Hyperpigmentation, a condition characterized by the darkening of certain areas of the skin, affects people of all skin tones and types. While hyperpigmentation is typically not dangerous, it can impact self-confidence, especially when it is visible or affects large areas of the body. Achieving noticeable improvement takes more than a single product. It involves a system-based regimen that includes specific products tailored to each patient’s hyperpigmentation needs. By taking a comprehensive, multi-faceted approach, we can target the visible effects of hyperpigmentation while simultaneously improving overall skin health.
Why Hyperpigmentation Develops
Hyperpigmentation occurs when the production of melanin in skin increases and experiences heightened activity. Several factors contribute to this acceleration, such as:
Sun Exposure: Ultraviolet (UV) rays from the sun are one of the most common triggers. Prolonged sun exposure causes an inflammatory cascade in the skin that stimulates melanocytes (pigment-producing cells) to produce melanin. Melanin acts as the body’s natural defense mechanism by forming a protective layer of pigment over cellular DNA to minimize further sun damage. In some cases, this response becomes excessive, leading to darker patches. This can be further aggravated if the skin is exposed to the sun following certain procedures—such as laser treatments, chemical peels, or microdermabrasion—as the melanocytes may perceive the treatment as an injury, triggering additional pigment production.
Hormonal Changes: Puberty, pregnancy, oral contraceptives, hormone therapies (including hormone-releasing IUDs) or simply being female can result in melasma, a hormonally driven form of hyperpigmentation that typically affects sun-exposed areas. These areas of discoloration are typically found on the face, but they can also appear on the chest and forearms.
Post-Inflammatory Hyperpigmentation (PIH): This type of hyperpigmentation develops after skin injury or inflammation. Acne, eczema, and psoriasis can trigger PIH, leading to residual dark marks after the original condition has healed. Individuals with darker skin tones (Fitzpatrick skin type III or darker) may also develop hyperpigmentation in response to procedures or products—such as exfoliating scrubs or at-home peels—if their skin is not preconditioned with a proper skincare regimen. Their skin may perceive these treatments as injuries and respond by producing increased pigment.
Aging: As skin ages, it becomes more susceptible to developing dark spots. These are often the result of cumulative and prolonged UV exposure over the years and the skin’s reduced capacity to regenerate and heal as it ages.
Genetics: Certain individuals are genetically predisposed to hyperpigmentation. The tendency to develop melasma can run in families, making some individuals more likely to develop dark spots regardless of environmental or lifestyle factors.
Types of Hyperpigmentation
There are several different types of pigmentation conditions that can appear on the skin, each with its own causes and characteristics. Understanding the type of hyperpigmentation is key to choosing the most effective type of treatment.
Freckles: Typically freckles develop in childhood, often before the age of 10, and are commonly seen in individuals with lighter skin types. Considered cute by many, they are actually an early sign of sun damage. They often appear on the face and body, becoming more pronounced with increased sun exposure and fade a bit during fall and winter.
Solar Lentigines (Age Spots, Liver Spots, Dark Spots, Sunspots): Larger than freckles, these darkened patches are also caused by sun damage and often appear on areas of the body frequently exposed to the sun, such as the face, back of the hands, and shoulders. They are most common in lighter-skinned individuals over the age of 35, or those who’ve experienced significant UV exposure. Unlike freckles, these spots tend to remain visible all year long whereas freckles tend to fade without sun exposure.
Post-Inflammatory Hyperpigmentation (PIH): As mentioned previously, this form of hyperpigmentation appears as an inflammatory response to a skin injury, whether from a scratch, burn, bug bite, photosensitive ingredient, or even a chemical peel or laser treatment. PIH is more common in individuals with darker skin tones, and the resulting dark spots can remain for weeks or even months after the initial skin injury has healed.
Melasma: Triggered by hormones including birth control pills, pregnancy, hormones, or IUDs, melasma appears as larger patches of darkened skin. Melasma is more common in women than men and is more frequently seen in individuals with darker skin tones. It also has a predilection for developing in areas of prior skin injury, such as the upper lip or eyebrows, after waxing but can also be seen on the forehead, cheeks, and jawline. Melasma usually gradually subsides within six months after stopping hormones or childbirth. In some instances, however, the melasma will persist until after menopause.
