Understanding Hyperpigmentation: Causes, Types, and Treatments

If you’ve noticed dark spots or patches on your skin, it might be due to hyperpigmentation. The variety of types can make it challenging to identify and treat.

Seeking insights from professionals like 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 can shed light on the causes and types of hyperpigmentation, as well as effective treatment options.

Understanding Hyperpigmentation

In the realm of skincare, Dr. Newman identifies four primary types of hyperpigmentation.

Referred to as chloasma, this skin condition manifests as darker patches on the skin, typically in brown or grey-brown hues, primarily on the face—specifically on the cheeks, forehead, nose, and upper lip,” he clarifies. 

“PIH can impact all skin types but is more prevalent in olive skin tones,” notes Dr. Newman. The untreated discoloration may persist for months to years.”

This type is characterized by dark, velvety discoloration and thickened skin, commonly occurring in body creases like the neck, armpits, and groin,” he elaborates.

Also identified as solar lentigines, liver spots, or age spots, these flat, brown spots emerge on sun-exposed skin areas like the face, hands, shoulders, and arms,” Dr. Newman details. “Typically found in older adults, these spots are generally benign.”

What leads to hyperpigmentation?

The causes of hyperpigmentation vary depending on the type.

For melasma, hormonal changes play a significant role. Women, particularly during pregnancy or when using oral contraceptives, are more prone to melasma due to hormonal shifts, as explained by Dr. Newman.

Similarly, hormonal fluctuations during menopause can also contribute to hyperpigmentation, according to Prisk.

Exposure to sunlight can exacerbate these dark patches by triggering melanin production through UV exposure, intensifying pigmentation, notes Dr. Newman.

Not wearing sunscreen, pollution exposure, skin damage, and certain medications are listed as additional causes, Prisk. Skin injury, inflammatory conditions like acne or eczema, and skin damage can also result in post-inflammatory hyperpigmentation (PIH) due to increased melanin production in response to skin inflammation, explains Dr. Newman.

Understanding Acanthosis Nigricans and Skin Pigmentation

Dr Newman explains that various health conditions can trigger Acanthosis Nigricans. Factors such as insulin resistance, obesity, hormonal disorders, or specific medications can be linked to this condition,” he elaborates. “While generally harmless, Acanthosis Nigricans may indicate underlying health concerns, particularly pertaining to metabolic imbalances like diabetes.”

Genetic Influence on Skin Pigmentation

Prisk adds, “More than 100 genes play a role in determining skin pigmentation, in conjunction with hormonal activity, regulating the melanin production in the skin.”

“These genes influence the levels of eumelanin or pheomelanin produced by skin cells, as well as their functionality, ultimately affecting changes in skin coloration over time.”

The best treatments for hyperpigmentation

Dr. Muntasar suggests that even regular moisturizing can be beneficial in reducing hyperpigmentation. Hydrating the skin, especially for darker skin tones, can make a significant difference in brightening pigmentation,” he explains.

Introducing specific ingredients into your skincare routine can also help diminish hyperpigmentation. “Exfoliating acids like glycolic acid and lactic acid can eliminate dead skin cells, while ingredients like alpha arbutin, kojic acid, and tranexamic acid work to reduce melanin production, resulting in a more radiant complexion,” according to Dr. Idriss.

Enhancing Radiance and Reducing Dark Spots

According to experts,  products contain additional ingredients like niacinamide, liquorice root, and vitamin C, which not only enhance radiance but also assist in reducing dark spots. The inclusion of retinol in these products promotes skin renewal, increasing the treatment’s effectiveness. Moreover, azelaic acid found in products also aids in addressing pigmentation concerns.

Other Beneficial Ingredients

These ingredients in products are not only useful for daily skincare routines but also prove beneficial when preparing for professional treatments. They play a crucial role in preventing further pigmentation issues and reducing the risk of post-inflammatory hyperpigmentation (PIH) that might occur after in-office procedures, especially in individuals with darker skin tones. Maintaining a well-prepped skin barrier is essential to minimize the chances of exacerbating pigmentation or scarring during laser or microneedling treatments.

In-office Solutions for Hyperpigmentation

Lasers

Best Treatment for Melasma:Various lasers can effectively address melasma, depending on the location and severity of the pigmentation, explains Dr. Muntasar. Options include both ablative and non-ablative lasers, tailored to individual skin sensitivity and hyperpigmentation extent.

Dr. Dorantes recommends fractional CO2 and picosecond lasers for deep pigmentation targeting, breaking it down for natural elimination without surface damage. The Nd: YAG laser is also a suitable choice, particularly for darker skin tones, effectively reaching deeper skin layers without causing irritation.

However, Dr. Idriss emphasizes the importance of complementing laser treatments with a proper skincare regimen. Utilizing lasers without consistent daily skincare is akin to undergoing dental cleaning without regular teeth brushing—ineffective!

IPL (Intense Pulsed Light)

Optimal for sunspots: According to Dorantes, IPLEveryone’s Talking About *That* Laneige Lip Glowy Balm can effectively address hyperpigmentation concerns, especially sunspots and hyperpigmentation by emitting broad-spectrum light targeting and breaking down excess pigment in the skin, gradually eliminating it from the body. However, caution is advised as it may not be suitable for all skin types.

