Hyperpigmentation? These are the best treatments (2023)

An uneven skin tone is extremely common. Regardless of skin colour, dark spots and patches can appear on any part of the face and body that's been regularly exposed to the sun, or been scarred for whatever reason. This is commonly referred to as hyperpigmentation.

Hyperpigmentation isa general term that describes an excessive production of the natural pigment, melanin,” explains aesthetic doctor Dr David Jack. “Hyperpigmentation presents as brown irregular patches on the skin with little surface change,” adds Dr Vanita Rattan, doctor and cosmetic formulator specifically for skin of colour.

Broadly, there are three main types of hyperpigmentation, as Dr Jack explains.

Sun damage hyperpigmentation (also known as sunspots or solar lentigines): “Over time as our skin is exposed to UV and even blue light from the sun and other sources, it is less able to regulate the production of melanin. As a result, an overproduction of melanin can create distinct pigmented patches on the skin. These are commonly found on the face, hands and décolletage, and can be found in all skin types.”

Post-inflammatory hyperpigmentation (PIH): “This occurs in response to inflammation in the skin and is particularly common in darker skin types. It is often the result of acne and scarring, and can happen after facial treatments such as laser, particularly in darker skin types.”

Melasma: “Melasma or chloasma is a condition where brown or greyish patches of pigmentation develop often as a result of internal body triggers, such as hormone changes like pregnancy and thyroid conditions. Melasma is often worsened by sun exposure in the summer and can improve in wintertime.”

How to prevent hyperpigmentation worsening

As skin expert Nilam Holmes reminds us, “prevention is better and cheaper than the cure, so I advise everyone from a young age to protect their skin from harmful UVA and UVB light with a full spectrum sunscreen.” Dr Rattan concurs. “The most important tip is to wear SPF50 in the morning even if you are staying indoors, as UV rays penetrate through glass and will encourage hyperpigmentation”.

When it comes to hyperpigmentation treatment, Dr Jacks likens his professional approach to a stepladder process. “Starting with the simplest solutions first, testing if they work. If they don’t, gradually going up the treatment stepladder to more advanced options.”

The best treatments for hyperpigmentation

“Topical solutions work to interrupt the pathways where pigment is produced in the melanocyte cells,” explains Dr Jack – “they mostly inhibit an enzyme called tyrosinase, which can limit the production of melanin.” Many skincare ingredients have tyrosinase-inhibiting effects, including some of the commonly used ingredients you’re likely to own, such as vitamin C and retinol. Some are stronger and are available on prescription.

Step 1: Home skincare products

Topical skincare can have noticeable effects, but often requires at least three months of consistent use to properly test effectiveness. These are the ingredients to look for:

Vitamin C "works by inhibiting an enzyme in pigment cells (melanocytes) called tyrosinase that is used to make melanin,” schools Dr Jack. “Vitamin C together with vitamin E also has strong antioxidant actions that can help reduce and protect the cells of the skin against future UV damage.”

Retinoids (vitamin A) work in a number of ways to reduce the production of melanin, Dr Jack confirms. Retinoids come in various strengths, so if you’re starting out, try something gentle. "Retinyl palmitate is great for people that are concerned about redness or peeling with stronger retinoids.” While Dr Rattan too recommends retinol, she says to avoid retinoic acid or Retin A if you have darker skin: “This speeds up cell turnover but makes brown skin very sun sensitive and can worsen pigmentation”.

Alpha hydroxy acids (AHAs) “such as mandelic acid, glycolic acid, lactic acid and citric acid all have beneficial actions on existing pigmentation and can reduce melanin production with repeated use,” says Dr Jack. The favourite of Dr Rattan is mandelic acid. “This is a safe and effective chemical peel especially for Asian, Arabic and African skin types.”

AHAs also have exfoliating effects, “so they can help improve the penetration of other skincare products into the skin,” adds Dr Jack.

Kojic acid, ferulic acid, azelaic acid, niacinamide (vitamin B3) and N-acetylglucosamine (NAG) perform in a similar way to vitamin C. “These tyrosinase inhibitors reduce over-production of melanin,” adds Dr Rattan.

Alpha-arbutin and beta-arbutin are molecules derived from hydroquinone, which is available in prescription-only pigmentation treatments in the UK. “Hydroquinone, alpha-, and beta-arbutin all work by inhibiting the enzyme tyrosinase,” says Dr Jack.

