The 4 Step Hyperpigmentation Treatment Plan
Originally published on February 12, 2014. Updated April 5, 2021 with additional hyperpigmentation treatment options
Quick Summary: Hyperpigmentation (skin color irregularities) is caused through sun spots, post-inflammatory hyperpigmentation, or melasma. Fortunately there are many great treatment options for hyperpigmentation including topical skin care products, chemical peels, laser or light therapy and Cosmelan Skin Lightening System. Continue reading to learn how to get rid of hyperpigmentation for good!
What is Hyperpigmentation?
Skin coloration irregularities are relatively common. Pigmentation disorders like hyperpigmentation or hypopigmentation can make the skin appear lighter or darker, or blotchy in places and can occur affect people of all races. Hyperpigmentation is a skin condition in which some areas of the skin produce more melatonin than others, causing dark spots.
Skin pigmentation is determined by melanin, a substance produced by melanocyte cells in the skin. Melanin absorbs UV light, thus protecting the body from its harmful effects. However, it is quite common for melanin to be excessively produced by the body leading to Skin pigmentation irregularities. These fall into one of three categories:
- Actinic lentigines, also known as sun spots
- Post-inflammatory hyperpigmentation
- Melasma
Actinic Lentigines
Actinic lentigines (AKA age spots or sun spots) are brown spots that develop as a result of the cumulative effects of sun damage inflicted on our skin, throughout the years. The spots are pale brown or gray in color and have a clearly defined edge. They typically develop on the areas of the skin most frequently exposed to the sun, such as the face and back of the hands. The number of sunspots become more visible as we age.
Actinic lentigines are particularly common in places like Austin, where the weather is hot and sunny and the residents like to spend lots of time outdoors.
Post-inflammatory Hyperpigmentation
Post-inflammatory hyperpigmentation is the result of inflammation in the skin caused by acne, burn, rash or traumatic injury.
It appears as irregular shaped patches of brown skin. They are caused when an injury, illness, or infection triggers an inflammatory response within the skin. This causes the melanocyte cells to increase their rate of melanin production, and the melanin leaks out and upwards towards the surface of the skin.
Melasma
Melasma shows up as larger patches on the cheeks, forehead, upper lip and jaw line. It is caused when the female hormones estrogen and progesterone stimulate the melanocyte cells to produce excessive amounts of melanin when exposed to sunlight. Due to this involvement of the female hormones, melasma is much more common in women, particularly pregnant women, and those taking birth control pills. The occurrence of melasma will increase the more the skin is exposed to sunlight.
It is typically the most difficult to treat because the pigment can be deep in the skin and the discoloration tends to recur easily with the slightest sun exposure.
Hyperpigmentation can result from sun exposure, inflammation, scarring, hormonal changes, or age. This relatively harmless condition can be treated multiple ways, each with their own pros and cons.
Hyperpigmentation Treatment Options
There are a range of cosmeceuticals and other hyperpigmentation treatment options available to combat any of the above pigmentation issues. The following is a basic road map for effectively treating hyperpigmentation:
Step 1: Sun Protection
The first course of action for any form of hyperpigmentation is to use sun protection to prevent it worsening. UV rays, from sunlight, are the primary cause of hyperpigmentation. You can protect your skin with a high sun protection factor (SPF) sunscreen, SPF clothing, wide brimmed SPF hats and sunglasses.
Our offices carry a variety of excellent broad spectrum sunscreens such as EltaMD, Skin Medica, IS Clinical and Revision Intellishade.
We can help you select one that best suits your skin type and lifestyle.
Step 2: Over The Counter Topical Products
The next step is the use of several over the counter topical products including the following:
Topical Lightening Creams
Lightening creams are available over the counter, or in stronger prescription-only formulas. They’re sometimes labeled as skin bleaching creams, fading creams or whiteners. These topical treatments are typically applied to the skin twice per day and lighten hyperpigmented spots over time.
Hydroquinone is the most popular active ingredient in lightening creams. Others include retinoic acid and other Vitamin A derivatives, kojic acid, arbutin or steroids. Although banned in the United States, some lightening creams still use mercury as the active ingredient, so be sure to read the label carefully. Mercurio, mercuric and calomel are alternative names for mercury.
