Hyperpigmentation

What is hyperpigmentation?

Hyperpigmentation is a common condition that makes some areas of your skin darker than others. “Hyper” means “more,” and “pigment” means “color.”

Hyperpigmentation can appear as the following colors:

• Brown
• Black
• Gray
• Red
• Pink

They may be spots or patches. Healthcare providers sometimes call them:

• Age spots
• Sun spots
• Liver spots

The spots can occur in just one area of your body or all over. Hyperpigmentation can affect people of any race or ethnicity.

Your skin is one of the first things you see when you look in a mirror. So it can be difficult when your skin changes color. A healthcare provider can help diagnose what’s going on and offer solutions for managing hyperpigmentation.

What causes hyperpigmentation?

Skin gets its color from a substance called melanin. Your skin cells make melanin. When those skin cells are damaged or unhealthy, they can produce too much melanin. The melanin can clump together, causing that area to appear darker than the skin around it

Many things can lead to hyperpigmentation:

• Adrenal disorders, like Addison’s disease
• Genetics (for example, your biological family may have a lot of freckles)
• Hormone changes, like during puberty or pregnancy
• Injury to your skin (for example, acne, cuts or burns), which providers may call post-inflammatory hyperpigmentation
• Medications, like oral contraceptives (birth control pills) and medications that cause skin sensitivity to light (photosensitivity)
• Melasma
• Not getting enough of certain vitamins, like B12 and folic acid
• Sun damage (providers call these spots solar lentigines)
• Thyroid disorders

Does hyperpigmentation cause any symptoms?

Other than dark spots, hyperpigmentation doesn’t cause any symptoms. If you have spots on your skin with any other symptoms, talk to your primary care provider or a dermatologist (skin doctor).

How is hyperpigmentation diagnosed?

To diagnose hyperpigmentation, a healthcare provider may:

• Ask you about your medical history, including when the darkened skin started and what medications you’re taking
• Do a physical exam to look at your skin
• Examine your skin under a special ultraviolet light, called a Wood lamp
• Recommend blood tests to check vitamins, hormones and iron, as well as thyroid function
• Take a small sample of your skin for a biopsy, which tests for any abnormal skin cells

How is hyperpigmentation treated?

Depending on the reasons for hyperpigmentation, your healthcare provider may suggest some changes, like:

• Avoiding sun damage by staying out of the sun, using sunscreen and wearing protective clothing
• Stopping any medications that may be causing it
• Taking vitamins

Creams for hyperpigmentation

Your healthcare provider may also recommend prescription or over-the-counter topical therapy. These are creams or ointments you put on your skin, like:

• Azelaic acid
• Corticosteroids
• Glycolic acid (alpha-hydroxy acid)
• Hydroquinone
• Kojic acid, a chemical that can reduce the amount of melanin your body produces
• Salicylic acid
• Tretinoin
• Vitamin C or B3 (niacinamide)

Procedures for hyperpigmentation

Other treatments may include:

• Chemical peels
• Cryotherapy
• Laser skin resurfacing
• Pigmented lesion laser treatment

How can I prevent hyperpigmentation?

You can’t always prevent hyperpigmentation. But protecting your skin from the sun helps. Follow these steps:

• Apply sunscreen every day. Choose one that’s “broad spectrum” (blocks ultraviolet rays, UVA and UVB) with an SPF of 30 or higher.
• Avoid too much sun exposure.
• Use physical blockers, like titanium dioxide or zinc oxide.
• Wear protective clothing and hats.

Does hyperpigmentation ever go away?

Hyperpigmentation is a lifelong condition. Treatments can help clear some dark spots and lessen others. But they might take a few months or a year to work. And other spots can appear over time, especially if you have ongoing sun damage.

How can I cope with age spots, sun spots, liver spots and other forms of hyperpigmentation?

The appearance of hyperpigmentation can make you feel self-conscious. The following strategies may help:

• Be patient with any treatments you’re trying, as they can take months to show improvement.
• Don’t pick at any skin conditions, like pimples.
• Reach out to others with hyperpigmentation through support groups or online chats.
• Realize that many people have hyperpigmentation and other skin differences. You’re not alone.
• Take care of your skin by washing, exfoliating and moisturizing regularly to help it be as healthy as possible.

Should I ever seek medical care for hyperpigmentation?

You should see a healthcare provider, like a dermatologist, if your skin is:

• Red
• Hot to the touch
• Itchy
• Painful
• Leaking blood, pus or any other fluids