Is hyperpigmentation bad?

What makes skin darker?

Melanin is the substance that gives skin its color. Extra melanin can create brown, black, gray, red or pink spots and patches. Common triggers include sun exposure, hormonal changes during pregnancy, medications and inflammation after acne or an injury. Dark marks left after inflammation are called postinflammatory hyperpigmentation. Age spots, sun spots and liver spots are names used for dark patches, because apparently one name wasn't enough. Ordinary hyperpigmentation does not hurt or itch, although its appearance can cause distress.2

Darkening in skin folds has more than one possible cause. A rare inherited condition called Dowling Degos disease produces a lacy pattern, often starting in the armpits or groin. Its pigmentation typically causes no health problems. Thick, velvety dark patches are a different pattern and deserve a medical check.34

Which dark patches need checking?

• Book an appointment for new, unexplained dark patches or skin changes you are unsure about.
• Have darker, thicker, velvety skin checked, especially on the neck, armpits or groin. This pattern can be acanthosis nigricans, which sometimes signals prediabetes, diabetes or a hormonal condition. It also occurs without an underlying illness.
• See a clinician if a dark area is itchy, painful, hot, red, bleeding or leaking fluid. Those are not symptoms of ordinary hyperpigmentation.
• Do not assume an unfamiliar or changing spot is a harmless sun spot. Solar lentigines are benign sun related spots, but distinguishing them from melanoma and other growths can require medical examination.

A clinician can review when the darkening began and which medicines you take, then examine your skin. Depending on the suspected cause, blood tests or a biopsy, a small skin sample, can help identify what needs treatment.2

What should you do about harmless dark marks?

1. 1Address the trigger first. Treat ongoing acne or other inflammation, avoid picking, and stop using skincare that burns or stings. If you suspect a prescribed medicine, ask the prescriber about alternatives rather than stopping it yourself.
2. 2Apply broad spectrum SPF 30 or higher every day. For dark spots in darker skin tones, choose a water resistant tinted sunscreen containing iron oxide, which also protects against visible light. Apply it before going outside to exposed skin.
3. 3Reapply sunscreen every two hours outdoors and after swimming or sweating. Wear a wide brimmed hat.
4. 4If you want to fade remaining marks, discuss a suitable treatment. Options include azelaic acid, glycolic acid, kojic acid, retinoids and vitamin C. Prescription treatments or procedures are sometimes needed.

A promise to fade spots is not enough to choose a product, even if that promise gets the starring role on the packaging. Some imported fading products have contained unlisted mercury or steroids. Never use household liquid bleach on skin.6

Cysteamine 5% cream is another treatment used for melasma and postinflammatory pigmentation. Research supports its use for epidermal melasma, pigmentation in the outer skin layer. It can cause burning, redness, irritation and dryness. Do not use cysteamine during pregnancy or breastfeeding, or with a personal or family history of vitiligo, a condition that causes pigment loss. Check the specific product directions before using it.7

Will hyperpigmentation go away?

Once the trigger stops, a mark a few shades darker than your usual skin color generally fades within 6 to 12 months. Deeper pigment can take years. Treatment can speed fading, but new spots can develop. If treatment is not delivering the improvement you want, a dermatologist can help choose or combine treatments safely.6