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Oct 07, 2021
7 min read

Hyperpigmentation: what is it, causes, and how to get rid of it

Hyperpigmentation is a term for spots or patches of skin that are darker than their surrounding areas. This includes freckles and age spots, as well as more pronounced or problematic skin conditions. Most forms of hyperpigmentation are harmless, and some resolve on their own. There are effective treatments for the different types of hyperpigmentation.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Pigment is another word for color. It’s also the term that experts use to describe the tone or complexion of a person’s skin.

Hyperpigmentation happens when an area of skin becomes darker than the skin surrounding it, thanks to an oversupply of skin pigment. This oversupply can cause the formation of skin spots, patches, or other discolorations.

For example, if you have freckles or age spots, then you have a type of hyperpigmentation. And while freckles and age spots are two of the more common types of hyperpigmentation, there are many more—with some skin tones being more likely than others to develop these dark patches (Atef, 2019). 

There are also triggers and risk factors that increase your risk for hyperpigmentation, as well as some effective treatments if you do develop it at some point (Lawrence, 2021).

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What is hyperpigmentation?

Your skin contains melanocytes, which are specialized cells that produce pigment (Tang, 2021). 

Hyperpigmentation happens when there are more melanocytes than usual in a particular area of skin or if these melanocytes become unusually active. Genetic and environmental factors can contribute to your risk for hyperpigmentation (more on that below) (Atef, 2019).

Types of hyperpigmentation

There are a handful of types of hyperpigmentation. Some are more common than others. These include:

Ephelides (freckles)

These small spots are usually light brown or red. They are genetic and more common among people with fairer skin types, including those of Caucasian or Asian descent. They often show up when a person is very young—two or three years old—and they tend to increase during adolescence. In some cases, they may fade during adulthood. 

Freckles often become a bit darker when exposed to sunlight, and they’re commonly found on a person’s face, arms, neck, and chest. People may have a handful or many hundreds of them (Praetorius, 2014). 

Solar lentigines (age spots or liver spots)

These are larger dark spots that are more likely to show up after age 50. Unlike freckles, which stem mostly from genetic factors, lentigines form in sun-exposed and sun-damaged skin. 

Like freckles, lentigines are more common among people with fairer skin types. People who have one often have several, and they tend to show up on sun-exposed parts of the skin—such as the face, backs of hands, and arms (Nouveau, 2016). 

Postinflammatory hyperpigmentation

These are darker spots or patches of skin that usually form in response to some kind of inflammation or injury. For example, acne and eczema are common postinflammatory hyperpigmentation (PIH) triggers. Bug bites, sunburns, and many different types of skin infections or allergic reactions can also cause PIH (Nouveau, 2016).

Unlike freckles and sunspots, which tend to be more common among people with lighter skin types, PIH is more common among people with darker skin types (Lawrence, 2021). In some populations, more than 70% of people who develop acne will also develop PIH (Nouveau, 2016). 

PIH often fades away. But this can take months or years. If the triggering event lasts a long time—for example, if you had acne for several years—then PIH also tends to stick around longer (Nouveau, 2016). The darker a person’s skin, the more intense and persistent the PIH tends to be (Lawrence, 2021). 

Melasma

Melasma (also sometimes called chloasma) is brown or blue-gray patches or spots that tend to show up on a person’s face—most commonly the forehead, nose, and upper lip (Ogbechie-Godec, 2017). 

Experts aren’t quite sure why melasma forms, although they think it has a close link to a mixture of sun damage and hormonal factors. It’s much more common among women than men, and people with darker skin types are also more likely to develop it.

According to some estimates, melasma tends to show up first around age 20 or 30 (Ogbechie-Godec, 2017).

 Periorbital hyperpigmentation

This is a darkening of the skin around a person’s eyes. It’s especially common among people of Asian descent. It tends to result from genetic factors, although different types of skin inflammation or injury—including sun exposure—may contribute to its development (Nouveau, 2016).

It’s more common among women than men, and it often first appears between the ages of 16 and 25. It’s harmless, but it can cause people distress or worsen their quality of life due to cosmetic factors (Sarkar, 2018).

