by applying acids that exfoliate the skin’s surface layers, removing dead skin cells and promoting the shedding of pigmented cells,” Dr Idriss explains.
“Peels typically contain alpha hydroxy acids (AHAs) like glycolic or lactic acid, beta hydroxy acids (BHAs) like salicylic acid, or trichloroacetic acid (TCA). These acids dissolve the bonds between skin cells, allowing the top layer to slough off, which helps lighten dark spots over time. Additionally, peels stimulate collagen production and accelerate cell turnover, revealing fresher, more even-toned skin underneath.”
Microdermabrasion
Best for sunspots: Whilst some practitioners recommend this, Dr Muntasar says he’s not the biggest fan. “Because it means physically scuffing off the top layer of skin,” he says. “So first, darker skin tones can actually cause post inflammatory hyperpigmentation (PIH) and that could be very difficult to treat.”
However, Dorantes says it would be a better option for surface-level hyperpigmentation. “It gently exfoliates the top layer of skin, revealing a brighter complexion and improving the absorption of lightening products,” she explains.
“Microdermabrasion doesn’t directly target pigment, but it can significantly improve skin texture and tone.”
How long does it take to get rid of hyperpigmentation?
Image – Audshule
PIH: “You can often see improvement within 2-3 months, with initial results appearing after 4-6 weeks of treatment,” says Dorantes.
Melasma: “This can be a bit trickier,” she warns. “Consistent treatment is key, and noticeable improvement may take several months.”
Sunspots: “Usually, 2-4 treatments are enough to see a significant reduction in pigmentation within 4-6 weeks.”
Acanthosis Nigricans: “Addressing underlying health issues is crucial,” Dorantes says. “Improvement can take anywhere from 3 to 6 months with consistent treatment.”
How to prevent your hyperpigmentation coming back
Dr Muntasar says that applying regular sunscreen is key. “To prevent it coming back, obviously SPF all year round is quite important,” he says.
“The reality is, if you don’t wear sunscreen in your early years, the damage is done before your 20s,” adds Dr Idriss. “You will see this sun damage creep up as you get older, which is why incorporating a maintenance routine is the best thing you can do for yourself.
So, sunscreen but also consistency post-treatment, says Dr Muntasar. “Once you’ve had your treatment, don’t just stop [treating it],” he says.
“You can drop down to weaker ingredients, like from tretinoin into a strong retinol, for example, or reducing the use of tretinoin to multiple times a week, rather than every night, so you can gradually come off it, rather than just stop it and think that you’re good to go.”
The takeaway
The four main types of hyperpigmentation are melasma, post-inflammatory hyperpigmentation (PIH), Acanthosis Nigricans and sunspots, all of which have different causes.
There are highly beneficial topical ingredients you can try at home such as, glycolic acid, azelaic acid and retinol, whilst higher end, in-office treatments include IPL, microneedling and chemical peels.
Don’t expect your hyperpigmentation to disappear quickly after treating it as it takes time for any treatment to work, particularly for melasma. But remember, keep going with applying the right products in between treatments to stay on top of keeping pigmented areas at bay.
Meet the experts
Dr Ahmed El Muntasar is a GP and award-winning aesthetician.
Dr Nathan Newman is a board-certified dermatologist and cosmetic surgeon.
Dr Shereene Idriss is board certified dermatologist and founder of Idriss Dermatology and Dr Idriss Skincare.
Nina Prisk is a Harley Street skin expert, aesthetics nurse and independent prescriber. She is the owner of Update Aesthetics Cosmetic Clinics in the UK.
Shawnda Dorantes, MSN, APRN, FNP-C, is founder of Beauty Lounge Medical Spa in California.
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