Botanical and plant extracts – from liquorice to green tea and mulberry extract – have been shown to be effective in the reduction of pigmentation. “Most of these are believed to work in similar ways to the ingredients listed above,” Dr Jack adds.

Step 2: At-home treatments

If you’ve exhausted home skincare treatment after more than three months of consistent use, or feel that they’re starting to work but want to try something slightly stronger, this is when Dr Jack might recommend home treatments such as a gentle peel or mask. “Home peels generally work by exfoliating the skin (to improve penetration of any products) and can have pigment-reduction benefits,” he says. “Most home peels generally use higher concentrations of active ingredients than regular skincare, but lower than those used in professional treatments.” A vast number of options are available for home peeling, from AHAs to retinoids and botanical peels, but approach with caution. Heed the advice of Dr Rattan regarding AHAs above, especially if you have a dark complexion.

Alongside home peels, you could also invest in a home LED mask. “These might help over time, but more evidence is needed before we have a good idea about their usefulness,” says Dr Jack. “Results are generally not permanent, so the use of LED really does require commitment – as often as daily use.”

Step 3: Prescription skincare

When home skincare and gentle peels haven't been successful, or you want something a bit more powerful, Dr Jack says it is now time to see a professional. “Most good skin clinics and dermatologists will have a wealth of experience in treating pigmentation issues. Whoever you decide to see should take a full medical history and assess your skin using a variety of methods before making a detailed bespoke plan for your treatments.”

Often a starting point will be prescribing skincare products to use at home. At Dr Jack’s clinic, “we will often try a period of strong retinol, such as tretinoin, plus introduce a hydroquinone-based product for about three-to-six months.”

Tretinoin is a prescription-strength retinoid that works with your skin to speed up cell turnover.

Hydroquinone is considered by many to be the gold standard treatment for pigmentation. “Hydroquinone blocks the production of pigmentation by inhibiting tyrosinase,” explains Dr Jack, adding that it does so in a particularly potent way. However, it is believed to have potential side effects that have limited its use to being prescription only.

If you're unable to visit a clinic, skincare platform GetHarley lets you consult with a dermatologist online and access prescription products. Alternatively, personalised skincare platform Skin+Me (powered by a team of experts, including dermatologists and pharmacists) also offers access to prescription ingredients.

Agata Pospieszynska for Harper's Bazaar

Step 4: Professional treatments

If prescription skincare isn't enough after a few months, or your particular case warrants more intense options, then you might benefit from some in-clinic treatments.

Peels are the most easily accessible treatment for all skin types. Commonest are AHA peels at higher strengths to those performed at home. “AHAs including mandelic, lactic, and glycolic acid are often very beneficial at intermediate strengths when used repeatedly on the pigmentation of most types,” explains Dr Jack. “AHA peels will usually be done once every month for four-to-six months for the best results. They can be combined with other treatments and prescription skincare.”

IPL works on the premise that high energy light will interact with a corresponding colour target, causing it to heat up and break apart, explains Dr Jack. “With IPL used for hyperpigmentation, when the pigment is fragmented it changes its molecular structure so is removed by the immune system – as it is no longer recognised as the body’s melanin protein.”

He uses the Lumecca system by InMode, “which consistently gives excellent results,” plus downtime is minimal compared to other high energy systems. Holmes agrees that it is the best of its kind on the market. “I have used many different IPL devices over the last 25 years with varying results, but I can reduce hyperpigmentation by 90 per cent within two sessions using the Lumecca,” she says.

However, IPL is not suitable or safe for dark skin tones. “For darker skin types I like to treat hyperpigmentation with skin peels and microneedling,” Holmes adds.

Microneedling using a dermaroller can benefit certain types of deeper pigmentation. “The small needles pierce the skin causing micro-injuries,” explains Dr Rattan. “This promotes the body to heal the area and normalise the melanin production process. It is a long treatment with about six sessions needed every three months.” Dr Jack notes that there is a small risk of post-inflammatory hyperpigmentation with this, and that “it is important for darker skin types to check that the clinic has experience in treating darker skin”.

Mesotherapy is another treatment that when done on a regular basis “can be helpful in treating certain cases,” according to Dr Jack. “It involves the very superficial injection of vitamin blends and skin-boosting ingredients such as hyaluronic acid into the deeper layers of the epidermis and upper dermis layer.”

So, when it comes to hyperpigmentation there’s clearly no one size fits all treatment for a more even skin tone. However, if it’s something that concerns you there are multiple options available. Just remember that care must be taken not to worsen matters by causing inflammation – especially if your skin is prone to this.