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Why doesn't the NHS offer hyperpigmentation treatment?
Currently, the NHS considers hyperpigmentation to be a cosmetic condition rather than a medical one. This means treatments to manage it aren’t offered by the NHS.
In this guide, we’ll look at the reasons why, how to get help from your GP, and other options you can try to treat hyperpigmentation.
Medically reviewed by
Sanjeda Chowdhury, Superintendent Pharmacist + Independent Prescriber
Why the NHS only covers certain conditions
The conditions the NHS offers treatment for are those they think put people’s health at risk. This means any that cause physical pain or psychological distress, and that are judged to be treatable in accordance with National Institute for Health and Care Excellence (NICE) guidelines.
Hyperpigmentation causes uneven patches of skin that are a darker shade than the surrounding skin. It’s a common condition, but one that is generally considered harmless to health. The NHS categorises hyperpigmentation as a cosmetic condition, because it only changes the appearance of skin rather than causing any pain or inflammation. So treatments for it aren’t considered a necessity.
There are lots of skin conditions which the NHS will cover, such as vitiligo and psoriasis, which can cause inflammation, redness and pain. Sometimes these skin conditions share overlapping symptoms with hyperpigmentation, as they can affect your skin tone.
So if you want to start a treatment solely for hyperpigmentation, you’ll need to use over-the-counter productions, or seek prescription-strength medications from a private provider.
Are there any exceptions?
The NHS won’t offer you treatments for hyperpigmentation symptoms alone. But in some circumstances, they might explore treatment options for you if they think your hyperpigmentation is caused by another condition that is covered, such as skin issues that are related to inflammation (like eczema) or caused by an overreactive immune system, or adrenal insufficiency.
This would usually happen on a case-by-case basis though. Post-inflammatory hyperpigmentation, for example, can occur following skin inflammation or an injury to your skin. It’s more prevalent in women and individuals with darker skin, and the intensity of the changes to the skin can vary. In this instance, GPs might offer treatments for eczema to use on the affected skin if the inflamed or injured area is cracked, sore, or red. And using treatments on eczema-affected areas of skin might also indirectly reverse or lessen any changes to your skin pigmentation.
Sometimes, hyperpigmentation can occur as a result of using hormonal medications such as birth control pills or hormone replacement therapy. If you use these kinds of medications and hyperpigmentation develops, your GP might review your treatment and suggest alternatives that are less likely to have this effect.
Another example of when a GP might consider hyperpigmentation treatment is if the changes to your skin are causing severe psychological distress. Here, they might refer you to a specialist dermatologist who can prescribe skin-lightening products such as hydroquinone, or mild forms of steroids that might help improve the condition of your skin.
But unfortunately, there’s currently no guarantee of what a response from your doctor will look like when you make an appointment to discuss your hyperpigmentation. Exploring your symptoms further is often at their judgement and discretion, and they might decide further medical attention beyond practical advice isn’t necessary.
Are GPs prevented from prescribing hyperpigmentation treatment?
Yes, they are. You might feel dismissed if your GP says they can’t help, but it’s because the integrated care board (ICB) prohibits the provision of cosmetic skin products and procedures on the NHS.
That doesn’t mean it’s not worth making an appointment with your GP to discuss your symptoms. Although they won’t prescribe you hyperpigmentation treatments, they might still recommend that you get some tests done. Some conditions, such as Addison’s disease, can affect skin pigmentation, so your GP might refer you for some routine blood tests to rule out anything like this.
They might also ask you about your recent skin exposure to the sun, and whether or not using a suncream with a higher SPF protects your skin better and helps any new patches of hyperpigmentation fade and change back to your usual skin tone.
What are the hyperpigmentation treatment options?
Hyperpigmentation can have lots of different causes, but one of the most common is sun exposure. To protect itself from the sun’s UV rays, your body produces more melanin, which can sometimes change your skin’s pigment.
So using a sun cream with an SPF between 30-50 can help protect your skin. If you have a type of hyperpigmentation called melasma, understanding this and how it can affect you might help you control your symptoms better, as your triggers might be unique to you. The hormonal changes during pregnancy can sometimes cause changes to your skin pigmentation, but so too can genetics and stress. Raised cortisol levels can leave your body in a permanent state of ‘fight or flight’, and this can damage skin cells and cause pigment changes.
If lifestyle changes and over-the-counter treatments aren’t improving your hyperpigmentation, it might be time to consider a prescription-strength option. You’ll have to get these privately, but there are several medications you can try which are prescribed ‘off-label’.
Often, off-label hyperpigmentation treatments contain acids, such as salicylic acid, azelaic acid and retinoic acid. You can apply them to affected areas of skin, and over time they can lighten dark spots.
But it’s important to remember that any hyperpigmentation treatment you use needs time. Often, this can take months — so you’ll need to be patient and monitor your skin for changes over time, as they might be gradual. If you do decide to use a prescription-strength hyperpigmentation treatment, your clinician can help you develop a treatment plan so you know exactly what to expect and how long it might be before you see noticeable changes. They’ll also recommend other things to try, such as a higher SPF suncream or covering your skin on hot days, that might help keep your hyperpigmentation under control while you’re treating it.
Reference Popover #ref1
Treated trusted source
Fisher, J (2024).
Demystifying hyperpigmentation: Causes, types, and effective treatments. Harvard Health.
Reference Popover #ref2
Treated trusted source
Mpofana, N., et al (2023).
Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life. Systematic reviews.
Reference Popover #ref3
Treated trusted source
Thawabteh, A.M., et al (2023).
Skin Pigmentation Types, Causes and Treatment—A Review. Molecules, 28(12), p.4839.
Reference Popover #ref4
Treated trusted source
Medicines and Healthcare products Regulatory Agency (2014).
Off-label or Unlicensed Use of medicines: Prescribers’ Responsibilities.
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