Hyperpigmentation

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Summary

Hyperpigmentation is a skin condition characterised by uneven patches of dark skin.
It might be caused by excess melanin, exposure to sun, or hormonal changes.
Treatments include off-label topical creams containing acids that can help lighten darkened skin patches.

Hyperpigmentation: essential info
Causes and symptoms
What are my options?
FAQ

Reviewed on July 21, 2023. by

Dr Alexandra Cristina Cowell

Writer & Clinical Content Reviewer

Registered with GPhC (No. 2241935)

Next review due on July 21, 2026

Last updated on July 20, 2023

Find the Hyperpigmentation treatment that’s best for you.

We’ve got a range of options, and our clinicians can help you find the one that’s best for your body and your budget.

Finacea

Azelaic acid

In stock

Powerful gel that stops inflammation, gets rid of bacteria and treats hyperpigmentation.

Starting from £39.95

Start now

CeraVe SA Smoothing Cream

Salicylic acid

In stock

A 3-in-1 treatment that softens, exfoliates and moisturises your skin.

Starting from £59.95

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Eucerin

Urea

In stock

Topical cream that hydrates your skin. Apply twice a day to moisturise or reduce hyperpigmentation.

Starting from £44.95

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Tretinoin + Niacinamide

Out of stock

Topical treatment to help fade hyperpigmentation and melasma.

Starting from £99.95

Out of stock

Tretinoin + Niacinamide + Hydroquinone

Out of stock

Triple combination treatment to treat hyperpigmentation and melasma.

Starting from £99.95

Out of stock

Skinoren Cream

Azelaic acid

Out of stock

Off-label topical cream. Can improve skin pigmentation in 6 months.

Starting from £30.95

Out of stock

Tretinoin

Off-label topical cream or capsule for lightening skin pigmentation. Contains a retinoid.

Not available

Hydroquinone cream

Hydroquinone

Out of stock

Prescription-strength topical treatment for dark skin areas. Can be used on the face.

Starting from £35.95

Out of stock

What is hyperpigmentation?

Hyperpigmentation is a term used to describe skin that has become darker and more uneven than before. It’s usually harmless, and the symptoms tend to involve changes to patches of your skin tone (pigment). The size of these affected areas can vary (they can be very small or cover large parts of your body) And they’re usually painless, but it could be the result of another health condition that needs addressing.

There are different types of hyperpigmentation. Some of the most common types are:

Sunspots – changes to your skin appearance as a result of too much sun. Tonal changes can affect any areas that have been overexposed to UV rays.
Melasma (chloasma) – usually caused by hormonal changes, such as pregnancy. Spots can appear anywhere on the body but typically show up on the face and stomach.
Post-inflammatory hyperpigmentation – areas that are affected by inflammation or injured skin. Acne is often responsible for these symptoms.

Who gets hyperpigmentation?

Hyperpigmentation can affect anyone.^[1] Because there are lots of causes and factors involved in changes to your skin pigmentation, a clinician can advise you about possible causes and treatment options.

The location of patches of darkened skin on your body can often indicate the cause behind them. Preexisting health conditions can sometimes lead to changes to your skin, as can medications you take regularly. Providing as much information as possible during your startup consultation can help narrow down the reasons your symptoms have developed.

How common is hyperpigmentation?

It’s hard to say exactly how common hyperpigmentation is. There are lots of factors involved in developing changes to your skin pigmentation, including overexposure to UV rays, hormonal changes and medications that can cause symptoms.

There are a wide variety of skin tones around the world. Some studies have shown people with certain skin tones are more susceptible to developing pigmentation disorders than others,^[2] but hyperpigmentation can occur on any skin type.

Treated trusted sources:

Markiewicz, Ewa, et al. “Post-Inflammatory Hyperpigmentation in Dark Skin: Molecular Mechanism and Skincare Implications.” Clinical, Cosmetic and Investigational Dermatology, vol. 15, 25 Nov. 2022, pp. 2555–256.
Nayak, ChitraShivanand, et al. “Skin Hyperpigmentation in Indian Population: Insights and Best Practice.” Indian Journal of Dermatology, vol. 61, no. 5, 2016, p. 487.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on July 21, 2023. Next review due on July 21, 2026.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

What causes hyperpigmentation?

There can be several causes of hyperpigmentation. One is excess melanin, a substance naturally produced by your body to give skin its pigmentation (colour). Pigment cells called melanocytes, located at the base of the epidermis (outer layer of skin), produce melanin. Dark-skinned people make more melanin than those with lighter skin, which explains why pigmentation disorders can affect people of colour more frequently.^[1]

Hormonal changes, such as those that occur in pregnant women, can also cause hyperpigmentation. Medications, such as drugs used during chemotherapy, skin and endocrine diseases (such as Addison’s disease) can also produce darkened, even spots to appear on different parts of your body.

Overexposure to UV rays from the sun, due to prolonged periods of time in it without the right protection, can also contribute to increased melanin production.

What are the symptoms of hyperpigmentation?

The main symptoms of hyperpigmentation are:

Patches of skin that appear darker, and can look brown or black
Discolouration of these patches after injury to the skin or inflammation
Areas of skin that become darker after exposure to UV rays (sunlight)
Raised patches that seem to be getting bigger

Patches can develop anywhere on the body, depending on the type of hyperpigmentation that’s affecting you. It can be generalised, and affect larger areas, or be more localised, appearing only on specific areas like your face, hands or stomach.

Can hyperpigmentation lead to other problems?

Hyperpigmentation isn’t normally a risk to your health. Though you might want to treat it if you feel like it is impacting your appearance or making you self-conscious.

Areas of skin with uneven pigmentation won’t necessarily lead to other conditions developing, but it’s advisable that you stay well informed about potential risks surrounding skincare.

