What is hyperpigmentation?

Hyperpigmentation is a common condition that makes some areas of the skin darker than others. “Hyper” means more, and “pigment” means color.

Hyperpigmentation can appear as brown, black, gray, red or pink spots or patches. The spots are sometimes called age spots, sun spots or liver spots.

The spots can occur in just one area of the body or all over.

Who can develop hyperpigmentation?

Hyperpigmentation can affect people of any race or ethnicity.

What causes hyperpigmentation?

Skin gets its color from a substance called melanin, which is made by skin cells. When those skin cells are damaged or unhealthy, they can produce too much melanin. The melanin can clump, causing that area to appear darker.

Many things can lead to hyperpigmentation:

• Adrenal disorders such as Addison’s disease, when the body doesn’t make enough of a hormone called cortisol.
• Genetics, such as a family with freckles.
• Hormone changes, such as during puberty or pregnancy.
• Injury to the skin (for example, acne, cuts or burns), which is sometimes called postinflammatory hyperpigmentation.
• Medications, such as oral contraceptives (birth control pills) and drugs that cause sensitivity to light.
• Melasma.
• Not getting enough of certain vitamins, such as B12 and folic acid.
• Sun damage (these spots are often called solar lentigines).
• Thyroid disorders.

Does hyperpigmentation cause any symptoms?

Other than dark spots, hyperpigmentation doesn’t cause any symptoms. If you have spots on your skin with any other symptoms, talk to your primary care provider or a dermatologist (skin doctor).

How is hyperpigmentation diagnosed?

To diagnose hyperpigmentation, a healthcare provider may:

• Ask you about your medical history, including when the darkened skin started and what medications you’re taking.
• Do a physical exam to look at your skin.
• Examine your skin under a special ultraviolet light, called a Wood lamp.
• Order blood tests to check vitamins, hormones and iron, as well as thyroid function.
• Take a small sample of the skin for a biopsy, which tests for any abnormal skin cells.

How is hyperpigmentation treated?

Depending on the reasons for hyperpigmentation, your healthcare provider may suggest some lifestyle changes:

• Avoiding sun damage by staying out of the sun, using sunscreen and wearing protective clothing.
• Stopping any medications that may be causing it.
• Taking vitamins.

Your healthcare provider may also recommend prescription or over-the-counter topical therapy (creams or ointments you put on your skin):

• Azelaic acid.
• Corticosteroids.
• Glycolic acid (alpha-hydroxy acid).
• Hydroquinone.
• Kojic acid, a chemical that can reduce the amount of melanin the body produces.
• Salicylic acid.
• Skin bleach.
• Tretinoin.
• Vitamin C or B3 (niacinamide).

Other treatments may include:

• Chemical peels.
• Cryotherapy.
• Laser skin resurfacing.
• Pigmented lesion laser.

Can I treat hyperpigmentation at home?

Many products claim to lessen hyperpigmentation. Talk to your doctor to see what products are effective and right for you.

Read more about understanding the ingredients in skin care products.

How long will I have hyperpigmentation?

Hyperpigmentation is a lifelong condition. Treatments can help clear some dark spots and lessen others. But they might take a few months or a year to work. And other spots can appear over time, especially if you don’t protect yourself from sun damage.

How can I prevent hyperpigmentation?

Hyperpigmentation can’t always be prevented, but protecting your skin from the sun helps:

• Apply sunscreen every day. Choose one that’s “broad spectrum” (blocks ultraviolet rays, UVA and UVB) with an SPF of 30 or higher.
• Avoid too much sun exposure.
• Use physical blockers such as titanium dioxide or zinc oxide.
• Wear protective clothing and hats.

How can I cope with age spots, sun spots, liver spots and other forms of hyperpigmentation?

The appearance of hyperpigmentation can make you feel self-conscious.

• Avoid sun damage.
• Be patient with any treatments you’re trying, as they can take months to show improvement.
• Don’t pick at any imperfections, such as pimples.
• Reach out to others with hyperpigmentation through support groups or online chats.
• Realize that many people have hyperpigmentation and other imperfections. You’re not alone.
• Take care of your skin by washing, exfoliating and moisturizing regularly to help it look as healthy as possible.

Should I ever seek medical care for hyperpigmentation?

You should see a healthcare provider, such as a dermatologist, if your skin is:

• Red.
• Hot to the touch.
• Itchy.
• Painful.
• Leaking blood, pus or any other substances.

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