Pros:
- Work best for flat, superficial age spots and melasma
- Work well on a variety of skin types
- Available over the counter
- Easy to apply at home
Cons:
- Can take longer to work than professional treatments
- Prolonged use of steroids may lead to unwanted health conditions
- Prolonged use of skin lighteners can lead to premature skin aging
- Prolonged use can increase risk of sun damage and skin cancer
Topical Facial Acids
Skin acids chemically exfoliate the top layer of skin to shed discolored skin cells and encourage new skin cell growth. They are available over the counter, or by prescription only for more concentrated strengths.
The most common of these acids are in the hydroxy acid family. The most used beta hydroxy acid is salicylic acid. Common alpha hydroxy acids include citric acid, lactic acid and glycolic acid. Vitamin-C, in the form of l-ascorbic acid, is an increasingly popular facial acid.
Pros:
- May decrease other signs of aging, including wrinkles
- Available over the counter
- Easy to use at home
Cons:
- Work best on light skin tones
- Increases risk of sunburn and sun damage
- Can cause dryness and irritation
Retinoids
Retinoids are a derivative of Vitamin-A and available over the counter, or in their most common prescription formula, as Retin-A. OTC varieties are gentler on the skin than Retin-A, although they will take longer to work.
Retinoids penetrate into the deeper layers of the skin to increase skin cell turnover. They also specifically block the formation of melanin.
Pros:
- May decrease other signs of aging, including wrinkles
- Suitable for all skin tones
- Available over the counter
- Easy to use at home
Cons:
- In some people, retinoids trigger hyperpigmentation
- Can take a long time to see results
- Increases risk of sunburn and sun damage
- Can cause dryness and irritation
Step 3: Cosmelan Skin Lightening Mask
For moderate to severe hyperpigmentation or melasma that is unresponsive to the treatments outlined above, there’s the option of using Cosmelan Mask by Mesoestetic. Cosmelan works by peeling surface pigment away to lighten any hyperpigmentation. It also blocks the enzyme involved in the melanin formation process to prevent any further pigmentation in the skin. This non-invasive skin lightening treatment rejuvenates the skin and brightens the complexion. It’s safe to use on all skin types and is highly effective on all types of hyperpigmentation, including melasma, sun spots, or hyperpigmentation caused by acne scarring.
Step 4: In Office (Professional) Treatments
If the hyperpigmenation is resistant to the Cosmelan Mask, we offer a variety of powerful in office treatments including:
Microdermabrasion
Microdermabrasion is a method of manual exfoliation that removes the top layer of skin. A hand-held tool sprays the skin with tiny crystals that sand off the top layer of skin cells which are then vacuumed up into the device.
Because it treats the epidermis only, microdermabrasion is only effective for superficial hyperpigmentation that doesn’t penetrate the deeper layers of skin.
Pros:
- A quick, in-office procedure
- Requires no downtime
- Unlike dermabrasion, microdermabrasion works well on all skin tones
Cons:
- Only targets surface hyperpigmentation
- Skin may be red and swollen for 24 hours after treatment
- Requires multiple sessions for best results
Chemical Peels
Chemical peels are facial acids applied at stronger concentrations by a dermatologist or trained esthetician. They reduce hyperpigmentation by removing the top layer of skin, encouraging skin cell turnover.
More stringent (concentrated) peels are able to penetrate deeper layers of the skin, but require more downtime to allow exposed skin to heal.
Pros:
- Works more quickly than OTC topical treatments
- Can penetrate into deeper layers of the skin, for more dramatic results
- Work well on age spots, sun spots and melasma
Cons:
- Works best on light skin tones
- May require downtime to heal
- Increases risk of sunburn and sun damage
- Can cause redness, blistering or general irritation
Laser Skin Resurfacing
Laser resurfacing treatments use the light from a laser to target hyperpigmented areas of the skin. Ablative lasers remove the top layer of the skin, while non-ablative lasers target the deeper layers of the skin to promote collagen growth and skin cell turnover while leaving the outer layer of the skin untouched. Popular resurfacing lasers include Fraxel and Clear + Brilliant.
