Hyperpigmentation is due to the presence of excessive melanin in the skin cells.
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Hyperpigmentation can be due to arises several different causes, some of which include:
- Post-inflammatory hyperpigmentation
- Prolonged heat exposure (i.e., over the lap when constantly using a laptop computer, or when a hot water pad or bottle is applied over a long period of time to some part of the body)
- Melasma, which is a darkening of skin over the forehead and cheeks, which can occur during pregnancy or when using oral contraceptives
- Becker’s nevus
- Certain medications such as minocycline, imipramine, or amiodarone
- Endocrine disease (i.e., Addison’s disease)
- Hemochromatosis or 'bronze diabetes' causes skin darkening in 90% of patients as a result of melanocyte stimulation by iron in the body.
- Tanning due to ultraviolet (UV) or sunlight exposure
- Age spots
- Acanthosis nigricans
After careful questioning about possible causes, such as iron overload or medications causing the skin to darken, some tests may need to be conducted. These can include a skin biopsy, as well as tests that measure both the adrenal and thyroid function.
- Skin lightening creams should be carefully used, not more than 3 weeks at a time. Always test on an inconspicuous area first. Commonly used topical agents include hydroquinone, kojic acid, and retinoids.
- Other non-drug topical agents include licorice, resveratrol, soy, and mulberry.
- Cosmetics to mask a darker area.
- Sunscreen with an SPF of 30 or more to avoid sunburn or further darkening of the skin
- Resurfacing or microdermal abrasion.
- Chemicals like tretinoin peel off the superficial layer of the skin with its contained melanocytes.
- Laser removal of the darkened layer.
- The use of high-intensity light in pulses.
- Fractional photothermolysis.
- Surgery should always be combined with sunscreen use to avoid the recurrence of darkening. After resurfacing procedures, drugs like procyanidin, tranexamic acid, and Polypodium leucotomos should be taken by mouth to prevent hyperpigmentation from recurring.
Support or counseling can also be utilized as required.