If you notice spots, patches, or regions of your skin that are darker or a slightly different color than your natural skin tone, it may be one of many forms of hyperpigmentation.
Hyperpigmentation is when extra melanin creates spots or areas of skin that look brown, grey, black, red, pink. There are no other symptoms like itchiness or flaking, just a difference in color. Hyperpigmentation is also what’s behind what we often call “age spots,” “liver spots,” or “sun spots.”
Many Causes, Many Types
Hyperpigmentation can affect any age group, and people of any skin color. It can be genetic (like freckles), or arise after hormonal changes (i.e. puberty, pregnancy, or menopause). This is called post-inflammatory hyperpigmentation. It can also occur as a result of sun damage to the skin.
It can also happen after injury to the skin like a burn. Chronic skin conditions, such as eczema, TSW, acne, and psoriasis, can also lead to hyperpigmentation due to chronic picking and scratching, which also injure the skin.
There are health issues that can also lead to hyperpigmentation: adrenal and/or thyroid disorders, nutritional deficiencies (often a lack of B12 or Folic acid), or it could be a side-effect of medications like oral contraceptives, or other drugs that make your skin sensitive to sunlight.
When you see your doctor or dermatology professional, they may ask questions or do a series of tests to find out what could be causing the hyperpigmentation. Be sure to get it checked, though, as a medical professional can evaluate your skin changes to assure that there isn’t a more serious underlying health problem or evidence of skin cancer.
Prevention and Treatment
The main way to prevent against hyperpigmentation is to avoid sun damage. Use sunscreen regularly, and.or wear protective clothing and hats. Also, try not to pick at acne, skin lesions, or scabs, as you’re more likely to leave a permanent scar or discoloration.
There are topical and cosmetic treatments that may lighten hyperpigmentation, including laser skin resurfacing, milk skin bleaching, chemical peels, cryotherapy, and more.
Topical therapies include:
Alpha Arbutin & Kojic Acid: Safe, plant-derived alternatives that block the enzymes responsible for dark spots
Vitamin C: A powerful antioxidant that brightens the skin and protects against environmental damage
Azelaic Acid & Niacinamide: Ideal for sensitive skin, they reduce inflammation and fade post-acne marks
Retinoids: These speed up cell turnover, helping to shed pigmented skin cells and bring fresh, even-toned skin to the surface.
Hydroquinone: Long considered the gold standard for lightening severe dark spots. However, it is typically used in short cycles to prevent adverse side effects.
Tranexamic Acid: A newer, very safe option that targets hormonal pigmentation.
It’s best to work with a licensed professional when trying these treatments, as some of these topicals are very strong, and an expert can help you choose the right one for your type of hyperpigmentation and your skin type.
However, if you have hyperpigmentation as an after-effect of lesions or scratching caused by a skin condition such as eczema, TSW, acne, and psoriasis, it’s important to resolve those conditions at their root cause. Topical treatments of hyperpigmentation may help the appearance of dark spots, but they don’t treat the internal imbalances leading to chronic or recurring skin diseases. Traditional Chinese herbal medicine can address the deeper issue and provide more lasting healing that reduces or prevents additional hyperpigmentation in the future.
Conclusion
The good news is that hyperpigmentation in and of itself is very common, and will not lead to further symptoms. There are many solid treatments that may help fade or even eliminate the discoloration, but it could take time. Meanwhile, makeup can be your friend while you work on a more lasting solution.
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About the Author
Olivia Hsu Friedman, LAc, Dipl.OM, DACM, Cert. TCMDerm, is the owner of Amethyst Holistic Skin Solutions and treats Acne, Eczema, Psoriasis, and TSW. Dr. Olivia treats patients via video conferencing using only herbal medicine. Dr. Olivia is the past chair of the board of directors of the American Society of Acupuncturists, serves on the Advisory Board of LearnSkin, and is a faculty member of the Chicago Integrative Eczema Group sponsored by the National Eczema Association.