Pros:
- Ablative lasers are strong and offer dramatic results
- Non-ablative lasers require no downtime
- Non-ablative lasers will also firm skin and may reduce wrinkles
Cons:
- Ablative lasers require several weeks of downtime
- Ablative treatments leave skin raw and exposed
- Ablative lasers work best on light skin tones
- Non-ablative lasers may also cause redness and swelling
- Non-ablative lasers cause some people’s skin to darken
Intense Pulse Light Therapy
Intense Pulse Light Therapy, or IPL, is a type of non-ablative resurfacing. This technique is sometimes known as a photo facial. IPL targets the skin with light at varying wavelengths, which is gentler than the intensely-focused single-wavelength laser.
The technique improves hyperpigmentation and will also boost collagen production for tighter skin and fewer wrinkles. IPL is also used for permanent hair removal.
Pros:
- Can also remove freckles, birthmarks and varicose veins
- Is gentler than laser resurfacing
- In-office sessions are quick and easy
- Requires no downtime
Cons:
- Works best for those with light skin tone
- Not recommended for those who scar easily
- Can cause mild redness and swelling
- Requires several treatments for best results
Recurrence
None of these treatments can completely prevent pigmentation problems from returning. You can minimize the possibility of pigmentation problems by limiting your skin’s exposure to the Sun’s UV rays.
Which Hyperpigmentation Treatment is Best for Me?
Choosing the hyperpigmentation treatment option that’s best for you depends on the severity of your skin spots, your tolerance for recovery time, and your skin tone.
Simple, at-home methods include lightening creams, facial acids and retinoids. Each of which is available in prescription strength for faster results.
More dramatic results are available with chemical peels or laser skin resurfacing, but these treatments may require a recovery period for skin to cycle through regrowth, peeling, and healing.
If you’re someone who tans easily, or has darker skin IPL therapy and more intense lasers may be off-limits. Lower-strength chemical peels and microdermabrasion work well on those with medium to dark skin tones.
An experienced dermatologist can help you decide which method is best for your unique skin type and skin condition.
Lela Lankerani D.O. received her undergraduate degree in Biology at Washington University where she graduated cum laude. Dr. Lankerani has published articles in several scientific journals and has presented at national scholarly meetings including the American Academy of Dermatology and American Osteopathic Academy of Dermatology.
I was wondering if the location of the hyperpigmentation makes a difference in terms of treating it? Is there a difference if its on your face vs. an arm?
Hi Stacy, the best course of treatment may differ depending on several factors like location and a person’s overall lifestyle. Please feel free to contact us for an individual analysis.
I can attest that treatment can vary by location. I’m getting treated for pigment problems on my face and shoulders using a topical medication on shoulders and IPL treatments on face. Seems to be working 🙂
Awesome post.
Fantastic write up. You have included some great tips! We also just did an article on 3 strange caused of hyperpigmentation. Please check out: https://getridofhyperpigmentationfast.com/three-strange-but-actual-causes-of-hyperpigmentation/
Can these techniques be used on Black skin? Years ago I had a dermabrasion what a mistake! Now I have a hyperpigmentation line on my neck. What can I do?
Hi Kathleen,
We’re sorry to hear about your issue. It’s true that there are some treatments that are not suitable for individuals with darker skin tones (in some cases causing damage).
The good news, however, is that there have been some breakthroughs (particularly in lasers) that provide better results and are safer on darker skin. This is one area where the cosmetics industry has made great strides.
We recommend contacting us to setup a consultation!
Thanks for your questions and for reading our blog,
— WD Staff
Are there effective treatments available for hyperpigmented lips on coloured people?
Hi Nii, thanks for the great question and for reading our blog! There are some treatment options for treating that area on individuals with darker skin. Depending on the exact indication there are a couple of great lasers (which are often utilized at a lower frequency to prevent further discoloring the skin).
Please feel free to give us a call to setup an appointment!
Thanks,
WD Staff
I’m an African American woman that lost pigment of my nipples after a breast reduction with free nipple graph. Is there anything to correct this? I’ve tried medical and professional tattooing several times. Color won’t stay
Hi Sheryl, Thanks for reading out blog and submitting this great question. Sometimes the color fades early because of the color composition of the ink. Sometimes small areas of hypo pigmentation can be surgically excised.