Different Levels of Hyperpigmentation
Hyperpigmentation varies in its severity and the depth within the skin where the discoloration occurs.
Epidermal Hyperpigmentation: The mildest and easiest to treat form of hyperpigmentation localized in the epidermis (upper layer of skin). This includes freckles, solar lentigines, epidermal melasma, and PIH. Because epidermal pigmentation is more superficial, it is more responsive to treatment with a comprehensive skin care regimen.
Dermal Hyperpigmentation: Occurs when pigment cells and pigment move deeper into the skin layers, making the discoloration more stubborn and challenging to treat. It often occurs following some type of trauma that disrupts the basement membrane between the epidermis and dermis and includes less common conditions such as dermal melasma and dermal PIH. Dermal pigmentation often requires the use of Q-switched, pico-second, or fractionated lasers to target the dermis and help break up the collected pigment.
Ways to Prevent Hyperpigmentation
The most important way to prevent hyperpigmentation is to take the necessary steps to avoid it completely. Here are some of my recommendations:
Minimize Sun Exposure: Solar lentigines and freckles are preventable by starting sun protection measures at the earliest age possible, avoiding sunburns, limiting sun exposure during peak hours (10 a.m. to 2 p.m.), and wearing a wide-brimmed hat for additional protection.
Use Sunscreen Daily: Broad-spectrum mineral sunscreen with SPF 50, such as SUZANOBAGIMD™ Tinted Physical Defense SPF 50 or Obagi Sun Shield™ Mineral Broad Spectrum SPF 50 should be applied daily, even on cloudy, overcast days.
Invest in a Quality Skincare Regimen That Includes:
Antioxidants
Incorporating antioxidants during the day, such as those found in Obagi Professional-C® Serums, can help defend skin against environmental aggressors including UV radiation and pollution which may lead to free radical damage. Free radicals contribute to the breakdown of collagen and elastin, resulting in premature aging and uneven skin tone. By neutralizing these free radicals, antioxidant serums promote a more even complexion and help protect skin from further damage.
Exfoliating Lotions
Exfoliation smooths and brightens the appearance of skin for a more radiant, refreshed look. Exfoliating lotions, like SUZANOBAGIMD™ Intensive Daily Repair (IDR), contain ingredients that gently remove dead skin cells, promote cell turnover, and may help improve the absorption of other skincare products. IDR also contains antioxidant properties which provide further protection against free radicals.
Retinoids
Retinoids are key in accelerating skin cell turnover. This process helps shed dead skin cells more quickly, allowing fresh, clear skin to emerge. Retinoids help address signs of aging, by improving skin texture, reducing fine lines, and fading hyperpigmentation over time. If you’re in your 20s, I suggest starting with Obagi360® Retinol 0.5% or 1.0%; in your 30s and 40s switching to SUZANOBAGIMD™ Retivance® Skin Rejuvenating Complex; and as you get older, adding a prescription-strength Obagi Rx Tretinoin cream or gel to your nightly routine.
Avoid Picking or Irritating Skin: Whether it’s acne, bug bites, or even a scrape, it’s crucial to avoid picking at the skin to prevent PIH.
How to Manage Hyperpigmentation
Once hyperpigmentation develops, it is important to begin a carefully designed regimen tailored to the specific type of hyperpigmentation. Consulting a dermatologist, aesthetic physician, or advanced practice provider (nurse practitioner or physician assistant), who can diagnose the discoloration and recommend appropriate protocols like the ones mentioned below, is strongly advised.
Obagi Nu-Derm® Rx System: This system is what I consider the optimal line to initiate patients with severe or stubborn hyperpigmentation. The complete Obagi Nu-Derm® Rx System is a powerful, prescription-strength skincare regimen that has been clinically proven for over 30 years to work quickly to correct stubborn hyperpigmentation. It is formulated with 4% Hydroquinone, the gold standard in hyperpigmentation treatment. The Rx System is ideal for those with severe hyperpigmentation, including melasma, but requires a prescription due to its potency. The Obagi Nu-Derm® System is customized for different skin types (normal to dry or normal to oily) and includes a cleanser, toner, alpha-hydroxy acids, sunscreen, and hydroquinone-based products. The system facilitates optimal dermal preparation, creating a more receptive cutaneous layer for subsequent in-office procedures such as laser therapies, injectables, and chemical peels. The Obagi Nu-Derm® System should be used under medical supervision to avoid side effects like irritation or rebound pigmentation and to ensure safe and optimal results.
