OverviewHyperpigmentation is a common skin condition that causes patches of skin to become darker than the rest of the body. Hyperpigmentation can occur anywhere on the body and affects people of all skin tones. Many people with hyperpigmentation choose to seek treatment to improve the skin’s appearance. (1)
There are a variety of factors that can make the body produce excess melanin, which leads to hyperpigmentation. These factors include:
- Sun damage: Sun damage can worsen existing areas of hyperpigmentation and cause new areas to form.
- Acne: After acne heals it can leave behind dark spots. This is called post-inflammatory hyperpigmentation (PIH).
- Medical conditions: Certain medical conditions can cause hyperpigmentation. These include Addison’s disease, an adrenal insufficiency, or hemochromatosis which causes too much iron to build up in your body. (2, 3)
- Skin inflammation/injury: Similar to scarring, other types of skin inflammation and injury like bug bites or allergic reactions can also cause PIH.
- Hormones: Hormones, especially from pregnancy or hormonal birth control, can cause melasma. Melasma is a type of hyperpigmentation usually consisting of flat gray or brown spots on the face. (4)
- Age: Age can cause some types of hyperpigmentation (also known as age spots), such as maturational dyschromia, especially in people with darker skin.
- Genetics: Some conditions, such as periorbital hyperpigmentation (dark circles under the eye) can run in families and may have a genetic component, in addition to other causes.
Hyperpigmentation should be diagnosed by a qualified doctor such as a dermatologist. This can usually be accomplished through a physical exam and a clinical interview. In some cases a biopsy may be required.
Topical Creams: There are a number of prescription products that can be applied to the skin to help lighten areas affected by hyperpigmentation. Hydroquinone, azelaic acid, retinoids like Retin-A cream, and topical steroids are examples of effective topical creams. (4) Because there are many available topical treatments for hyperpigmentation, side effects and indications for use vary widely. To determine the best hyperpigmentation treatment for your skin concerns, speak with a qualified dermatologist or plastic surgeon. Creams used to treat hyperpigmentation may be more affordable than more invasive options. However, the cost of creams will depend on what your doctor prescribes and whether it is covered by your insurance provider Microdermabrasion: Microdermabrasion is a non-chemical abrasive procedure breaks up dead skin cells for healthier looking skin. During the procedure, aluminum oxide crystals are blown onto the face and then vacuumed up. It takes about 30-40 minutes when completed on the face. This treatment may require multiple sessions. Recovery time is minimal. Side effects can include mild discomfort during the procedure, tingling, redness, and sensitivity. (5, 6) Microdermabrasion costs an average of $136 per session. (7) Keep in mind that because microdermabrasion often requires multiple sessions, your total cost will likely be higher. Chemical Peel: Chemical peels remove the damaged outer layer of the skin, evening out the skin tone by revealing newer, smoother skin underneath. Chemical peels can target different layers of skin from light to deep. The deeper the chemical peel is, the longer it takes to recover from. This can be used as a stand-alone treatment, or it can be done in conjunction with other procedures. (4) This type of treatment is not recommended for those who are pregnant, have used oral acne medicine in the past 6 months, or have frequent cold sores. Side effects include redness, infection, or scarring. Recovery time is approximately 7 to 14 days. The average cost of a chemical peel is $644, though of course this will vary by geographic area and provider. (8) Laser Skin Resurfacing: In addition to helping remove fine lines, wrinkles and scars, laser skin resurfacingis also effective in treating cases of hyperpigmentation. This treatment removes the outer layer of the skin using either an ablative or non-ablative laser. An ablative laser removes the outermost layer of skin and heats up the skin underneath, which stimulates collagen growth. When the outer layer heals it looks smoother. A non-ablative laser also improves collagen growth but is less invasive. This means it requires less recovery time, but it can also be less effective. Side effects for ablative lasers include redness and post-inflammatory hyperpigmentation can also be a side effect for some patients, especially those with darker skin. Recovery time around 5 days on average. (9) The average cost of ablative laser skin resurfacing is $1,963, and non-ablative procedures cost an average of $1,201. (10) Also consider possible added costs like the anesthesia fees, fees charged by the surgical facility, and the cost of any medications prescribed. Intense Pulsed Light (IPL): Although IPL, sometimes also called photofacial, can be confused with laser skin resurfacing, the two procedures are different. While laser resurfacing uses light that has only one wavelength, light used in IPL consists of multiple wavelengths, sometimes called incoherent light. This light is usually less intense than that used in laser resurfacing. Because this light is less intense, often multiple sessions of IPL are needed to achieve desired results. You shouldn’t get IPL if you are pregnant, use a retinoid cream, have skin cancer, have very dark skin, or have very severe scarring. Side effects of IPL include pain during the procedure, redness and peeling. Recovery time is minimal, though swelling may last for a few days. The average cost of IPL is $406 per treatment. (11) Some providers may offer a package of treatments which can reduce your cost.
Whether you choose to seek treatment or not, preventing future hyperpigmentation is key. The most effective way to prevent it is to use a broad-spectrum sunscreen of at least 30 SPF, wear sun-protective clothing, and avoid prolonged sun protection. It is important to use sunscreen every day and to reapply it every 2 hours. Not only will this help you avoid new hyperpigmentation, it will also prevent any existing dark spots from worsening. (12)
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