- Hyperpigmentation is a common problem for women of color.
- There are many different causes of hyperpigmentation.
- You can make hyperpigmentation better by addressing the root cause, protecting the skin, and using treatments to even the color.
Hyperpigmentation is when areas of skin become darker than the normal skin surrounding them. It’s one of the most common reasons women of color see a dermatologist.
While not usually physically harmful, hyperpigmentation can be distressing. To make it better, you need to address the cause and protect the skin and even the pigment.
What causes hyperpigmentation?
If you’re a woman of color, chances are you’ve already dealt with dark marks on your skin.
Different types of hyperpigmentation might look the same, but they happen for a variety of reasons.
The most important thing is to identify the root cause. Some common reasons for skin darkening are detailed below.
Skin injury / Post-inflammatory hyperpigmentation
The skin’s injury response is activated by any:
This response is a series of steps the body takes to heal itself. The key to healing is inflammation.
Inflammatory cells arrive to clear damaged tissue and prepare for rebuilding. The inflammation causes hyperpigmentation in two ways:
- It turns up activity of melanocytes, the cells that make the pigment melanin.
- It disrupts skin cells, making them leak melanin.
Melasma is brown-grey discoloration that comes up on the face. It’s especially common in women of color.
Experts don’t know exactly why it happens, but it’s likely a mix of genetics, sun exposure, and hormones.
Medications are the cause of hyperpigmentation about 10% to 20% of the time.
The color and pattern of the pigmentation vary. Some examples include:
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Tetracycline antibiotics, specifically minocycline (Minocin)
- Phenytoin (Dilantin, Phenytek)
- Anti-malaria medicines: chloroquine (Aralen) and hydroxychloroquine (Plaquenil)
- Amiodarone (Pacerone)
- Blood pressure medicines: diltiazem (Cardizem), hydrochlorothiazide (Microzide), and amlodipine (Norvasc)
- Psychotropic medicines: chlorpromazine (Thorazine), tricyclic antidepressants
Hyperpigmentation in the skin can rarely be a sign of a medical problem:
- In acanthosis nigricans, people get dark, velvety patches on the back of the neck or in the armpits. It can be a sign of pre-diabetes or even cancer.
- Hemochromatosis causes the body to absorb too much iron. The first sign is often bronzing or darkening of the skin, especially in sun-exposed areas.
- In Addison’s disease, people don’t make enough of the stress hormone cortisol. To tell the body to make more, the pituitary gland produces a signal called ACTH. ACTH causes the skin to darken in sun-exposed areas, over joints, on scars, in nails, and in the mouth. The color change is often the first sign of the condition.
- Vitamin deficiencies in B12 or folate can also cause hyperpigmentation.
Why is hyperpigmentation more common in people of color?
Darker skin makes pigment more readily than lighter skin. Pigment-producing cells, called melanocytes, make more melanin in response to sun exposure, skin injury, and inflammation.
Other skin cells, called keratinocytes, hold the melanin that gives us our skin tone. If disrupted, these cells release the pigment below the surface of the skin to cause hyperpigmentation.
Melasma is a type of hyperpigmentation that affects women 90% of the time. It’s linked to genetics, sun exposure, and hormones. Female hormones present in the skin itself play a role in the darkening.
Women of color have more pigment in the skin at baseline as well as female hormones, making them especially prone to melasma.
Can I prevent hyperpigmentation?
If you’re prone to hyperpigmentation, there is no way to completely prevent it. But you can take measures to minimize it.
First, it’s important to address any inflammation in the skin right away. If you have a rash or breakouts, getting treatment early can help lessen the aftermath of hyperpigmentation.
Scratching, rubbing, and friction add to inflammation and can darken the skin over time. Avoid irritating products and aggressive scrubbing.
Perhaps the best thing you can do is to protect your skin. Ultraviolet rays from the sun and high-energy visible light (blue light) that comes from devices can worsen hyperpigmentation.
Use a mineral sunscreen with iron oxides to shield your skin from both.
What are the best treatment options for hyperpigmentation for women of color?
If you have hyperpigmentation, the first step is to find out why. The only way to get lasting results is to address the root cause.
Beyond that, there are three ways to fade the dark spots and even the skin: skin protection, medications, and procedures.
It’s important to protect your skin from the darkening effects of the sun and blue light. This is best done with a mineral sunscreen that contains iron oxides.
Several medications can help hyperpigmentation. The best option will depend on how widespread the issue is, how sensitive your skin is, and if you’re pregnant, planning, or nursing.
Often, you’ll get best results by combining, alternating, or rotating them. Here are some medications that may help.
Hydroquinone works by blocking the enzyme that makes pigment. It has the potential to damage pigment-producing cells. Creams that contain hydroquinone 2% are available over the counter. The typical prescription strength is hydroquinone 4%.
Higher strengths are available at compounding pharmacies. A combination product called Triluma contains hydroquinone 4% along with a light steroid and tretinoin.
Arbutin is a milder form of hydroquinone that’s plant derived. It blocks the pigment-making enzyme without damaging cells. Arbutin-based products are available over the counter.
Retinoids are derived from vitamin A, and they work by increasing skin turnover and dispersing pigment. Retinoids are available by prescription. The lighter version, called retinol, is available over the counter.
Alpha hydroxy acids
All are available over the counter, with the exception of azelaic acid 15%, which is by prescription.
Tranexamic acid can be taken as a pill or applied as a topical to improve melasma. It’s an option for people who don’t see improvement with other forms of therapy. The pill version has been called a “game changer” by a leading American dermatology journal.
However, there’s a higher risk of blood clots in people who take tranexamic acid. Your doctor will screen you for risk factors before prescribing it.
Cosmetic dermatology procedures can help even skin tone faster. These include:
- Microdermabrasion: Uses a rough crystal to gently exfoliate the outer, dead skin cell layer. Helps with penetration of topicals that improve skin tone.
- Chemical peels: Chemicals applied to the skin exfoliate the outer layers to reveal the more even skin from below.
- Lasers: Lasers that target pigment can be helpful for treating hyperpigmentation.
How long does hyperpigmentation take to go away?
The most important thing is to identify the root cause and address it early.
Once the hyperpigmentation is there, combining adequate sunscreen, medications and procedures will work fastest.
The bottom line
Hyperpigmentation is a common and especially troublesome issue for women of color. Improving it starts with understanding the root cause, protecting the skin, and exploring treatment options to even the pigment.
Written by Dr. Maryann Mikhail, MD via GoodRX