Obagi Nu-Derm Fx System: For those seeking a hydroquinone-free option or with drier or more sensitive skin, the Obagi Nu-Derm Fx System is a step-by-step skincare regimen formulated to transform skin by significantly reducing dark spots and post-inflammatory hyperpigmentation on the skin. With continuous use, it helps reduce the look of these forms of hyperpigmentation which result in the appearance of prematurely aged skin and uneven skin tone. Powerful key active ingredients like arbutin, vitamin E, lactic acid, and glycerin work synergistically to enhance skin turnover and minimize uneven skin tone to reveal skin that’s clearer, brighter, and smoother.
SUZANOBAGIMD™ Line: Alternatively, patients with older skin that tends to be thinner and drier can use the gentler SUZANOBAGIMD™ line, which includes a cleanser, toner, polyhydroxy acid, sunscreen, retinaldehyde-based retinoid, and add in Obagi Nu-Derm Clear and/or Obagi-C® Rx 10% Clarifying Serum (with Hydroquinone).
Topical Retinoids: Retinoids help to increase cell turnover, encouraging the shedding of pigmented cells and the formation of new, healthy skin. I always recommend a topical retinoid in the evening as well, ideally prescription-strength Obagi Tretinoin if able to be tolerated nightly. For patients with sensitive skin, a topical retinoid twice per week with SUZANOBAGIMD™ Retivance® Skin Rejuvenating Complex used on the other five nights.
Chemical Peels and Laser Treatments: Once skin shows significant improvement, I like to incorporate light peels, non-ablative fractionated lasers, and microneedling to help further improve the appearance of skin. However, starting these procedures without first preparing the skin can result in further hyperpigmentation.
When to Expect Results
Results using 4% Hydroquinone are typically noticeable within four to six weeks in most patients, depending on the severity of the hyperpigmentation. Once a patient has achieved clear or almost clear skin, they can be transitioned over to a maintenance skincare line to help keep their skin healthy while continuing to combat sun damage and aging.
It's important to remember that prolonged use of hydroquinone-containing products can lead to a rare, yet permanent form of hyperpigmentation known as ochronosis. Ochronosis occurs when excess pigment is deposited in the connective tissue, leading to a blue-black discoloration of the skin. This is usually avoided by ensuring patients prescribed hydroquinone also use sunscreen daily, avoid direct sun exposure, do not use hydroquinone-based products for more than 3-6 months at a time, and incorporate a polyhydroxy or alpha-hydroxy acid lotion in the morning and a retinoid at night to help mitigate the effects of incidental sun exposure.
I typically have patients cycle off hydroquinone-containing products for at least 3-6 months each year while continuing all their other Obagi products and include the addition of Obagi Professional-C 10%, 15%, or 20% depending on their skin type.
Underlying Risks of Hyperpigmentation
Since hyperpigmentation is a response to sun damage, the main risk of having hyperpigmentation is that it is an indicator of sun damage in the skin.
The goal of treatment should never be solely to target hyperpigmentation with hydroquinone-containing products. Treatment should aim to correct both the hyperpigmentation and the underlying sun damage. This is why it is essential to include topical antioxidants, alpha/polyhydroxy acids, mineral sunscreens, and retinoids together with hydroquinone or its alternative, arbutin-based products.
I frequently see patients who haven’t seen significant improvement in their hyperpigmentation because their previous treatments relied solely on hydroquinone. While hydroquinone helps, it should be part of a broader regimen. A system-based, multi-product approach that’s implemented daily, is essential to achieving both visible results and longer-term skin health.
Final Thoughts
Many treatments can significantly reduce the appearance of discolorations, but hyperpigmentation is a chronic condition that can be managed and dramatically improved. While dramatic improvements in the appearance of uneven skin tone can occur, ongoing maintenance is often required to prevent a recurrence and to maintain an even skin tone.
Patients often ask me how they can completely prevent hyperpigmentation. Since staying indoors for an entire lifetime is the only way to completely avoid it, I recommend taking the preventative measures mentioned above and finding a comprehensive skincare system like the Obagi Nu-Derm System along with professional in-office treatments to keep skin looking its healthiest for many years to come.
