How to clear hyperpigmentation

What kind of pigmentation are you treating?

Hyperpigmentation means an area has more melanin, the pigment that gives skin its color, than the surrounding skin. It can affect any skin tone. The cause matters: marks left after inflammation, melasma and sun spots do not all need the same treatment. Hormonal changes, certain medications and some health conditions can also cause darkening.2

How to start treating dark marks

1. 1Address the trigger first. Treat ongoing acne, eczema or psoriasis rather than only the marks left behind.
2. 2Apply sunscreen daily to exposed skin. Choose broad spectrum SPF 50 or higher, preferably tinted with iron oxide to protect against visible light as well as ultraviolet light.
3. 3Reapply sunscreen every two hours outdoors and after swimming or sweating. Add a hat with a wide brim and seek shade.
4. 4Choose a suitable pigment treatment. Options include azelaic acid, vitamin C, glycolic acid, kojic acid and retinoids such as retinol or prescription tretinoin.
5. 5Stop using a skincare product if it burns or stings. Irritation can cause more dark spots.

For sensitive skin, look for gentle products labeled for sensitive skin or without fragrance. If a medication seems to be causing discoloration, ask the prescriber about alternatives rather than stopping it yourself. Never apply household liquid bleach to skin.1

How to fade marks left by acne or irritation

Postinflammatory hyperpigmentation is darkening that remains after skin inflammation or injury has healed. It can happen to anyone, but marks tend to be more intense and last longer in darker skin tones. The marks sit where the original problem occurred and range from light brown to black. Sunlight can darken them further.3

Creams applied to the skin work best on pigment in the epidermis, the outer skin layer. Options include azelaic acid, vitamin C, tretinoin, hydroquinone and cysteamine. Niacinamide, kojic acid and licorice extracts are also used. Improvement differs between treatments, and combinations are often needed for a substantial change. Pigment trapped in the dermis, the deeper skin layer, is more difficult to clear.3

Chemical peels, lasers and intense pulsed light can help some superficial pigmentation, but injury from the procedure can also make pigmentation worse. These procedures do not effectively treat pigment in the deeper skin layer. A stronger procedure is therefore not automatically a better answer.3

How long does hyperpigmentation take to fade?

After the cause stops, marks a few shades darker than your natural skin color usually fade within 6 to 12 months. Deeper discoloration can take years. Slate blue, gray or very dark brown marks can indicate deeper pigment. Treatment can speed fading.1

Some spots clear with treatment, while others only become lighter. New spots can develop over time, especially with further sun damage. Avoid picking pimples, which can injure skin and leave another mark. Continue sun protection even after the spots improve; clearing an existing mark does not prevent the next one.2

What if the patches are melasma?

Melasma often affects the cheeks, forehead, nose or upper lip. Ultraviolet and visible light promote pigment production, and pregnancy or hormonal contraception can contribute. Superficial melasma usually responds better than deeper melasma. Mixed melasma contains pigment at different depths and often improves only partly. A dermatologist can identify the pattern and depth rather than relying on color alone.46

Melasma triggered by pregnancy can fade after delivery, but it can also persist for years. A treatment plan should account for your triggers, skin tone and pigment depth. The goal is to restore your natural skin tone, not to negotiate a new one.6

When prescription treatment helps

For melasma, a dermatologist can prescribe hydroquinone or a combination of tretinoin and a corticosteroid, which reduces inflammation. Triple combination cream contains all three. Hydroquinone is not available without a prescription in the United States. Azelaic acid, kojic acid or vitamin C can be gentler alternatives. There is no single best melasma treatment; sun protection and medication are often combined.6

For prescribed melasma treatment, apply medication before sunscreen and camouflage makeup after sunscreen. Camouflage makeup can hide pigmentation while treatment works, which gives makeup a more realistic job than rewriting your skin's history. Melasma treatment usually takes 3 to 12 months to show results, and longstanding patches can take longer.6

For resistant melasma, a dermatologist can consider tranexamic acid applied to the skin or taken orally. Tell the dermatologist if you have had a blood clot before considering this medication. Chemical peels, microneedling and laser treatments are other options that require a board certified dermatologist.6

Melasma procedures carry a risk of worsening pigmentation. Microneedling, intense pulsed light and lasers also carry a risk of relapse and more resistant disease, so they need expert selection and use. Even successful treatment can be followed by returning pigmentation after summer sun exposure. Melasma needs ongoing, lifelong sun protection rather than a temporary sunscreen phase.4

When to get dark spots checked

Have new or changing moles, markings or unexplained discoloration assessed before treating them as ordinary pigmentation. Changes in size, shape, texture or color deserve attention. Not every dark spot is excess pigment that needs a fading cream: melanoma can appear in an existing mole or as a new dark spot.5

Hyperpigmentation itself does not cause pain or itching. See a healthcare provider if the area is red, hot, itchy, painful or leaking blood or pus. A clinician can review when the discoloration began and your medications, examine the skin and, when needed, arrange blood tests or a small skin sample to identify the cause.25