Hyperpigmentation is any area of skin that has become darker than the surrounding skin. The most common forms are melasma (symmetric brown patches on the cheeks, forehead, and upper lip driven by hormones and sun), post-inflammatory hyperpigmentation after acne or injury, sun spots, and drug-induced pigmentation, including the darkening of skin, nails, and mouth that can follow chemotherapy. Pigment disorders are more common and more visible in skin of color and require treatment tailored to skin tone.

What causes hyperpigmentation?

Sun and visible light, hormones (pregnancy, oral contraceptives), inflammation, and medications including certain chemotherapies, antimalarials, and minocycline. Melasma has a strong genetic component and is worsened by heat and light, which is why it recurs each summer without protection.

How is melasma different from other dark patches?

Melasma is symmetric, has a mottled or geographic pattern, and sits on the sun-exposed center of the face. It is chronic and controlled rather than cured. Post-inflammatory marks follow a prior breakout or rash; sun spots are discrete and appear with age; drug pigmentation often involves the nails or mucosa.

How is hyperpigmentation treated?

Broad-spectrum, tinted sunscreen every day is the foundation; iron oxide in tinted formulas blocks the visible light that drives melasma. Topical regimens combine hydroquinone or non-hydroquinone lighteners, tretinoin, azelaic acid, and tranexamic acid; oral tranexamic acid is used for stubborn melasma. Peels and select lasers are added cautiously, especially in darker skin, where aggressive treatment can worsen pigment.

How Tono treats hyperpigmentation and melasma

Tono's board-certified dermatologists see patients with hyperpigmentation within days, not months, by video visit in 33 states and in person at Tono clinical centers. Our Skin of Color center treats melasma and hyperpigmentation in Black, Hispanic, Asian, South Asian, and Middle Eastern skin, and our oncodermatologists manage chemotherapy-related pigmentation. Regimens are adjusted by photo follow-up between visits. Your visit ends with a written plan, prescriptions sent to your pharmacy, and follow-up scheduled with the same dermatologist. Most insurance is accepted and no referral is required.

When should I see a dermatologist for hyperpigmentation?

See a dermatologist if patches are spreading, if over-the-counter products have not helped after three months or have caused irritation, or if pigmentation began with a new medication.