Causes and risk factors of hyperpigmentation

Your age, skin color, and gender assigned at birth can all increase your risk for one or more forms of hyperpigmentation.

Family history—a.k.a., your genes—often matters. For example, about 30% of people who develop melasma have a family history of the condition. Meanwhile, 60% to 80% of people who develop sunspots or freckles have a family history of these types of hyperpigmentation (Atef, 2019). 

For most kinds of skin hyperpigmentation, sun exposure is also a risk factor. That’s because the sun’s ultraviolet rays damage skin cells and their melanocytes in ways that can both trigger and worsen the appearance of hyperpigmentations (Nouveau, 2016). 

When it comes to postinflammatory hyperpigmentation (PIH), acne, skin infections, and pretty much any other cause of inflammation or injury can trigger the condition (Lawrence, 2021). 

Research has also found that some drugs—including anti-inflammatories and medications for hypertension—may increase your risk for hyperpigmentation (Giménez García, 2019). 

Diagnosing and treating hyperpigmentation

Dermatologists are doctors who specialize in skin conditions and disorders, and they tend to be the ones who diagnose and treat hyperpigmentation-related skin disorders or complaints.

In some cases, they may require specialized equipment—such as a Wood’s lamp (ultraviolet lamp)—in order to make a hyperpigmentation diagnosis. Blood tests and skin biopsies can also help them determine the underlying causes of hyperpigmentation (Sheth, 2014).

Once they make a diagnosis, healthcare providers have a few treatment options at their disposal. There’s some evidence that the various treatment options for hyperpigmentation may be effective, but follow-up research is needed.

These treatments include:

Sunscreen

Sun exposure tends to darken freckles, sunspots, and melasma. It can also extend or worsen PIH and other forms of hyperpigmentation. For this reason, the daily use of a high-SPF, broad-spectrum sunscreen is one of the first-line treatments to help improve the appearance of these skin conditions (Lawrence, 2021; Sarkar, 2018).

Topical lightening agents

Some chemical creams, gels, or other topical agents can help lighten the areas of the skin affected by hyperpigmentation (Nautiyal, 2021). 

The mainstay of these is hydroquinone, which is sold in both OTC (usually 2% strength) or higher prescription-only concentrations (usually 4%). Hydroquinone blocks the synthesis of melanin, which is the natural pigment in your skin (Schwartz, 2021). 

Hydroquinone is sometimes combined with other chemicals, such as a topical retinoid, which can help reduce inflammation or irritation caused by hydroquinone. (These topical retinoids can also combat acne, which contributes to PIH.) Examples of topical retinoids are tretinoin, adapalene, and tazarotene (Nautiyal, 2021; Lawrence, 2021). Other lightening agents include kojic acid and glycolic acid (Nautiyal, 2021). 

Lightening creams can be effective for freckles and sunspots. They’re often prescribed to treat melasma, periorbital hyperpigmentation, and PIH (Schwartz, 2021). 

Chemical peels

Also known as “chemical exfoliation,” chemical peels actually strip away or destroy the outermost layers of skin cells that contain the excess skin pigment (Lawrence, 2021). These are usually a second-line treatment for hyperpigmentation because they come with potential side effects, such as skin burning, blistering, lasting damage, as well as infection (Nautiyal, 2021).

There are different types of chemical peels. Some penetrate more deeply than others. While there are some at-home peels, most require professional application—usually by a dermatologist or clinician. They can treat a range of hyperpigmentation conditions, from freckles and melasma to periorbital hyperpigmentation and PIH (Samargandy, 2021). 

Laser therapy

There are many different laser treatments for hyperpigmentation. While some block the activity of pigment-producing cells, others remove the topmost layer of the skin, similar to a chemical peel. Some do both (Nautiyal, 2021). 

There’s evidence that several forms of laser therapy may provide benefits. Intense pulsed light (IPL) therapy is one of the more commonly used and evidence-backed types. But, like chemical peels, laser therapy can cause skin damage and other side-effects, so it’s usually considered a second-line therapy (Nautiyal, 2021).

 Other treatments for hyperpigmentation

There are some other treatments that may be options for some people with hyperpigmentation. But these are not as common—either because their benefits are in doubt, or because they often come with a greater risk of side effects. 

