Hyperpigmentation
Hyperpigmentation covers any patch of skin gone darker than the skin around it because melanocytes deposited excess melanin there. It occurs in every skin type and on any part of the body. Three forms account for most of what a dermatologist sees: solar lentigines, the flat brown spots that accumulate on sun-exposed skin over decades; post-inflammatory hyperpigmentation, the stain left behind after acne, a burn, a rash or a procedure; and melasma, the hormonally driven facial patterning that behaves quite differently from the other two. Dr. Julia Tzu examines pigment depth before selecting a wavelength, and treats sun-driven brown spots at the practice's Financial District office with lasers that target melanin selectively, leaving unpigmented skin around the spot untouched.
At a Glance
- Hyperpigmentation occurs when skin cells produce excess melanin, causing darker patches[1]
- Post-inflammatory hyperpigmentation commonly accompanies acne, especially in darker skin tones[2]
- Most dark spots will fade over time after the underlying cause is treated, though it may take many months[1]
- Treatments can take several months to a year to show noticeable improvement[2]
What are the symptoms of Hyperpigmentation?
- Patches or spots darker than surrounding skin
- Flat, darkened areas of various sizes
- Brown, tan, or gray-brown discoloration
- Spots that may enlarge over time
- Clusters of freckle-like spots
- Darkening of areas where skin was injured or inflamed
When should you seek care for Hyperpigmentation?
- Brown or gray patches that bother you cosmetically and have not faded on their own
- A pigmented spot newly appeared, growing, changing color, or looks unlike your others, which needs a cancer evaluation before any cosmetic treatment
- Darkening that appeared where acne, a burn, a rash, or a previous procedure healed
- Facial patterning that arrived during pregnancy or after starting hormonal medication
- Pigment unmoved by over-the-counter lightening products after several months of consistent use
- Any plan to treat pigment with laser, as tanned skin has to be avoided for four weeks beforehand and pigment depth needs assessing first
Have questions about hyperpigmentation? Our team is here to help.
What causes Hyperpigmentation?
- Sun exposure (solar lentigines/age spots)
- Skin injury or inflammation (post-inflammatory hyperpigmentation)
- Hormonal changes (melasma)
- Acne scarring
- Medications causing photosensitivity
- Adrenal disorders
- Vitamin B12 or folic acid deficiency
- Genetic factors
How is Hyperpigmentation treated?
We offer a service to help manage this condition: Laser Treatment.
Prognosis
- Many dark spots fade over time once the cause is addressed
- Sun-related spots may not fade without treatment
- Post-inflammatory hyperpigmentation often improves but can take months to years
- Treatment can significantly lighten most hyperpigmentation
- Ongoing sun protection prevents new spots and recurrence
- Some stubborn pigmentation may require combination treatments
Frequently Asked Questions
What is hyperpigmentation?
Hyperpigmentation is a common skin condition where patches become darker than surrounding skin due to excess melanin production. Common types include sun spots (age spots), post-inflammatory hyperpigmentation from acne or injury, and melasma from hormones. While usually harmless, it can be cosmetically concerning.
What causes dark spots on the skin?
Dark spots develop when skin cells produce excess melanin. Common causes include sun exposure (creating age spots), skin injury or inflammation like acne (post- inflammatory hyperpigmentation), hormonal changes (melasma), certain medications, and genetic factors. The cause determines the best treatment approach.
When should I see a dermatologist about dark spots?
See a dermatologist if dark spots concern you cosmetically, you notice new or changing pigmented areas, spots developed after acne or skin injury, or you want professional treatment options. An in-person evaluation can determine the type of hyperpigmentation and guide appropriate treatment selection.
How is hyperpigmentation treated?
Treatment starts with daily sunscreen to prevent worsening. Options include topical lightening agents (hydroquinone, vitamin C, azelaic acid, retinoids), chemical peels, and laser treatments. Treatment may take months to show results. The underlying cause must also be addressed.
Will dark spots fade on their own?
Some dark spots, especially post-inflammatory hyperpigmentation from acne or injury, may fade over time once the cause is treated. However, this can take months to years. Sun spots often don't fade without treatment. Consistent sun protection helps prevent new spots and speeds fading.
How can I prevent dark spots from forming?
Prevention centers on sun protection: use broad-spectrum SPF 30+ sunscreen daily, reapply every two hours outdoors, wear protective clothing and hats, and avoid tanning beds. Treating underlying conditions like rashes or acne promptly helps prevent post-inflammatory hyperpigmentation. Avoid injuring and picking at skin.
Which type of hyperpigmentation responds best to laser?
Solar lentigines, the flat brown spots from cumulative sun exposure, respond most predictably. Laser energy is absorbed by the melanin in the spot and destroys it while the surrounding unpigmented skin is left alone. Post-inflammatory pigment often fades substantially on its own and is usually approached with topicals first. Melasma is managed with sun protection and topical therapy first.
How long before treated dark spots clear?
Complete clearance normally takes more than one session. Treated spots darken first, then flake away over the following weeks, and healing is generally finished within a few weeks per session. Results from laser brown-spot removal often hold for several years. What determines whether they come back is sun exposure afterwards.
Why is sun avoidance required for four weeks after laser treatment?
Freshly treated skin will lay down new pigment if it is exposed, which produces exactly the dark patch the treatment removed. Sun exposure in the four weeks after a session is the most common reason a good result reverses. Tanned skin before a session is a problem too: the laser cannot distinguish a tan from the target spot.
Can dark spots be a sign of something other than sun damage?
Yes. Adrenal disorders, some medications that cause photosensitivity, and vitamin B12 or folate deficiency all produce pigment changes. Separately, a pigmented lesion that is asymmetric, irregularly bordered, multi-colored, larger than a pencil eraser, or changing needs evaluation for melanoma. All of it is assessed at the appointment before cosmetic treatment is discussed.
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Have questions about hyperpigmentation? Our team is here to help.
Sources & References
This article draws from 4 peer-reviewed sources.
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Medically reviewed by Dr. Julia Tzu, MD, FAAD, FACMS · Last reviewed: 2026-08-19