Sun exposure is responsible for lots of cases of hyperpigmentation, as UV rays activate melanin production. Melanin can absorb these rays and has antioxidant properties and the ability to protect you from potentially dangerous free radicals.^[2] Too much exposure to the sun, however, has been linked to cancer. Excessive UV radiation can damage the DNA in your skin cells, and make them grow out of control. This, along with sunburn, can cause cancer to develop.^[3] Before spending long amounts of time in the sun, it’s best to get fully informed of potential risks and take all the proper steps to stay protected.

Treated trusted sources:

Oakley, Amanda. “Pigmentation Disorders | DermNet NZ.” Dermnetnz.org, 2009.
Brenner, Michaela, and Vincent J. Hearing. “The Protective Role of Melanin against UV Damage in Human Skin†.” Photochemistry and Photobiology, vol. 84, no. 3, 16 Nov. 2007, pp. 539–549.
Cancer Research UK. “How Does the Sun and UV Cause Cancer?” Cancer Research UK, 25 Apr. 2019.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on July 21, 2023. Next review due on July 21, 2026.

How we source info.

What medications are there for hyperpigmentation?

There are several options available when it comes to managing hyperpigmentation, and there might be some trial-and-error before you find a medication that works best for you.

Creams that contain acids are often prescribed off-label to lighten darkened spots and patches of skin. These include:

CeraVe SA Smoothing Cream, which contains salicylic acid
Skinoren (primarily used to treat acne), which contains azelaic acid
Tretinoin, which treats acne and sun-damaged skin, contains all-trans retinoic acid. (A synthetic version of vitamin A.)

Using medications to treat hyperpigmentation can often be a process that involves time and patience before you start to notice changes. We recommend getting expert advice from a clinician before using over-the-counter products to manage your skin condition long-term.

Are hyperpigmentation treatments available over the counter?

There are lots of cosmetic creams available over the counter that contain ingredients designed to improve pigmentation-related skin conditions. They are sometimes sold as serums, toners and moisturisers. Often, they contain ingredients such as vitamin C, alpha-hydroxy acid (AHA) and niacinamide. Some treatments, like prescription-only off-label treatments for hyperpigmentation, contain azelaic acid.

While over the counter products might offer some benefits to your skin, there is no guarantee they will work in the same way as prescribed medications. By using prescription-only treatment, you know the medications have been approved by a licensed healthcare professional. Speaking to a clinician also means you can get more specific help, by answering questions and providing more detail about your condition.

Does hyperpigmentation always need treatment?

Managing hyperpigmentation often comes down to how you’re personally affected by it. Because it won’t make you seriously ill or cause pain, the decision to get treatment to improve your skin is often an aesthetic one. So while skipping treatment for it won’t result in the darkened spots or patches getting worse, you might feel the need to improve your hyperpigmentation so you’re happier with your appearance.

We’ll always give you the best advice we can about options that are suitable for you, and what to expect from them.

How we source info.

FAQ: Hyperpigmentation

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

Does hyperpigmentation treatment always work?

Answer:

Hyperpigmentation treatments have been shown to be effective in studies. In one trial of darker-skinned patients who used azelaic acid 20% cream to treat facial hyperpigmentation, the results were positive. After a period of 24 weeks, patients reported that the cream was more effective than previous treatments. It was also well tolerated and helped to improve pigmentation intensity.^[1]

Improving dark spots and uneven patches of skin can sometimes be a long-term process that can often take months. There are effective medications available that have been proven to help manage hyperpigmentation, but sometimes the improvements you want to see can be a personal issue. You can talk to a clinician about what you expect from a treatment, and get advice about how long you’ll need to use any medication for.

Can you get side effects from hyperpigmentation treatment?

Answer:

There are a lot of options available when it comes to managing hyperpigmentation. Most medications cause side effects, but that’s not a guarantee you’ll get any. They often affect people differently and sometimes settle down once you adjust to a new medication.

Creams that contain azelaic acid can sometimes cause mild burning or skin irritation, but are often well tolerated. If side effects are bothering you to the point you want to stop using your hyperpigmentation medicine, speak to a clinician about trying an alternative.

If you ever have a reaction to a treatment that seems unexpected, and possibly allergic, you should stop taking it and immediately seek professional help.

Will hyperpigmentation clear up without treatment?

Answer:

It’s hard to say whether your hyperpigmentation can clear up without treatment. Often it depends on the initial cause of it. Skin that’s changed colour due to injury or inflammation may fade over time, but it can take a long time for the skin to fully heal. The discolouration can lessen, but there’s no guarantee it will heal completely.

To prevent sun spots or changes to your skin as a result of sunburn, you should always make sure you’re protected. This can be done by covering up if you’re light-skinned and prone to burning or making sure you use suncream with a high SPF (sun protection factor).

Melasma related changes to your pigmentation might improve by using skin-lightening creams, such as hydroquinone. Dark spots or patches brought on by hormonal changes might fade over time once your hormones have settled down (such as after pregnancy or once you’re off medications that contain oestrogen) but creams can help your skin return to its natural tone.

How is hyperpigmentation diagnosed?

Answer:

A clinician will usually be able to diagnose your hyperpigmentation by looking at the photographs you’ve provided and asking about your symptoms.

You might also be asked to provide some test results or be advised to get some done through your GP. A skin biopsy can help determine what’s causing your hyperpigmentation, but it can also rule out anything more serious and highlight underlying conditions that might be behind it.

Treated trusted sources:

Lowe, Nicholas J., et al. Lowe, Nicholas J., et al. “Azelaic Acid 20% Cream in the Treatment of Facial Hyperpigmentation in Darker-Skinned Patients.” Clinical Therapeutics, vol. 20, no. 5, Sept. 1998, pp. 945–959.

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