Ask a Dermatologist: How Can I Treat Hyperpigmentation?

woman applying skincare to cheeks

Stocksy/Design by Cristina Cianci

Hyperpigmentation is one of those annoying skincare concerns that seem to pop up out of nowhere—it's as though you just wake up one morning and right there across your forehead, cheeks, or chin is a smattering of brown-tinged patches that continue to taunt you every time you get even remotely close to a mirror.

But if you think these spots will disappear as effortlessly as they seemed to materialize, get ready for a rude awakening: Hyperpigmentation treatment is going to take a little bit of effort. While some types of hyperpigmentation, like the sort that comes after you've popped a rather big pimple, will slowly fade, this can still take months. And there are other types (like the kind produced by UV exposure) that will take a little coaxing for it ever to fade.

This topic is one that is definitely best discussed with experts, so we turned to dermatologists Anita Sturnham, GP, Rachel Nazarian, MD, and Scott Wells, MD, who walked us through the options. Keep reading for what they had to say.

Meet the Expert

  • Anita Sturnham is a general practitioner and the founder of Nuriss Skincare & Wellness Clinics.
  • Rachel Nazarian, MD, is a board-certified dermatologist specializing in cosmetic treatments, skin cancer, and dermatologic surgery.
  • Dr. Scott Wells, MD, is a New York-based plastic surgeon and skincare expert with a focus on facial rejuvenation. He has more than 20 years of professional experience.


What Is Hyperpigmentation?

"Hyperpigmentation is a common skin condition that can affect all skin types and all ages," explains Sturnham. If you have it, you'll start to notice patches on the skin that don't seem to match your normal skin color. It'll often show up as brown patches, not too dissimilar to large freckles. There are two classifications, Sturnham adds, "localized or diffuse, meaning it appears in small patches on the skin or as a larger area of altered pigmentation."

What Causes Hyperpigmentation?

"Most cases of diffuse hyperpigmentation are caused by systemic conditions," reveals Sturnham. These conditions can include Addison's disease, hyperthyroidism, or hemochromatosis. Diffuse hyperpigmentation may also occur because of a medication side effect.

On the other hand, localized hyperpigmentation tends to represent a direct injury or inflammation to the skin, and is the more common type seen in dermatology clinics. "Anything that causes inflammation in the skin can potentially send a signal to our melanocytes, the cells that produce brown melanin pigment as part of an immune response," she explains. "This inflammation can be caused by UV damage, acne spots and breakouts, harsh chemicals on the skin, and even hormonal fluctuations, such as those in pregnancy or when taking the contraceptive pill."

Are Some People More Susceptible to Hyperpigmentation Than Others?

Unfortunately, the answer is yes. "Melanocyte instability is the main reason we develop hyperpigmentation. These pigment-producing cells that live at the dermo-epidermal junction and basal layers of our skin can become hyperactive if triggered and start overproducing melanin, leading to hyperpigmentation and sunspots," Sturnham breaks it down for us. "The more baseline melanin you have in your skin (i.e., the darker your skin tone), the more risk you have of developing hyperpigmentation in the first place."

Can You Avoid Getting Hyperpigmentation?

As with most skincare concerns, prevention is better than cure. First up: Nip any potential problem areas in the bud by caring for wounds as soon as they appear. “Wound care is important because areas of healing, such as a scratched bug bite or a picked pimple, are prone to infection and inflammation—making hyperpigmentation of the skin more likely,” says Nazarian. “That also means cleaning the skin with a gentle cleanser and not picking at the leftovers (scabs or old pimple scars) or scrubbing with a harsh cleanser.”

You'll definitely want to make sure you're taking proper sun care precautions (regardless of whether or not you have any recent wounds). “Sun exposure is one of the most controllable factors," says Wells. "Patients prone to hyperpigmentation must avoid direct exposure, wear hats and other occlusive clothing, and always wear a sunblock of SPF 30 or higher. My overall favorite types of sunblock are mineral blocks containing micronized zinc and titanium dioxides”

Sturnham also suggests you avoid retinol during the day—as UV rays destabilize skincare ingredients and increase your risk of photosensitivity—and use skincare that includes pigment-stabilizing ingredients, so they'll be less likely to overproduce melanin and leave you with pigment spots (whether the trigger is UV damage, hormones, or outbreaks).

How Can Hyperpigmentation Be Treated?

"Hyperpigmentation is multifactorial: There may be genetic, metabolic, hormonal and environmental factors, all acting as triggers," warns Sturnham, reminding us that there is no single therapy available that will completely cure hyperpigmentation. But with a more holistic, multitherapy approach, you can get great results. "Using a combination of at-home and in-clinic based procedures, we can generally achieve adequate reduction and even complete resolution in many patients," she promises.

