Hyperpigmentation

Hyperpigmentation Treatment at Prescription Skin

Hyperpigmentation is a descriptive term, not a single diagnosis. It means areas of skin look darker than your surrounding skin because extra melanin has been made and deposited there. Sun exposure is the most common driver, but darkening can also follow pimples, eczema or minor trauma (post-inflammatory hyperpigmentation), be hormonally influenced as in melasma, or relate to medications and procedures [1–4]. It can appear as scattered freckles, well-defined sun spots, mottled patches, or broad symmetrical areas on the cheeks, forehead and upper lip. In deeper skin tones it often looks slate-brown or grey rather than red-brown [1–2]. Most hyperpigmentation is harmless, although any new, changing, or very dark solitary spot should be assessed by a clinician to rule out other causes [3–4].

What causes hyperpigmentation?

Hyperpigmentation happens when skin makes and deposits extra melanin, the pigment that gives skin its colour. It can be focal or diffuse:

Focal hyperpigmentation

Focal hyperpigmentation most often follows inflammation or injury, for example after acne, eczema, a cut or a burn. It can also occur in some autoimmune conditions like cutaneous lupus. Very importantly, new or changing dark patches can, in some cases, be due to skin cancers such as melanoma, so anything uncertain or evolving should be assessed by a doctor [2–4].

Diffuse hyperpigmentation

Diffuse hyperpigmentation involves more widespread darkening and can be triggered by medications, internal medical conditions or, rarely, cancers. Medicines that are known to darken skin in some people include amiodarone, antimalarials, certain chemotherapies and some antibiotics. Systemic conditions linked with diffuse darkening include Addison’s disease, haemochromatosis and primary biliary cholangitis. Because internal causes are possible, sharing your full medical history and medication list with your clinician is important when hyperpigmentation is being evaluated [3–5].

At a cellular level, hyperpigmentation results from over-production and transfer of melanin. UV radiation is the most common trigger. When skin senses UV, melanocytes, the pigment-producing cells, ramp up melanin as a protective response. Melanin acts like a natural sunscreen by absorbing and scattering UV, but the extra pigment is then handed off to surrounding skin cells, which makes dark patches more visible. Inflammation from acne, eczema, scratching or sunburn can amplify this process and deepen existing colour changes [1–3].

In short, sun exposure and inflammation are the usual culprits, but medications and internal health conditions can also play a role. Accurate diagnosis guides safe treatment, so a clinical review is the best starting point, especially for new, changing or very dark solitary spots [3–5].

Risk factors for hyperpigmentation

People with darker skin tones (Fitzpatrick IV–VI) are more prone to hyperpigmentation because their skin produces more melanin and responds strongly after inflammation. High UV or heat exposure increases risk, so outdoor work, frequent sun, tanning, or hot environments often lead to solar lentigines and can worsen melasma. Hormonal factors also matter, so pregnancy, hormonal contraception, HRT, and thyroid disease are linked with melasma susceptibility. Acne and other inflammatory skin conditions, along with rubbing or picking, raise the chance of lingering dark marks. Recent procedures or irritation from peels, lasers, microneedling, waxing, or harsh skincare can trigger post-inflammatory hyperpigmentation, especially in darker tones. Certain medicines and chemicals, like some antibiotics, antimalarials, amiodarone, chemotherapy agents, and photosensitising fragrances, can darken skin, and some systemic conditions such as Addison’s disease, haemochromatosis, or liver disease may cause diffuse hyperpigmentation over time [1–5].

Ingredients that make a difference

Hydroquinone

Hydroquinone reduces unwanted pigment by blocking tyrosinase, the key enzyme that starts melanin production, and by interfering with melanosome formation and transfer. Used once or twice daily in short cycles, it gradually lightens patches of melasma, sun spots, and post-inflammatory hyperpigmentation. Clinicians often taper the frequency or rotate off to maintenance to minimise irritation and rebound. Strict daily photoprotection is essential during and after treatment or results will stall [6–10].

Retinoids

Retinoids accelerate epidermal turnover and improve even dispersion of pigment within the skin. Over time they help fade post-acne marks and mottled photoageing, and they boost the performance of other lightening agents by improving penetration. They are also ideal for maintenance after stronger protocols, keeping tone more even while supporting collagen and texture [9–11].

Azelaic acid

Azelaic acid inhibits tyrosinase, calms inflammation, and reduces oxidative stress that drives post-inflammatory darkening. It is well suited to sensitive or acne-prone skin because it helps with bumps and redness while gradually evening tone. Many clinicians use it as a primary option for PIH, as a hydroquinone-alternative, or as a maintenance step between hydroquinone cycles [12–13].

Tranexamic acid

Tranexamic acid reduces melanocyte activation signals that follow UV exposure and inflammation by modulating the plasminogen–plasmin pathway. It is helpful for melasma that is slow to respond or relapses easily. Oral use requires screening for clotting risk and medical supervision. Topical forms are often combined with other agents in custom formulas [14–16].

Why prescription treatments are better

Prescription treatment beats DIY brightening because it targets the type of pigment you have with medical-grade actives at effective strengths, then sequences them safely. Your clinician can combine ingredients to take advantage of their effects, like hydroquinone to quiet tyrosinase, a retinoid to speed turnover, azelaic/niacinamide to calm inflammation, and tranexamic acid for melasma. You also get tinted SPF and maintenance built in, so results hold rather than yo-yo. Plus, a proper assessment rules out look-alikes and medication causes, keeping the plan effective and safe [6–16].

What to expect and when

• Weeks 2–4: Early “brightness” changes and a more even look at the edges of dark patches. Post-acne marks often look a touch lighter. Skin may feel smoother if a retinoid is included. Any irritation from new actives should be mild and settling by now with moisturiser support and strict SPF [9–11,13].
• Weeks 4–8: Visible fading becomes more apparent for post-inflammatory hyperpigmentation. Hydroquinone or triple-combination protocols usually show clear movement in this window. Azelaic acid and prescription retinoids continue to even out tone and help new marks resolve faster. Expect steadier progress with daily broad-spectrum, ideally tinted SPF to block UV and visible light [6–11,13,15–16].
• Weeks 8–12: Melasma typically needs this longer runway. Triple-combination therapy and regimens that include tranexamic acid often show meaningful improvement now. If progress stalls, it is usually a consistency or photoprotection issue, so double-check morning SPF, reapplication, hats and shade [8–10,14–16].
• Months 3–6: Colour keeps softening and mottling blends into surrounding skin. Many plans transition from “active clearance” to maintenance, for example cycling off hydroquinone, continuing a retinoid and azelaic acid, and keeping daily tinted SPF. Any in-clinic procedures, if chosen, are spaced and always paired with rigorous sun and heat avoidance to reduce rebound [6–7,9–11,13,15–16].
• Beyond 6 months: Results are maintained rather than chased. Retinoids, azelaic acid or tranexamic acid are used as anchors, with seasonal or short re-introductions of hydroquinone if spots return. Ongoing photoprotection is what prevents back-sliding [6–16].

How Prescription Skin can help you

Start with a quick online skin assessment and a medical review. We personalise your formulation to your skin tone, sensitivity and goals, then adjust strengths and companions over follow-ups. For example, we titrate retinoids to tolerance, choose appropriate BPO or azelaic acid strengths, and decide when to add, continue or stop systemic therapy. For adult female acne we assess suitability for hormonal therapy; for scarring-risk disease we discuss isotretinoin early and coordinate care safely. Clear, step-by-step instructions ensure you know what to use, when to use it, and how to manage temporary irritation while results build.