Hyperpigmentation Treatment Guide

Hyperpigmentation is a color problem with more than one cause, so a sound plan starts with the cause rather than the treatment. The American Society for Dermatologic Surgery explains that hyperpigmentation occurs when the pigment-producing cells of the skin, called melanocytes, begin to produce too much pigment, which leads to light to dark brown to grey spots or patches on the skin surface. The American Society for Dermatologic Surgery adds that the patches are often worsened with sun exposure, and that the condition affects both men and women and occurs in all skin colors, though it is typically more common in patients with darker skin tones.

Common causes, according to the American Society for Dermatologic Surgery, include inflammation or trauma to the skin, medications, contact with certain cosmetics or plants, and melasma. The American Society for Dermatologic Surgery also describes post-inflammatory hyperpigmentation, which follows trauma such as a cut, burn, abrasion or surgical incision, or inflammation such as a rash, acne or severe dryness, and is located in a pattern similar to the original event. A page on melasma is a good next read for that cause.

The American Academy of Dermatology states that getting rid of hyperpigmentation begins with finding out why you get dark spots or patches, and that if you can eliminate the cause, many spots will clear on their own and new ones can be prevented. For the condition in full, the society also keeps an overview of hyperpigmentation.

Three treatment questions, three guides

• Chemical Peels for Brown Spots: Explains what a peel removes, how light and medium depths differ and what the healing period involves.
• Melasma Triggers and Care: Looks at what sets melasma off and what ongoing care involves.
• Dermabrasion for Uneven Pigment: Covers dermabrasion as an option for uneven pigment and the questions to ask before choosing it.

Sunscreen first, procedures second

The American Society for Dermatologic Surgery says treatment often begins with a skin care regimen of daily sunscreen, moisturizers and skin care brighteners, and lists hydroquinone, vitamin C, azelaic acid, tretinoin and kojic acid among the more common brighteners. For patients who do not see improvement with a regimen alone, the American Society for Dermatologic Surgery says procedures may be added, including superficial chemical peels, microdermabrasion, intense pulsed light and lasers, and it adds that lasers should be used with care in patients with darker skin tones by an experienced laser surgeon.

On sun protection, the American Society for Dermatologic Surgery recommends wearing sunscreen daily with an SPF greater than 45 and reapplying it. The American Academy of Dermatology recommends a tinted sunscreen with iron oxide, because iron oxide helps protect the skin from the sun's visible light, which is a cause of dark spots.

Patience belongs on the checklist too. The American Academy of Dermatology says a spot that is a few shades darker than your natural skin color will usually fade within 6 to 12 months, while color that lies deep in the skin can take years to fade. A plan that skips sun protection, or that promises a quick fade, is the shortcut to watch for.