Understanding How Hyperpigmentation Affects Black Skin

Melanin is a pigment that’s present in skin. While melanin is found in most skin, skin of color contains higher amounts of melanin than white skin.

In some cases, excess amounts of melanin can form in the skin. This can lead to hyperpigmentation, which is when an area of skin appears darker than the skin that surrounds it.

Your skin consists of different tissue layers. The outermost layer is the epidermis. The dermis is found deeper in your skin, lying below the epidermis. Hyperpigmentation can affect the epidermis, the dermis, or both.

Generally speaking, epidermal hyperpigmentation is easier to treat, although it may take several months to see improvement. Dermal hyperpigmentation is more difficult to treat and, in some cases, can be permanent.

Hyperpigmentation is common in Black skin. In fact, it’s one of the top five most commonly diagnosed skin conditions in Black people.

While hyperpigmentation is physically harmless, it’s typically more severe and longer-lasting in Black skin. Because of this, it can cause a high degree of psychological stress and impact quality of life. This is why effective treatment is important.

Hyperpigmentation will appear as a mark, spot, or area that’s noticeably darker than your surrounding skin. The exact color of a hyperpigmented spot can depend on what’s causing it to occur, as well as on your individual skin tone.

Generally speaking, you can look out for spots that appear:

• tan
• brown
• dark brown
• grey-brown
• blue-grey
• purple
• black

The images below show various examples of what hyperpigmentation can look like on Black skin.

You’ll typically see a dermatologist for hyperpigmentation. This is a type of doctor that specializes in diagnosing and treating various skin conditions.

The first step will involve collecting your medical history. The dermatologist may ask about:

• any existing health conditions you may have, particularly those impacting the skin
• if you’re currently taking any medications or supplements
• your lifestyle habits, like whether or not you use sun protection
• when exactly the hyperpigmented spots appeared
• which treatments you’ve already tried, if any

After taking your medical history, your dermatologist will examine the affected area. This is typically enough to diagnose hyperpigmentation, but your dermatologist may also perform an examination using a black light.

This exam is called a Wood’s lamp examination and may be used to help diagnose skin disorders like infections, vitiligo, or other hyperpigmentation. A Wood’s lamp exam can also help determine which layers of skin are affected by hyperpigmentation.

If the cause of the hyperpigmentation is unclear from an examination of your skin, your dermatologist may perform a skin biopsy. During this procedure, a small skin sample is collected and evaluated under a microscope.

Now let’s take a look at how hyperpigmentation on Black skin may be treated.

Treating underlying conditions

Some skin conditions, like acne and psoriasis, can contribute to the development of hyperpigmentation. Because of this, treating these conditions is important for slowing or stopping the appearance of new dark spots.

Your dermatologist will work with you to diagnose and set up a treatment plan that’s appropriate for your specific condition. It’s important that you stick to this plan to prevent the occurrence of additional hyperpigmented spots.

Evaluating medications

It’s possible for some medications to cause hyperpigmentation. If this is the case, your dermatologist may recommend a different dose or an alternative medication.

It’s important to never stop or adjust a medication unless you’re under the supervision of a doctor. Doing so could potentially be harmful to your health.

Daily sunscreen

Your skin cells produce additional melanin in order to better absorb harmful UV rays. This means that exposure to sunlight can make dark spots even darker. Because of this, using sunscreen is vital in treating hyperpigmentation.

If you have hyperpigmentation, follow the sunscreen tips below:

• Plan to apply sunscreen prior to going outside each day, regardless of the weather.
• Select a sunscreen that offers broad-spectrum (UVA and UVB) protection and has an SPF of 30 or higher.
• Use sunscreen on all areas that aren’t covered by clothing, making sure to apply it 15 to 30 minutes before going outside.
• Reapply sunscreen every 2 hours.

In addition to wearing sunscreen daily, it’s also important to practice sun avoidance behaviors during treatment. Some examples include:

• avoiding being outside when the sun is strongest
• seeking shade where possible
• choosing clothing that can protect from the sun, like wide-brimmed hats, long sleeves and pants, or sunglasses

Skin-lightening products

Skin-lightening products can be applied directly to existing dark spots, helping to lighten them. They work by slowing the production of melanin so that hyperpigmented spots slowly fade to match your surrounding skin.

You can find some skin-lightening products over-the-counter (OTC), while others need to be prescribed by a dermatologist.

Hydroquinone is the “gold standard” topical skin-lightener for hyperpigmentation treatment. Some examples of others that may be used include:

• mequinol
• retinoids, like tretinoin and adapalene
• azelaic acid
• kojic acid
• niacinamide
• vitamin C

Often, a combination of topical products is used for treating hyperpigmentation. An example of such a combination is:

• hydroquinone
• a retinoid
• a corticosteroid

Topical corticosteroids can help lessen the amount of skin irritation caused by skin-lightening products. But they should only be used for a short time. This is because they can lead to skin thinning or discoloration.

