Hyperpigmentation 101: Causes, Treatments And Prevention

Hyperpigmentation, or discoloration of the skin, can be tricky to deal with. It can be caused by a variety of factors, from pregnancy hormones and birth control pills to acne and sun exposure.

Depending upon the cause of your hyperpigmentation, it may eventually go away on its own, but melasma—the type that’s caused by hormones—is the most stubborn.

“Melasma is most common in medium skin tones and it’s very difficult to treat. Sometimes you can make it worse, so it’s important to see a professional who really knows what they’re doing,” says Diana Flis, M.D., a plastic surgeon at Henry Ford Health. Here, she shares over-the-counter and in-office treatments for hyperpigmentation.

Topical Treatments For Hyperpigmentation

A few key ingredients can even out your skin tone, fade dark spots and help prevent hyperpigmentation from returning. But before you overhaul your medicine cabinet, know that some of these ingredients can be irritating, so introduce one new product at a time. Once you know that you don’t have a reaction to it, you can introduce another. Try:

1. A skin-lightening ingredient like hydroquinone or cysteamine hydrochloride. Hydroquinone has been used for decades to help lighten dark spots. It’s recommended for those who have stubborn melasma—you probably don’t need hydroquinone if you have mild hyperpigmentation, says Dr. Flis. You can also use an ingredient called cysteamine hydrochloride, which is the active ingredient in a treatment cream called Cyspera. Talk to your dermatologist to see what is right for you.
2. A brightening serum with vitamin C. If you have mild to moderate hyperpigmentation, vitamin C can help fade dark spots. Since vitamin C is a potent antioxidant, it can also protect your skin from future sun damage and environmental stressors (i.e., air pollution). Because of its sun-protective benefits, it’s best used in the morning—but you should still follow it with sunscreen.
3. A physical sunblock with at least SPF 30. “You shouldn’t even think about treating hyperpigmentation unless you’re already wearing sunscreen daily,” says Dr. Flis. “Otherwise, you’re wasting your time because the sun will worsen your hyperpigmentation. Not to mention the fact that some of the ingredients used for hyperpigmentation can make your skin more sensitive to the sun.” Look for a physical sunblock with zinc oxide or titanium dioxide, as she says it may give you better protection than a chemical block.
4. A chemical exfoliant like salicylic, glycolic or lactic acid. Chemical exfoliators use gentle acids to dissolve the bonds that hold skin cells together, helping to slough off the top layer of skin (where the dark spots are) to reveal fresh skin underneath. You can find salicylic, glycolic and lactic acid in cleansers, serums, lotions and exfoliating pads and peels. Try salicylic acid if you have oily skin, and glycolic or lactic acid if you have dry or sensitive skin.
5. Retinol. Pretty much everyone—hyperpigmentation or not—can benefit from this do-it-all product. Retinol is a derivative of vitamin A that promotes skin cell turnover deep within the skin's layers. Retinol evens skin tone, refines pores, helps prevent acne and treats fine lines and wrinkles. That said, retinol can be drying, so start slowly. “Start by using a pea-sized amount every three days and slowly work up to every day,” says Dr. Flis. “Use it only at night as it can make your skin more sensitive to the sun. It takes about four to six months to see results, so use it diligently.” Also: if you’re pregnant or nursing, you shouldn’t use retinol. Talk to your dermatologist about whether a prescription or over-the-counter retinol is best for you.

In-Office Treatments For Hyperpigmentation

If you’re looking for more instantaneous results, or if you have severe hyperpigmentation, a dermatologist can give you stronger treatments than what you can buy at the drugstore, such as:

• Glycolic or salicylic acid peels. Similar to the peels you can buy over the counter, in-office glycolic and salicylic acid peels can promote skin cell turnover—but to an even stronger degree. They can help fade dark spots, brighten skin, decrease the appearance of pores and minimize fine lines. Depending upon your skin type and degree of hyperpigmentation, most experts will recommend a series of peels, spaced about a month apart.
• Microdermabrasion. Microdermabrasion is a mechanical exfoliator, meaning it uses an abrasive surface to manually remove the top layer of skin to (gently) promote cell turnover. It can help eradicate hyperpigmentation and decrease the appearance of fine lines and wrinkles. With this in-office procedure, you may have mild redness afterward but it should go away shortly after. Talk to your dermatologist to see how many sessions would be necessary for you.
• Lasers. Lasers use heat to “zap” melanin (or pigmentation) at a deep layer. “Sometimes, right after a laser treatment, your hyperpigmentation can become darker,” says Dr. Flis. “Then, the pigment works its way to the surface of the skin and will shed or peel off.” Depending upon your skin type and degree of hyperpigmentation, most experts will recommend a series of laser treatments, spaced about four to six weeks apart. Be sure to protect your skin from the sun before and after laser treatment, as lasers can make your skin more sensitive to the sun.

In fact, just about any treatment that helps promote skin cell turnover can make your skin more sensitive to the sun, so whatever you do, being committed about wearing sunscreen is important.

“Wear sunscreen every day to sun-exposed areas (and don’t forget your hands)," says Dr. Flis. "Keep a wide-brimmed hat around when you’re in the sun. Stay in the shade when possible. Get a UV-protective sun cover for your windshield and your driver’s window. It is more common to develop skin cancers on the left side of the face and left arm since we drive on the left side. Protecting your skin won’t just help keep hyperpigmentation at bay, but also wrinkles and—most importantly—skin cancer.”

Find a dermatologist or plastic surgeon at Henry Ford. Call 1-800-436-7936 to schedule a dermatology appointment or 1-844-432-6763 to schedule a plastic surgery consult.

Diana Flis, M.D., is a plastic surgeon at Henry Ford Health Medical Center—Cascade Ridge.