What is the difference between pigmentation and hyperpigmentation?

Does pigmentation mean something is wrong?

No. Your skin gets much of its color from melanin, a pigment made by special cells called melanocytes. Your natural amount of melanin helps determine your skin tone. Hyperpigmentation can develop when those cells produce more melanin or when the number of pigment making cells increases. Pigmentation names the color, not a diagnosis, although the vocabulary does make having a face sound like an administrative matter.13

What causes hyperpigmentation?

Common triggers include sun damage, hormonal changes, skin inflammation and some medicines. Postinflammatory hyperpigmentation means darkening left after inflammation or injury, such as acne, a cut or a burn. Hyperpigmentation can affect any skin tone. In medium to dark skin tones, irritating skin or hair care products can also trigger dark spots.245

Not every pigmentation change comes from extra melanin. Some medicines cause color changes because the drug or substances produced as it breaks down accumulate in the skin. Drug related pigmentation can appear blue or gray as well as brown. Tell your prescriber about new discoloration and ask whether your medicine could be responsible; do not stop taking it yourself.45

Is melasma the same as hyperpigmentation?

Melasma is one cause of hyperpigmentation, not another word for every dark spot. It usually causes flat patches on both sides of the face, often on the cheeks, forehead, chin or above the upper lip. Melasma is most common in women, especially those with medium to dark skin tones, and often starts during pregnancy or after starting birth control pills. It can fade after pregnancy, persist for years or return after treatment. During pregnancy, wait until after birth to start melasma treatment rather than choosing a dark spot cream yourself.6

What should you do about dark spots?

Choosing a dark spot treatment starts with finding the cause, not giving every bottle in the bathroom an audition.5

1. 1Address the trigger first. If acne or another inflammatory skin condition keeps producing marks, treating that condition helps stop new ones.
2. 2Protect your skin daily. Use broad spectrum SPF 30 or higher. For dark spots in darker skin tones, choose a water resistant tinted sunscreen containing iron oxide for visible light protection. Apply before going outside and reapply every two hours outdoors, and after swimming or sweating.
3. 3Avoid more irritation. Use gentle products, do not pick pimples, and stop using a cosmetic product if it burns or stings.
4. 4Choose treatment for the cause. Options include azelaic acid, glycolic acid, kojic acid, retinoids and vitamin C. A dermatologist can help choose or combine treatments when spots persist.

How long does hyperpigmentation take to fade?

Once the trigger stops, a spot a few shades darker than your natural skin color usually fades within 6 to 12 months. Deeper discoloration can take years. Treatment can speed fading, but new spots can form. Drug related pigmentation often fades after the medicine is changed or stopped under medical supervision, although some changes last or become permanent.45

When should you see a doctor?

Hyperpigmentation itself does not cause pain or itching. Get medical advice if discolored skin is painful, itchy, hot, red or leaking blood or pus. A clinician can assess the pattern, when it started and your medicines; some pigment changes relate to hormone disorders or other illnesses rather than a cosmetic concern. If a nonprescription melasma treatment has not helped within three to six months, see a dermatologist.26