Other treatments

Additional treatments may also be used for hyperpigmentation. This is particularly true if hyperpigmentation is hard to treat with sunscreen and topical skin-lighteners alone.

But these treatments must always be performed carefully and under the supervision of a dermatologist, particularly in individuals with dark skin tones. This is because they may increase the risk of skin irritation or post-inflammatory hyperpigmentation.

• Chemical peels. Chemical peels are applied topically. They work by gradually removing cells in the epidermis that contain excess melanin. Some examples of chemical peels include glycolic acid and salicylic acid.
• Laser treatment. In laser treatment, a laser of a specific wavelength is directed at areas of hyperpigmentation. The energy from the laser works to destroy cells that contain pigment, lightening the skin.

A variety of things can cause hyperpigmentation to happen in people of color. Let’s explore some of them now.

Post-inflammatory hyperpigmentation

Having an injury or an inflammatory skin condition can lead to hyperpigmentation in Black people. This is called post-inflammatory hyperpigmentation (PIH).

PIH has many potential causes, including:

• acne
• pseudofolliculitis barbae
• eczema
• contact dermatitis
• psoriasis
• lichen planus
• lupus
• infections that cause rashes, blisters, or sores
• insect bites
• cuts
• burns
• some cosmetic procedures

PIH appears at the site of injury or inflammation. For example, you may notice that darker spots appear on your skin after acne heals.

Melasma

Melasma is a condition where larger areas of hyperpigmentation appear. This typically happens on the face and can appear on the:

• forehead
• nose
• cheeks
• jawline
• chin

Melasma can also happen on the neck, arms, and chest. But this is less common.

Hyperpigmented areas in melasma typically have an irregular border. They’re also symmetrical, impacting both sides of the body.

It’s still unknown what exactly causes melasma. Some factors that are believed to contribute to it are:

• frequent exposure to sunlight
• genetic factors
• hormonal changes, like those due to pregnancy or taking birth control pills
• certain types of medications or cosmetics

Periorbital hyperpigmentation

Periorbital hyperpigmentation (POH) is when hyperpigmentation happens around your eyes. People with this condition have dark spots around their eyes that can sometimes give them a tired appearance.

Some potential causes of POH are genetic factors, swelling around the eyes, or anatomical changes around the eyes. Post-inflammatory hyperpigmentation can also lead to POH, particularly after a flare-up of eczema or contact dermatitis.

Acanthosis nigricans

Acanthosis nigricans leads to hyperpigmentation that affects areas like the armpit, neck, and groin. The skin in the affected area may also have:

• thickening
• itching
• skin tags
• an unpleasant odor

There are several potential causes of acanthosis nigricans. These include:

• having obesity
• type 2 diabetes
• conditions that affect hormone levels, like polycystic ovary syndrome (PCOS) or thyroid disease
• certain medications, like birth control pills and corticosteroids
• cancer, particularly in the stomach

You can follow the tips below to help prevent hyperpigmentation:

• Use sun protection. UV rays can cause damage to skin of all colors, potentially affecting pigmentation. When you’re going to be out in the sun, plan to wear sunscreen, stay in the shade, and wear protective clothing.
• Avoid irritants. Aim to avoid using any cosmetic or personal care products that cause skin irritation or inflammation.
• Seek treatment for skin conditions. Treating inflammatory skin conditions like acne and eczema can help prevent new dark spots from forming.
• Take all medications as directed. Some health conditions, like psoriasis or lupus, can lead to areas of hyperpigmentation, so always be sure to take all medications for these conditions exactly as directed.

Most of the time, hyperpigmentation will gradually fade. But this can take time, so it’s important to be patient and stick to your treatment plan. Many types of hyperpigmentation will fade in about 6 to 12 months.

But some types of hyperpigmentation may require longer or more intensive treatment. For example, hyperpigmentation that impacts the dermis may take years to fade and, in some cases, can be permanent.

It’s vital to continue to protect yourself from the sun during your treatment. Because sunlight can make an already dark area darker, it’s possible to undo weeks or months of treatment with an afternoon of intense sun exposure.

Hyperpigmentation is when an area of skin becomes darker than the surrounding skin. Some examples of things that can cause hyperpigmentation include, but aren’t limited to, inflammatory conditions, sun exposure, or changes in hormones.

While anyone can experience hyperpigmentation, it’s often more severe or longer lasting in Black skin. This can cause a great deal of stress and may impact quality of life.

The first steps in treating hyperpigmentation typically involve treating underlying conditions, practicing sun avoidance, and using topical skin lighteners. Chemical peels or lasers may be used for hyperpigmentation that’s difficult to treat.

Treatment for hyperpigmentation can take time. It may be several months, or even years, before you see improvement. During this time, it’s important to stay patient and stick to your treatment plan.