That does come with a disclaimer, however: It's not going to be easy for all of us. "The most challenging treatments are those patients with post-inflammatory pigmentation (PIH) and a darker skin type. There may be some residual pigmentation, but it is reduced to a level where self-confidence is restored," which does give us all some hope.

Sun Protection

SPF, we meet again."It goes without saying that protection from melanocyte-triggering UV damage is integral to the success of your treatment program," says Sturnham. "Look for a combination of mineral and chemical blocking agents such as titanium dioxide and ethyl salicylate to provide adequate broad-spectrum protection."

Nazarian concurs. “The initial step is to avoid anything that may prolong pigment deposition in the skin and keep hyperpigmentation from resolving on its own. Sunscreen, at least SPF 30, will help encourage fading by blocking UV radiation, which typically keeps and produces more pigment in skin. Elta MD is a great choice,” Nazarian suggests.

Over-the-Counter and Perscription Topicals

Our good old friend retinol can help here—when used only at night, of course. "A daily dose of vitamin A (retinol) 0.5 percent to 1 percent works well for most patients as it's a fabulous multi-tasker and in a good quality cosmeceutical formulation it works to reduce cell damage, boost repair, regulate oil production, boost collagen formation and reduce pigmentation," Sturnham explains. "It has a melanocyte-stabilizing and melanin-breakdown effect." Look for a night cream or serum formulas that contain this magical ingredient (UV rays will destabilize it) and ones that come in opaque packaging. 

Also look for skincare formulas that contain natural skin brighteners. Sturnham loves anything with sunflower (rich in B vitamins), niacin, and pantothenic acid (commonly labeled as vitamin B5), which naturally brighten and improve skin tone. But whatever you do, "don't use bleaching agents on your skin to try to lighten pigment," says Sturnham. "This can potentially worsen pigmentation and lead to scarring."

If over-the-counter options aren't yielding your desired results—or you just want to call in the big guns—pay a visit to your derm. “Of course, you can always discuss with your dermatologist other options,” Nazarian offers. “Prescription lightening creams (including those with kojic acid and hydroquinone) are ideal for stubborn dark spots."

Exfoliation

“Gentle chemical exfoliants can also enhance and increase the rate of skin cell renewal—basically inducing the hyperpigmented skin to be replaced by new skin cells," says Nazarian. "This can also be done through topical creams, washes, and solutions that have ingredients like vitamin C or glycolic acid. I suggest Revision Vitamin C lotion 30%.” A physical exfoliant is also an option, she says: “Microdermabrasion is a gentle physical form of exfoliation. It can be utilized to slough surface skin cells causing a faster cell turnover and quicker fading of darkened skin.”

Lasers and In-Office Treatments

For more advanced treatments and procedures, it's definitely worth consulting a dermatologist, who can prescribe the right course of treatment for your individual hyperpigmentation.

Peels are among the most popular in-office treatments for hyperpigmentation, used in conjunction with topicals. “Reducing pigment that exists already in the skin is best done using a combination of in-office peels combined with a regimen of retinol and Arbutase, which we custom-blend for our patients," Wells says. "The retinol helps even out pigment cells while the Arbutase contains hydroxy acids for cellular turnover (as well as brightening agents). Patients may stay on this ‘resurfacing cream’ for extended periods safely.” Sturnham notes this approach is particularly effective for specific kinds of hyperpigmentation. "In the case of melasma or PIH, topical treatment options may also include prescription-strength retinoids, azelaic acid, and chemical peels."

"Deeper chemical peels can be done to lift stains and help with long-term hyperpigmentation," says Nazarian. "For that, I typically recommend the VI Peel along with stronger resurfacing lasers (such as Fraxel), which may have longer downtime but lead to more dramatic results."

What Sturnham tends to see as the best course of action for many of her patients is the use of lasers. "I find a combination of Clearlift Q-switch laser and AFT laser works well to break down pigmentation at the dermo-epidermal junction and the older, more superficially lying pigmentation," she reveals.

Wells notes that lasers, which he uses "under certain circumstances," are "slightly riskier, however, since the laser itself can stimulate pigment cells not effectively destroyed by the treatment. Make sure your doctor is very experienced.”

And ultimately, Sturnham says, when it comes to treating hyperpigmentation one of the most important tools in your arsenal is simply patience. "Reassurance and time are also essential elements of a successful treatment program."

Article Sources
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  1. Stulberg DL, Clark N, Tovey D. Common hyperpigmentation disorders in adults: part i. Diagnostic approach, cafe au lait macules, diffuse hyperpigmentation, sun exposure, and phototoxic reactions. AFP. 2003;68(10):1955-1960.

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