Hyperpigmentation is a common cause of darkened skin spots. Hormone changes, inflammation, and even some medications can trigger it, but a common culprit is sun exposure, especially in people with melanin-rich skin. Regular use of sun protection, including a broad-spectrum tinted sunscreen, is the best way to prevent hyperpigmentation. Your clinician can also recommend treatments to help if the spots are bothersome for you.
Although hyperpigmentation is often harmless, it can be bothersome, affect confidence, and possibly be a sign of an underlying condition. Learning what’s causing your hyperpigmentation and how to prevent it with sun protection is a good idea for everyone. There are also many different treatment options, bHi TNG readers! We’ve written about sun safety and sunscreen, including the new sunscreen ingredient bemotrizinol (BEMT). Sun protection is an important way to prevent skin cancer and photoaging. But there’s one more reason you may not know about: hyperpigmentation.
➡️ What is hyperpigmentation?
Hyperpigmentation is when areas of skin become darker than your usual skin tone. It might look tan, brown, or purple. And it can show up as spots or larger splotches anywhere on the body.
Anyone’s skin can become hyperpigmented, but it’s much more common in people with melanin-rich skin, and the spots may be more noticeable and stay longer.
But it’s important to talk with a clinician or pharmacist first.
➡️ What causes hyperpigmentation?
Hyperpigmentation can occur for many reasons. Sun exposure, inflammation, and hormonal changes are the most common causes.
When inflammation is the trigger, it’s called post-inflammatory hyperpigmentation, or PIH for short. Anything that causes your skin to become inflamed or injured may also lead to PIH. Common examples include:
- Skin conditions such as eczema or psoriasis
- Acne
- Bug bites
- Skin picking
- Cosmetic procedures such as chemical peels or laser treatments
- Injury causing a wound, cut, or burn
- Infection, such as impetigo
- Sunburn
- Adverse reactions to a medication
A hormone-related cause is melasma, a skin condition that most often occurs in women under 40 who have medium to dark skin tone, especially during pregnancy.
💊 Some medications can cause or worsen hyperpigmentation. Ask your pharmacist or clinician if a medication you’re taking might be playing a role.
Some health conditions can also cause hyperpigmentation, including:
- Pigmentary disorders, including solar lentigo
- Acanthosis nigricans, skin thickening that can be a sign insulin resistance, such as in type 2 diabetes
- Autoimmune disorders, such as thyroid disease or lupus
- Addison’s disease
- Hemochromatosis (too much iron in the body)
- Vitamin B12 deficiency
- Pseudofolliculitis Barbae (“razor bumps” or ingrown hairs on areas of skin after shaving)
🤔 Skin is our largest organ. And skin varies from person to person and changes day to day and throughout our lives. Skin conditions can be hard to diagnose just by appearance alone. This is why it’s a good idea to have any new skin changes or bothersome symptoms checked out by a trained clinician. Many skin changes are harmless, but some may need treatment, such as skin cancer. Skin changes can also be a sign of a condition elsewhere in the body, such as diabetes or thyroid problems. And not all underlying conditions that affect skin are strictly physical. PIH from skin picking, for example, could be a sign of Body-Focused Repetitive Behavior.
➡️ What should I do if I have hyperpigmentation?
Hyperpigmentation itself does not require treatment in the same way that an infected rash does. Some people may not be bothered by it, while others may notice itching or feel self-conscious about it. Like acne or other conditions with noticeable skin changes, hyperpigmentation can cause mental distress.
Over time, skin spots typically fade and become less noticeable, or even disappear. Spots that are only slightly darker than the rest of skin may fade within a year. However, discoloration that is much darker or bluish-grey may take years.
⚖️ Health Equity Alert: Many clinicians who treat skin conditions may have limited experience in caring for people of color. What’s more, medical research and medical training have historically focused on lighter skin tones, and those inequities persist today. Many sunscreen products have also been designed more for less pigmented skin, even though sunscreen is important for everyone. Advocating for more inclusive research and education is something we all can do. For more information, including sources to help find clinicians experienced with diverse skin tones, consider these sources:
➡️ How can I prevent hyperpigmentation?
Regular sun protection is the best way to protect your skin from forming spots.
A broad-spectrum sunscreen product will block UVA and UVB rays. This is important because these types of radiation can cause skin damage, which might build up over years, leading to premature aging and possibly skin cancer.
But hyperpigmentation can also be triggered by visible light from the sun.
🤓 Wondering how visible light can cause hyperpigmentation? Researchers think this is how:
When high-energy visible light (also called blue light) hits skin, it flips a switch in pigment cells (melanocytes) called opsin-3. This sets off a chain reaction that causes cells to make more skin color pigment than usual. The more melanin-rich your skin, the more likely you are to develop hyperpigmented spots from sun exposure.
