Can hyperpigmentation be cured?

What decides whether it goes away?

Marks after inflammation, called postinflammatory hyperpigmentation, can follow acne, eczema, irritation or injury. Treating the original skin condition helps stop new marks. Pigmentation also has other causes, including sun damage, hormonal changes and medications, so the right treatment starts with identifying the cause rather than choosing a stronger cream.13

Melasma causes blotchy brown facial patches. Pigment near the surface generally responds better than pigment deeper in the skin; mixed melasma often improves only partly. Melasma triggered by pregnancy can fade after delivery, but it can also last for years or a lifetime. Even a good treatment result can reverse with summer sun exposure.24

How long does fading take?

Once the trigger stops, a spot a few shades darker than your natural skin color usually fades within 6 to 12 months. Deeper pigment can take years. With melasma treatment, results usually take 3 to 12 months, sometimes longer when the patches have been present for a long time.14

What should you do first?

1. 1Address the trigger. Continue treatment for acne or eczema, avoid picking pimples, and stop skincare products that burn or sting. If you suspect a medication, ask the prescriber about alternatives rather than stopping it yourself.
2. 2Apply sunscreen daily. Choose tinted, broad spectrum SPF 30 or higher with iron oxide and water resistance. Apply it to exposed skin before going outside, reapply every two hours outdoors and after swimming or sweating, and wear a wide brimmed hat.
3. 3Consider a fading treatment once the trigger is controlled. Options include azelaic acid, glycolic acid, kojic acid, retinoids and vitamin C. Follow the chosen product's directions rather than treating the ingredient list as a schedule.

Iron oxide helps protect against visible light that contributes to dark spots. Sun protection helps prevent darkening, but sunscreen alone does not remove pigment deep in the skin. For melasma, protection needs to continue year round, including after the patches improve.125

When should you see a dermatologist?

See a dermatologist if treatment is not helping or you are unsure what the patches are. A melasma plan can combine sun protection with prescription hydroquinone, tretinoin or a combination cream. Apply prescribed melasma medication before sunscreen, then makeup. Camouflage makeup can hide patches while treatment works, without requiring the concealer to solve the underlying problem.4

Peels and lasers can help selected cases, but can also damage skin and create more pigment. Melasma procedures require expert care because relapse and worsening are possible. Discuss them with a dermatologist rather than assuming a procedure is a permanent cure.25

Dark pigmentation alone should not be painful or itchy. Get medical care for patches that are red, hot, itchy, painful or leaking blood or pus. Dark patches can also represent conditions other than hyperpigmentation, so an uncertain diagnosis needs assessment before cosmetic treatment.35