These treatments include oral drug treatments, new forms of laser therapy, and a number of topical treatments that use nano (very small) agents to improve the appearance of hyperpigmentations (Nautiyal, 2021). 

Prevention of hyperpigmentation

For all of the different types of hyperpigmentation, prevention means avoiding risk factors that are within someone’s control. Again, limiting sun exposure or protecting skin with broad-spectrum sunscreen can offer protection against sunspots and PIH, and to a lesser extent, freckles, melasma, and other forms of hyperpigmentation (Lawrence, 2021). 

Meanwhile, getting prompt treatment for skin conditions—such as acne or eczema—can prevent the kind of damage or inflammation that contributes to some forms of hyperpigmentation, such as PIH (Lawrence, 2021).

Hyperpigmentation is common and often treatable. If you’re not happy with the appearance of your skin, a dermatologist can help you identify the underlying causes or factors, as well as the best treatments. 

References

  1. Atef, A., El-Rashidy, M. A., Abdel Azeem, A., & Kabel, A. M. (2019). The Role of Stem Cell Factor in Hyperpigmented Skin Lesions. Asian Pacific journal of cancer prevention : APJCP, 20(12), 3723–3728. doi: 10.31557/APJCP.2019.20.12.3723. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173358/
  2. Giménez García, R. M., & Carrasco Molina, S. (2019). Drug-Induced Hyperpigmentation: Review and Case Series. Journal of the American Board of Family Medicine : JABFM, 32(4), 628–638. doi: 10.3122/jabfm.2019.04.180212. Retrieved from https://www.jabfm.org/content/32/4/628.abstract
  3. Kanlayavattanakul, M., & Lourith, N. (2018). Skin hyperpigmentation treatment using herbs: A review of clinical evidences. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 20(2), 123–131. doi: 10.1080/14764172.2017.1368666. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/14764172.2017.1368666
  4. Lawrence, E., & Al Aboud, K. M. (2021). Postinflammatory Hyperpigmentation. [Updated Aug 7, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559150/
  5. Nautiyal, A., & Wairkar, S. (2021). Management of hyperpigmentation: Current treatments and emerging therapies. Pigment cell & melanoma research. doi: 10.1111/pcmr.12986. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33998768/
  6. Nouveau, S., Agrawal, D., Kohli, M., Bernerd, F., Misra, N., & Nayak, C. S. (2016). Skin Hyperpigmentation in Indian Population: Insights and Best Practice. Indian journal of dermatology, 61(5), 487–495. doi: 10.4103/0019-5154.190103. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029232/
  7. Ogbechie-Godec, O. A., & Elbuluk, N. (2017). Melasma: an Up-to-Date Comprehensive Review. Dermatology and therapy, 7(3), 305–318. doi: 10.1007/s13555-017-0194-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28726212/
  8. Praetorius, C., Sturm, R. A., & Steingrimsson, E. (2014). Sun-induced freckling: ephelides and solar lentigines. Pigment cell & melanoma research, 27(3), 339–350. doi: 10.1111/pcmr.12232. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24517859/
  9. Samargandy, S., & Raggio, B. S. (2021). Skin Resurfacing Chemical Peels. [Updated Jul 25, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547752/
  10. Sarkar, R., & Das, A. (2018). Periorbital Hyperpigmentation: What Lies Beneath?. Indian dermatology online journal, 9(4), 229–230. doi: 10.4103/idoj.IDOJ_303_17. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042190/
  11. Schwartz, C., Jan, A., & Zito, P. M. (2021). Hydroquinone. [Updated May 10, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539693/
  12. Sheth, P. B., Shah, H. A., & Dave, J. N. (2014). Periorbital hyperpigmentation: a study of its prevalence, common causative factors and its association with personal habits and other disorders. Indian journal of dermatology, 59(2), 151–157. doi: 10.4103/0019-5154.127675. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969674/
  13. Tang, J., Fewings, E., Chang, D., Zeng, H., Liu, S., Jorapur, A., et al. (2020). The genomic landscapes of individual melanocytes from human skin. Nature, 586(7830), 600–605. doi: 10.1038/s41586-020-2785-8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581540/