You may have heard about blue light also coming from electronic screens. This is true, but in far smaller amounts than the sun. The vast majority of blue light exposure comes from the sun.
While blue light isn’t known to cause skin cancer, it does contribute to or worsen hyperpigmentation, particularly in people with darker skin tones.
➡️ Which sunscreen is best to protect from hyperpigmentation?
As a pharmacist, I say what dermatologists usually say: the best sunscreen is the one you’ll regularly use. Is it affordable? Does it feel good on your skin? Those things matter. But some products may offer more protection from hyperpigmentation than others.
🌟 Consider a tinted sunscreen: here’s why.
A tinted, broad-spectrum sunscreen used daily may help prevent hyperpigmentation or uneven skin tone. The pigments that give these sunscreens their tint often come from iron oxides, which act as a physical shield against visible blue light.
Note: You won’t see iron oxides listed under the “Active Ingredients” in the “Drug Facts” box on the back of the bottle, because they aren’t classified as UV filters, though they do filter visible light.
➡️ What can help treat hyperpigmentation?
The most important first step to consider is getting to the root cause of what’s causing your hyperpigmentation. There are many possible causes, and more than one might apply to your situation. Talking to a clinician is really important to make sure what you’re seeing is hyperpigmentation, and then working with them to figure out any possible causes so they can be addressed.
😎 Daily sunscreen use with a broad-spectrum tinted sunscreen is recommended for everyone with hyperpigmentation. Sunglasses, sun hats, shade, and other sun protection measures are important too. For more tips, check out this post: What are the 3 most important sun-safe habits for your skin?
Beyond sun protection, there is no single “best” hyperpigmentation treatment, and multiple approaches are often needed.
Clinicians may prescribe medication to treat hyperpigmentation, or they might recommend trying an over-the-counter (OTC) product. These are typically topical medications, such as a lotion or cream, and they need to be applied regularly to work, following your clinician’s instructions. Some medications are only safe when used for a short time, and not all are safe for everyone, including pregnant people.
⚠️ OTC doesn’t mean safe for everyone so talk to your clinician or pharmacist before buying a product. They can help you choose a product that’s safe to try. Avoid DIY “lightening” remedies like bleach or unregulated products bought online. These may include harmful ingredients that may do far more harm than good.
For moderate to severe hyperpigmentation, the most effective medications and strengths are sold by prescription.
✅ Some medications used to treat hyperpigmentation work by causing the skin to make less melanin (pigment) in the areas where it is applied. Hydroquinone and cysteamine are common examples.
✅ Other topical medications like tretinoin or azelaic acid make skin cells turn over more quickly to help clear up darkened spots faster.
✅ For melasma, your clinician might prescribe tranexamic acid either as a pill or topical agent.
✅ Corticosteroids you apply to your skin might also be recommended for a short time to help lower inflammation.
A combination of medications is often needed, or using one and then switching to another. There are many different treatment options. There are also procedures, such as chemical peels or laser treatments, that your clinician might recommend. Once hyperpigmentation is under control, ongoing use of sunscreen is crucial and topical products with azelaic acid or a retinoid may also be needed to prevent flares.
⚖️ Could a diagnosis code determine whether your prescribed treatment is covered? It might. A 2024 study that compared Medicaid coverage for topical tretinoin found that coverage was three times more likely if it was associated with an acne diagnosis versus a code for melasma or PIH. Greater advocacy is needed for ensuring coverage of conditions more common in people from racial minority groups, the authors concluded.
It’s especially important to find a clinician with expertise in treating hyperpigmentation, especially if you have more melanin-rich skin. Some ingredients and procedures can make hyperpigmentation worse, especially in skin of color, if not carefully recommended and monitored.
🧡 Stay tuned …
The best way to really understand a condition is to hear from people living with it. So I checked in with my fellow nerdies here at TNG. We do a lot of that behind the scenes, and it’s what makes this community so special! It’s a true joy connecting and learning from each other.
I caught up with fellow nerdy Kenzie Isaac, a Doctoral Candidate in Population Health (Bioethics) and Rhodes Scholar at the University of Oxford.
Kenzie told me that later this year, she’ll write a TNG post sharing her own experience of her skin’s reaction to stress, and the lasting hyperpigmentation marks it left. Importantly, she’ll also share what it taught her about healthcare system inequities as well as the relationship between chronic stress and low-grade inflammation.
“Skin is our largest organ,” Kenzie says. “And it can be one of the biggest mirrors into our sense of mind-body harmony and an indicator of whether we’re getting the medical and community healthcare we need—including simply getting some rest!”
Stay rested, sun-protected. And please do stay in touch! 🧡