If you have further questions please feel free to give us a call to setup an appointment. Seeing you in person would help us determine the best course of treatment.
Thanks again,
WD Staff
DO NOT USE LASER for hyperpigmentation!! Its too strong and will make it worse!! These treatments are very expensive.
Since we have sensitive skin anyway, what works is using products with glycolic acid as that is gentler and will take away the hyperpigmentation over time without BURNING it off (which wil leave scars). I use two creams for my hyperpigmentation and I have seen results in one month of daily use. (1) the Made from Earth Pure Aloe Vera – I use this on my body, and (2) the Lady Soma Renewal Serum – I use this on my face.
Aloe is a safe, gentle and effective method of treating hyperpigmentation, while the Lady Soma Renewal Serum has gentle gycolic and hyaluronic acid that takes the pigment away without the laser burning.
Hi Robbi, thanks for reading our blog and for your contribution! We completely understand your reservations regarding laser treatments, however we would counter that there are some excellent laser options that use lower power (wavelengths) to address hyperpigmentation without causing any issues. Especially in the hands of an experienced provider, laser treatments are a safe and effective treatment option.
However, as you stated, there are also other products and treatment options that are effective.
Thanks,
WD Staff
I did BBL facial, about 5 treatments, instead of making my skin better, i ended up with Hyperpigmentation. I am brown skin. Whenever i complained during procedure, the lady responded, that it is pulling all the pigmentation out, but now i am left with bad skin. I didnt have all the dark marks on my skin (patches)I do not recommend any laser treatment for brown skin people. I am going to order these two products. Now this lady is talking me to get a peel, i tried one before didnt help. Hydroquinonone, didnt help either (made it worst)
Hi, I have hyperpigmentation on my breast. My dermatologist recommend me retain A , I think I receive rashes and darken my chest areas using Retain A. Should I get laser treatment?
Hi Fatima, Thanks for reading our post and submitting your question. We would encourage you to visit your dermatologist and discuss your reaction to the Retin A before trying any new treatments. That being said, there are many great laser treatments that can treat hyperpigmentation. Please let us know if you would want to schedule a consultation, we can discuss several new potential treatment options.
Thanks,
WD Staff
Hey there! I’ve been following your site for some time now and finally got the courage to go ahead and give you a shout out from Humble Texas! Just wanted to mention keep up the fantastic work!
My esthetician gave me Tattoo removal treatment and it actually helped with my hyperpigmtation as well. i had tried almost everything before this but this is best.
Hi Lakh – I’m curious. Do you happen to know what sort of laser tattoo removal your doctor did and also what Fitzpatrick skin type you have? Thank you!
Do you know the name of the tattoo removal cream?
I have bad acne, and the other day I got a pimple and I poped and picked at it. ( I know I am not suppose to) Anyway now the spot where the pimple was has a scab color but it is not a scab it is my skin. I don’t know what to do.
I don’t know any thing about the different kinds of acne or what I have. I don’t know how long it will take to heal, or if I should see a doctor. Can you please help me?
Yes, you are right. Hyper-pigmentation can be avoided and treated using best quality pigmentation skin care products which we can buy online or offline from any retailer. I have been using the skin care an beauty products of famous brands. One can buy online pigmentation cream of various reliable brands like Aspect, Cosmedix, PCA Skin etc.
Does laser help to remove hyperpigmentation forever?
Hello, thanks for reading our post and submitting your question. Laser treatments are great for addressing pigmentation issues. Treatments can be tailored to treat the specific type and degree of hyperpigmentation on a patient to patient basis. Please give us a call if you would like to learn more!
Hi I have PIH spot on my face for over 2 years ..i used many creams and stuff but it just came back after getting better..2 weeks back i had laser treatment…Short bursts …my doc said it will take 4-5 weeks ..but my question is it looks even darker now than before?? wats wrong is it getting worse after the laser or wat?
Male .Skin ( Brown/Tan)
Hi Dervesh, thanks for reading our post and I’m sorry for your issue. Post-treatment darkening after laser therapy can be common, especially for individuals with darker skin tones. In fact, treating hyperpigmentation in darker Fitzpatrick scales can be difficult in general. Your physician may be correct in that it could take some time clear.