It is recommended to avoid IPL treatment on darker skin tones (Fitzpatrick skin types IV–VI) due to the higher melanin content, which can lead to excessive light absorption, increasing the risk of burns or exacerbating pigmentation issues,” she stresses. Moreover, IPL may not be suitable for treating melasma as it could potentially worsen the condition.

Dr Idriss also warns that while initial improvements may be seen in the first three months post-treatment, there is a risk of skin rebounding worse, complicating long-term treatment efforts.

It is crucial to seek advice from a trusted aesthetician or dermatologist before considering IPL for addressing pigmentation concerns.

Microneedling

Effective for Post-Inflammatory Hyperpigmentation and Acanthosis Nigricans: “Utilizing shallow microneedling can be beneficial for addressing superficial hyperpigmentation as it can diminish melanocytes’ activity, helping to fade dark marks,” stated Dr. Muntasar.

“Microneedling targets hyperpigmentation by introducing controlled micro-injuries with small, fine needles,” noted Dr. Idriss.

“These micro-injuries trigger the skin’s natural healing response, stimulating collagen production, and expediting cell regeneration. As the skin repairs itself, new, healthier skin cells replace older, pigmented cells, gradually diminishing the presence of dark spots.”

Chemical Peels

Recommended for Various Skin Concerns:

According to Dorantes, chemical peels are effective for treating hyperpigmentation by utilizing acids that remove dead skin cells and encourage the shedding of pigmented cells,” Dr Idriss clarifies.

These peels often contain alpha hydroxy acids (AHAs) such as glycolic or lactic acid, beta hydroxy acids (BHAs) like salicylic acid, or trichloroacetic acid (TCA). These acids break down the bonds between skin cells, allowing the outer layer to slough off, leading to the gradual lightening of dark spots. Furthermore, chemical peels boost collagen production, enhance cell regeneration, and reveal smoother, more even skin over time.

Microdermabrasion

Effective for sunspots: Despite some recommendations, Dr. Muntasar is hesitant about advocating for microdermabrasion. He points out that it involves physically removing the top layer of skin, which may lead to post-inflammatory hyperpigmentation (PIH) in individuals with darker skin tones, making treatment challenging.

On the other hand, Dorantes sees potential benefits for surface-level hyperpigmentation. She notes that it gently exfoliates the skin’s upper layer, unveiling a more radiant complexion and enhancing the effectiveness of lightening products.

While microdermabrasion may not directly address pigmentation, it can notably enhance skin texture and overall tone.

How long does it take to eliminate hyperpigmentation?

Post-Inflammatory Hyperpigmentation (PIH): Results can start showing within 2-3 months, with initial improvements seen after 4-6 weeks of using products.

Melasma: This condition may require more time,” she advises. “Consistent use of products is essential, and noticeable changes might take several months to be visible.”

Sunspots: Typically, 2-4 treatments could lead to a significant decrease in pigmentation within 4-6 weeks when using products.

Acanthosis Nigricans: “Dealing with underlying health conditions is crucial,” Dorantes explains. “Improvement may take between 3 to 6 months with consistent use of products.”

Preventing Recurrence of Hyperpigmentation With SPF

Dr Muntasar emphasizes the importance of regular sunscreen application to prevent hyperpigmentation reappearance. “To avoid its return, using SPF throughout the year is crucial,” he advises.

“If you neglect sunscreen in your youth, the damage is already done by your 20s,” notes Dr Idriss. “The effects of sun damage become more apparent with age, underscoring the significance of establishing a consistent maintenance routine.”

In addition to sunscreen, maintaining a post-treatment regimen consistently is essential, according to Dr Muntasar. “After undergoing treatment, it’s crucial not to abruptly discontinue it,” he advises.

Transitioning to milder products, such as switching from tretinoin to a potent retinol or reducing the frequency of tretinoin application to a few times a week instead of nightly, allows for a gradual weaning off process rather than sudden cessation,” he explains.

Key Points to Remember

There are four primary types of hyperpigmentation, including melasma, post-inflammatory hyperpigmentation (PIH), Acanthosis Nigricans, and sunspots, each with distinct underlying causes.

Effective topical ingredients like glycolic acid, azelaic acid, and retinol can be used at home, while more advanced in-office treatments such as IPL, microneedling, and chemical peels are also available.

Results from treatments may not be immediate, especially for melasma, as patience is required for visible improvements. Consistent use of the right products between treatments is crucial for maintaining control over pigmented areas.

Our Esteemed Experts

Dr Ahmed El Muntasar, an accomplished GP and renowned aesthetician, brings a wealth of expertise to our team. 

Dr Nathan Newman, a skilled dermatologist and cosmetic surgeon with board certification, enhances our team with his expertise. 

Dr Shereene Idriss, a board-certified dermatologist and the visionary behind Idriss Dermatology and Dr Idriss Skincare, adds tremendous value to our team.

Nina Prisk , a respected Harley Street skin specialist and aesthetics nurse with prescriptive authority, leads our team with her expertise as the owner of Update Aesthetics Cosmetic Clinics in the UK.