Cosmetic Procedures for Skin Hyperpigmentation

Because of sun exposure, almost everyone will get small dark spots on their skin as they age. But some people develop large areas of discoloration that may cover the forehead or cheeks.

These dark patches are called skin hyperpigmentation, and they occur when melanin, the pigment in your skin, forms deposits. Skin hyperpigmentation can happen to anyone, regardless of skin color, and appear anywhere on the body.

The good news is that skin hyperpigmentation isn’t dangerous and hyperpigmentation treatment can help rejuvenate skin. There are many cosmetic procedures at your dermatologist’s disposal, including a hyperpigmentation laser.

What’s Behind Skin Hyperpigmentation?

Factors from the sun to hormonal changes can cause skin hyperpigmentation, says Cameron K. Rokhsar, MD, a laser surgeon at New York Aesthetic Consultants and assistant clinical professor of dermatology at Albert Einstein College of Medicine, both in New York City. These include:

  • Genetics. Some people are born with more freckles than others. The same goes for larger areas of darker skin from hyperpigmentation. A skin condition called melasma, which causes brown or gray-brown skin patches on the cheeks, nose, forehead, chin, and upper lip, often runs in families and usually affects women. It’s also more common among people who have darker skin, such as those with an Asian, Indian, Latin, Middle Eastern, or Mediterranean background. Their skin often has more melanocytes, the skin cells that produce pigment.
  • Sun damage. Ultraviolet rays from the sun will cause your skin to produce more melanocytes, which leads to the dark spots commonly called age spots or liver spots. Prescription drugs that make your skin more sensitive to the sun can also be behind skin hyperpigmentation.
  • Hormonal changes in women. Hormone changes can also stimulate more skin pigment to be produced. Hyperpigmentation during pregnancy is referred to as the “mask of pregnancy” because it causes darker patches on the face and other areas. Birth control pills and hormone replacement therapy can also cause these skin changes, Dr. Rokhsar says.
  • Skin irritation. People who have darker skin may get some hyperpigmentation after acne or psoriasis, Rokhsar says. And for some, using skin care products that irritate the skin will cause the skin to produce more pigment and cause dark patches. Even rubbing and itching an area of the skin can make it darker, he adds.

Skin Hyperpigmentation Treatment Options

If hyperpigmentation is a result of hormonal changes, your skin may go back to normal at the end of your pregnancy or when you stop taking birth control pills or hormone replacement therapy. In other cases, there are cosmetic procedures an experienced dermatologist can suggest, from skin creams to a hyperpigmentation laser.

  • Bleaching creams. Bleaching agents that contain hydroquinone can help even out skin tone, Rokhsar says, though these creams can take up to three months to be effective. Although you can find this hyperpigmentation treatment over the counter, as well as by prescription, using it incorrectly can result in some serious side effects, such as an uneven skin tone that’s hard to reverse. That’s why you should always seek treatment through a doctor, Rokhsar says. Overusing bleaching creams can even make skin look black and blue, he adds. Your dermatologist may suggest a combination treatment, alternating between a high- strength hydroquinone cream and a product with tretinoin, corticosteroids, or glycolic acids. Newer topicals that contain Finacea (azelaic acid) or kojic acid may also be used to help fade some dark spots.
  • Skin peels. A chemical peel or microdermabrasion performed by a dermatologist or plastic surgeon are more aggressive options that can help even out skin tone.
  • Hyperpigmentation laser. Your doctor may suggest a laser to make your skin tone more even, Rokhsar says. As with bleaching creams and peels, it’s important to go to a skilled doctor for treatment. Someone who is not properly trained can damage your skin with a laser.
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