However, if the issue persists we would recommend seeing your doctor to try a different treatment!
Hi, I had laser resurfacing treatment nearly a month ago. I started seeing hyper pigmentation about a week or so ago and now I am seeing more. How long after a treatment can it show up? I have a lot of areas on my face that are turning brown. I had beautiful skin before but I wanted to get rid of fine lines. I’m so disappointed and scared that these brown spots will just continue to show up
Hi Jackie, It sounds like you may have developed some post-inflammatory hyperpigmentation after the laser treatment. The good news as it should be easily treatable. We would encourage you to contact your provider to be assessed in person and discuss options.
Thanks,
WD Staff
I read a lot of reviews about Hiperpigmentation and it sounds to me like treating the problem on brown skinned people could be difficult so could you please provide me with options take work for asian Indian skin tone.
Hi Preeti, Thanks for reading our post and submitting your question. You are very correct: treating individuals with darker skin tones can be difficult as there is the potential for unwanted discoloration issues when done improperly.
Because of those issues, the best advice we can give is for your to see a licensed dermatologist in your area for assessment. It would be impossible for us to recommend a “full proof” treatment without assessing you in person.
Thanks,
WD Staff
I have a hyper pigmentation on my cheek bone. Can i get rid off it ?
Hi Runaize, there are lots of great treatments that can take care of that hyperpigmentation. If you are in the Austin area, please give us a call to schedule an appointment! We will find the best treatment option given the specific characteristics of your skin.
I have dark spots on my cheeks, forehead, chin and above my upper lip, and after 2 months of dermalmd lightening serum use, they have nearly vanished. I highly recommend dermalmd serum! Be sure to wear sunscreen everyday to keep the dark spots from coming back.
I suffer from hyperpigmentation, leaving dark spots on my skin. Used dermalmd lightening serum for 30 days, 2x a day. I was really surprised by the results. I’ve tried every product. Either it didn’t work at all or irritated my skin. Dermalmd serum tingled the first few times I used it, but that went away and no redness.
Lies! Dermalmd lightening serum ruined my face! I wanted to get rid of some acne scars but instead I’m left with huge brown spots. I wish I could turn back time. You’ve been warned!
How bad was your hyperpigmentation and what colored skin are you because people said it was different for other skin tones but I am thinking about it and I want to hear the negatives
Thanks for your tip to keep your skin safe with sunscreen, clothes, and hats. I like how you said that you should also look into masks for treatment as well. My sister is considering getting skin pigmentation treatment, and we are looking into health from medical professionals; thanks for the tips.
Thanks for this article! I think when you’re looking at something as laser treatment you have to talk to a doctor. At-home remedies are good to start, but they won’t give you extremely noticeable results. In-office treatments, on the other hand, can definitely give you a better idea of what the laser treatments can do for you.
very helpful thanks for sharing 🙂
Dermalmd lightning serum really works! After only one week the dark spot on my face was so light you could hardly see it. Great stuff
Nice information.
There are various types of laser treatment procedures which mostly used for getting fresh skin.
Thanks I am a mother and very busy! This helped me alot!
Great tips, I will consider a laser treatment. If anyone did such a treatment and reads this please let me know how it was 🙂
Thanks for all your help guys! I read this post and called in for a consultation. Going in for my first laser treatment next week and hoping to finally get my pigmentation issues under control 🙂
Very informative post. I’ve also created a post with some tips for treating oily and acne prone skin. You can find it here: https://www.reequil.com/blogs/care-tips/home-remedies-for-oily-skin-pimples/
You have included some great tips! Thanks for sharing this post, it is very helpful article!
Great plan, I followed this and its gotten better for me
Dermalmd Skin Lightening Serum actually has cleared a lot of my hyperpigmentation in less than a month. Its a great product
I’ve got melasma but have darker skin. Can I do laser treatments? I heard it could mess up my skin?
Hi Gretchen,
Great question! We have a great resource video on the topic here: https://www.westlakedermatology.com/blog/video-treating-hyperpigmentation-darker-skin/.
Dr. Stevens discusses hyperpigementation treatments for darker skin tones in depth. If you still have questions, please feel free to give us a call!
Thanks,
WD Staff