Deep Dive: Treating Hyperpigmentation
PA-recommended solutions for treating and preventing dark spots
Hyperpigmentation is one of the most common skin concerns, affecting people of all skin tones. Whether caused by sun exposure, acne, hormonal fluctuations, or inflammation, dark spots and uneven skin tone can be frustrating to treat. In my Harvard Health Publishing article, I explored the different types of hyperpigmentation and what causes them. Now, let’s dive deeper into the most effective treatment options—ranging from prescription creams to in-office procedures—recommended by dermatologists to help fade discoloration and restore an even complexion.
Topical Treatments for Hyperpigmentation
1. Prescription Hydroquinone
Hydroquinone has traditionally been considered the gold-standard treatment for hyperpigmentation. This skin-lightening agent works by inhibiting tyrosinase, an enzyme involved in melanin production. Dermatologists often prescribe hydroquinone (usually at 4% or higher) for conditions like melasma, post-inflammatory hyperpigmentation (PIH), and sunspots. However, long-term use should be monitored, as overuse may lead to ochronosis, a paradoxical darkening of the skin. In recent years, the FDA has banned hydroquinone in over-the-counter (OTC) lightening products raising some concern for its safety.
My recommendation: Ask your dermatologist about Rx skin lightening creams such as Tri-Luma and use only as prescribed. These medications can work great, but do carry risks if used inappropriately or for extended periods of time.
2. Retinoids (Retinol, Adapalene, and Tretinoin)
Retinoids accelerate cell turnover, helping to fade hyperpigmentation over time. Prescription-strength options like tretinoin or tazarotene are more potent than over-the-counter retinol, making them effective for stubborn dark spots. They also help prevent new discoloration by improving skin renewal and reducing clogged pores. Retinoids are also a key part of an anti-aging skincare routine.
My recommendation: If you’re looking for an OTC, try DIFFERIN 0.1% ADAPALENE GEL TREATMENT. But if you want something stronger, talk to your dermatologist about Rx strength tretinoin. Apply in the PM 2-3x weekly, increasing use as tolerated.
3. Azelaic Acid
Azelaic acid (available in 15-20% formulations both prescription and OTC) is an excellent option for people with sensitive skin or those prone to post-inflammatory hyperpigmentation. It has both anti-inflammatory and melanin-inhibiting properties, making it ideal for acne-prone skin.
My recommendation: The Ordinary Azelaic Acid 10% Suspension Brightening Cream
4. Vitamin C Serums
A powerful antioxidant, vitamin C (L-ascorbic acid) brightens skin and reduces oxidative stress that can lead to dark spots. Regular use of a stabilized vitamin C serum (10-20%) can help even skin tone and protect against future pigmentation.
My recommendation: SkinCeuticals C E Ferulic Serum - apply in the AM before your sunscreen
5. Niacinamide (Vitamin B3)
Niacinamide is another effective ingredient that helps slow down pigment transfer within the skin. It also strengthens the skin barrier and reduces inflammation, making it a great addition to a hyperpigmentation skincare routine.
My recommendation: La Roche-Posay Mela B3 Dark Spot Serum With Melasylâ„¢ + Niacinamide
6. Kojic Acid and Licorice Extract
Both of these ingredients inhibit tyrosinase activity and can be found in combination products designed to lighten dark spots. Kojic acid is a byproduct of fermentation, while licorice extract contains glabridin, which reduces pigmentation and soothes irritation.
My recommendation: DRMTLGY Hydra-Fader Skin Lightening Treatment
7. Tranexamic Acid
Tranexamic acid (TXA) is an emerging ingredient in hyperpigmentation treatment. Originally used as an oral medication to control bleeding, TXA has been found to inhibit melanin production when applied topically. It is particularly beneficial for melasma and is often combined with other brightening agents for enhanced results. Oral TXA is also prescribed off-label by some dermatologists for treatment of hyperpigmentation.
My recommendation: Topicals Faded Serum for Dark Spots and Discoloration
In-Office Dermatological Treatments
1. Chemical Peels
Professional-grade chemical peels containing glycolic acid, lactic acid, or trichloroacetic acid (TCA) can help exfoliate the skin and fade hyperpigmentation. Superficial peels require minimal downtime, while deeper peels provide more dramatic results but may involve longer recovery periods.
2. Laser Therapy (Fraxel, PicoSure, and Q-Switched Lasers)
Lasers specifically target melanin to break up pigment clusters in the skin. Fraxel laser, for instance, stimulates collagen production while treating sunspots and melasma. Q-switched lasers and PicoSure are excellent for stubborn pigmentation and are often used on darker skin tones, as they minimize the risk of post-inflammatory hyperpigmentation.
3. Intense Pulsed Light (IPL) Therapy
IPL uses broad-spectrum light to target pigmentation and redness. It is highly effective for sun-induced hyperpigmentation but may not be suitable for darker skin tones due to the risk of unwanted pigmentation changes.
4. Microneedling with PRP (Platelet-Rich Plasma)
Microneedling creates micro-injuries in the skin to stimulate collagen production and improve skin texture. When combined with PRP, which is rich in growth factors, microneedling can enhance skin healing and fade hyperpigmentation more effectively.
Preventing Hyperpigmentation: The Role of Sunscreen
Regardless of the treatment method, sunscreen is a non-negotiable part of any hyperpigmentation regimen. UV exposure exacerbates pigmentation and can undo progress made with treatments. Dermatologists recommend using a broad-spectrum sunscreen with SPF 30 or higher, ideally containing zinc oxide or titanium dioxide for optimal protection. Even during the winter months and on cloudy days, sun exposure can prevent you from seeing desired results.
Final Thoughts
Hyperpigmentation can be challenging to treat, but with the right combination of topical treatments and in-office procedures, achieving a more even complexion is possible. The key is patience—many treatments take weeks to months to show visible results. Consulting a dermatologist can help determine the most effective approach for your specific skin type and concerns. Many of the above mentioned OTCs can be effective with time and consistent use. However, prescription options may be stronger and allow for faster results.
References
Nautiyal A, Wairkar S. Management of hyperpigmentation: Current treatments and emerging therapies. Pigment Cell Melanoma Res. 2021;34(6):1000-1014. doi:10.1111/pcmr.12986
Shivaram K, Edwards K, Mohammad TF. An update on the safety of hydroquinone. Arch Dermatol Res. 2024;316(7):378. Published 2024 Jun 8. doi:10.1007/s00403-024-02990-6
US Food and Drug Administration (2022) FDA works to protect consumers from potentially harmful OTC skin lightening products. https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect... . Accessed 10 February 2025
Chen T, Xue J, Wang Q. Tranexamic Acid for the Treatment of Hyperpigmentation and Telangiectatic Disorders Other Than Melasma: An Update. Clin Cosmet Investig Dermatol. 2024;17:2151-2163. Published 2024 Sep 25. doi:10.2147/CCID.S479411
Mahjoub TT, Milibary HH. Oral tranexamic acid in the treatment of hyperpigmentation disorder beyond melasma: A review. J Cosmet Dermatol. 2023;22(4):1157-1162. doi:10.1111/jocd.15561
Gharib K, Mostafa FF, Ghonemy S. Therapeutic Effect of Microneedling with Platelet-rich Plasma Versus Microneedling with Tranexamic Acid for Melasma. J Clin Aesthet Dermatol. 2021;14(8):44-48.