How to treat hyperpigmentation on the body

What caused the dark patches?

Hyperpigmentation means an area has become darker because of extra melanin, the pigment that gives skin its colour. Marks that remain where a rash, pimple, burn or injury healed are called postinflammatory hyperpigmentation. They can affect anyone, but are more common, more intense and longer lasting in darker skin tones. Sunlight can darken them further.34

Not every dark patch is a leftover injury mark. Sun damage, hormonal changes, medications and some medical conditions can also cause hyperpigmentation. Treatment depends on the cause, not how confidently a bottle uses the word brightening. A clinician can review when the patches started, your medicines and other symptoms, then examine your skin or arrange tests if needed.35

How do you start treating body dark spots?

1. 1Address the trigger first. Treat ongoing acne, eczema or psoriasis rather than treating only the marks they leave. Avoid injuring the area again, and do not pick pimples.
2. 2Remove irritating skincare. Use gentler products, including options labelled for sensitive skin or without fragrance. Stop a product if it burns or stings.
3. 3Protect exposed skin every day. Use broad spectrum sunscreen, which protects against UVA and UVB rays. SPF 50 or higher is a practical choice for exposed areas with postinflammatory pigmentation. Clothing can cover the remaining skin.
4. 4Add a pigment treatment once the trigger is controlled. Surface pigment responds to topical treatments more readily than pigment deeper in the skin. Persistent marks sometimes need a clinician to combine treatments.

Apply sunscreen before going outside to skin that clothing will not cover. Reapply every two hours outdoors and after swimming or sweating. A tinted sunscreen containing iron oxide also protects against visible light, which can contribute to dark spots; choose water resistance and a tint that blends with your skin tone.1

What can you use for hyperpigmentation?

Azelaic acid, glycolic acid, kojic acid, vitamin C and retinoids are options for fading dark spots. Retinoids include retinol and prescription treatments such as tretinoin. Niacinamide, also called vitamin B3, is another topical option. These are treatment choices, not a list of ingredients you must use together.13

Topical treatments have varying success with pigment in the epidermis, the outer skin layer. A dermatologist can select combinations when one treatment is insufficient. Deeper pigment needs different expectations: hydroquinone does not treat pigment in the dermis, the deeper skin layer, and procedures used for surface pigmentation are not effective for that deeper pigmentation either.46

How is hydroquinone used?

Hydroquinone reduces production of new melanin and is used for several types of hyperpigmentation, including marks after acne. Creams and lotions contain concentrations of 1% to 5%. Availability depends on the country; it requires a prescription in New Zealand and many other countries. Follow your prescription and the medicine directions for your country.6

1. 1Test an area about 1 cm across and wait 24 hours for irritation or redness.
2. 2Apply a thin film only to affected skin, initially once daily. If there is no irritation after one week, the frequency can increase to twice daily.
3. 3Keep hydroquinone away from the eyes and mouth. Do not add other topical medicines, particularly benzoyl peroxide, unless your prescriber has arranged a combination treatment.
4. 4Wait 10 minutes before applying sunscreen or cosmetics.
5. 5Review treatment at three months. Stop if there has been no benefit; maintenance use after improvement should follow your treatment plan.

Stop hydroquinone for excessive redness, scaling, itching or weeping. Do not use it if you are allergic to hydroquinone or a formulation ingredient. Pregnancy and breastfeeding safety is uncertain, so discuss treatment before use. High concentrations used repeatedly for years can cause ochronosis, a form of skin discoloration.6

What about dark armpits, the neck or groin?

Dark, thick, dry patches that feel velvety, especially in these folds, can be acanthosis nigricans. Have them checked by a doctor rather than assuming they are ordinary dark spots. Sometimes small skin tags appear on the patches. Acanthosis nigricans can occur in otherwise healthy people, but can also be linked to obesity, type 2 diabetes, hormonal conditions or medicines.2

Treating the underlying cause comes first, and the patches should fade over time once that cause is treated. Depending on the diagnosis, a doctor can recommend changes to medicines or treatment for hormone or insulin problems. There is no specific treatment for the patches themselves, although a dermatologist can suggest ways to improve their appearance.2

How long does body hyperpigmentation take to fade?

After the trigger stops, a spot a few shades darker than your usual skin colour generally fades within 6 to 12 months. Deeper pigment can take years and often looks slate blue, grey or much darker brown. Treatment can speed fading, but new spots can form if inflammation or sun damage continues.1

Will a peel or laser work faster?

Chemical peels, lasers and intense pulsed light can help some surface pigmentation, but they can also worsen postinflammatory marks by injuring the skin. They do not treat deeper dermal pigmentation. Have a dermatologist assess the type and depth of pigment before choosing a procedure, particularly if previous irritation has left dark marks.4

How do you treat hyperpigmentation on the face?

Facial marks after inflammation follow the same basic approach: control the trigger and protect against sunlight. Brown or grey facial patches can also be melasma, which needs its own treatment plan. Pregnancy or medications can trigger melasma, and it sometimes fades when the trigger ends. Do not stop prescribed medication without speaking to the prescriber.157

Melasma treatment often combines sun protection with prescription creams, including hydroquinone or a combination of hydroquinone, tretinoin and a mild corticosteroid. Apply melasma medication before sunscreen, then camouflage makeup if used. Results usually take 3 to 12 months, and longstanding melasma can take longer.7

When should you get the discoloration checked?

Arrange medical assessment for new or changing discoloration, especially a mole or marking changing in shape, size, texture or colour. Seek care if the area is red, hot, itchy, painful or leaking blood or pus. Those symptoms are not typical of uncomplicated hyperpigmentation. Persistent marks that do not improve with treatment also warrant a dermatologist's assessment.135

Never apply household liquid bleach to skin. Avoid unverified lightening creams: some have contained undeclared mercury or steroids. If a medicine seems responsible for discoloration, ask the prescriber about alternatives rather than stopping it yourself.1