Hyperpigmentation: Causes and Treatments By Nicole Strickland, MD

Hyperpigmentation, or darkening of the skin, is actually a descriptive term for a multitude of skin conditions. Sometimes hyperpigmentation can be caused by other skin disorders (psoriasis, acne, eczema, etc.)- this is called post-inflammatory hyperpigmentation.

Melasma is a hyperpigmentary disorder that we commonly see in clinic. It usually presents with light brown patches on the face, but can also be on the neck, chest, and forearms. There are many causes of melasma, including UV exposure, hormones (primarily estrogen, which is why melasma is commonly caused the “mask of pregnancy”), and genetics. 

While hyperpigmentation does not impact overall health and therefore doesn’t require treatment, it can be distressing and treatment may be desired. There are topical regimens containing hydroquinone (a traditional “bleaching” cream but cannot be used long-term as it can cause darkening itself with prolonged use), dicarboxylic acids such as azelaic acid and kojic acid, mild corticosteroids, and tretinoin. More procedural treatments include microneedling, chemical peels, and lasers; however, caution must be taken with the last 2 options as they can lead to post-inflammatory hyperpigmentation. A key management strategy is avoiding triggers, so minimizing sun exposure, wearing mineral sunscreen, and avoiding scrubbing/ waxing/ other skin behaviors that can traumatize the skin and create more inflammation.  To get started on an effective treatment plan for your hyperpigmentation, schedule an appointment with your dermatologist.

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