Hyperpigmentation 101. What is it and how do we treat it?

Hyperpigmentation is a skin condition found in over 70% of the patients who visit a dermatologist’s office.
Although it is annoying and requires a lot of patience, there are many treatments and prevention methods!

Melanin is the pigment that gives color to our skin and hair. It is produced by the melanocytes, a group of cells in the epidermis’s basal layer, through a process called melanogenesis. The more pigment we have, the darker the skin. When this process is altered, dark spots develop. Just as we have hyperpigmentation, we can have hypopigmentation, but this is a discussion for another episode of dermatology talks!

How many types of hyperpigmentation do we know?


It usually appears during pregnancy due to hormonal changes. You can prevent it by using skincare products with niacinamide, vitamin C or glycolic acid right from the start. ACOG (The American College of Obstetricians and Gynecologists) approves OTC products like azelaic acid, glycolic acid and low concentration salicylic acid for preventing hyperpigmentation and acne.

Solar Lentigines

Cumulative sun exposure is the leading cause of hyperpigmentation. It appears both on the face and the hands. There is no way to prevent dark spots or freckles without using sunscreen, broad-spectrum (UVA + UVB), minimum SPF 30. My recommendation is to always go for SPF 50.

Post-inflammatory hyperpigmentation

Any dark spot that appears after a trauma or inflammatory process is called post-inflammatory hyperpigmentation (PIH). There are many causes that can trigger PIH, like acne, scratches, cuts, burns, eczema, various mycoses (skin fungi), and psoriasis.

It usually goes away on its own in about 3-6 months, but may also require cosmetic dermatology treatments. My favorite? Dermapen microneedling!

How do we treat hyperpigmentation?

Antioxidants & Topical Treatments

  • Vitamin C
  • Niacinamide
  • Arbutin
  • Kojic acid
  • Tranexamic acid
  • Azelaic acid
  • Licorice
  • Retinoids
  • Hydroquinone
  • Sunscreen SPF 30 or 50

Cosmetic procedures

“Careful! Must be performed only in medical offices, by dermatologists, nurses or licensed estheticians! Otherwise, you can make it worse! Believe me, I have seen some incredible post microneedling or chemical peels errors. The skin got even darker, and the hyperpigmentation got really bad and hard to treat! But let’s don’t get sad.


Dermapen is my favorite procedure. I love the end result of a correctly performed microneedling. The principle is to create micro-wounds. Sounds simple right? But it is very effective! The healing process will then stimulate collagen production, cell renewal, and correct the abnormal process of melanin production.


Lasers are not my first choice when it comes to treating hyperpigmentation. It depends a lot on what caused them, how long you have them, other treatments you’ve done, etc. But for post-inflammatory hyperpigmentation due to acne, fractional laser, Q-switch or Nd: Yag are good options you should discuss with your dermatologist.

Chemical peels

There are strong, professional peels, which must be performed by specialized estheticians, dermatologists or nurses. Examples: glycolic acid, Jessner solution, TCA.

Risk factors

  1. Undoubtedly uncontrolled sun exposure!
  2. Oral contraceptives
  3. Hormone replacement therapy for menopause
  4. Pregnancy
  5. Certain photosensitizing drugs (e.g. Accutane, Doxicillin)
  6. Injuries
  7. Dark skin

Regardless of the treatment method, none will work and results will not last if you do not regularly use sunscreen. So, before spending large amounts of money on treatments and cosmetics, try for a while to create a habit in applying SPF. Once it has become indispensable in your skincare routine, only then you should start investing in depigmenting treatments.

With love,

Your dermatologist