What should you know about severe hyperpigmentation?

Hyperpigmentation is darkening caused by increased or uneven melanin in the skin. It can follow acne, eczema, burns, shaving irritation or other inflammation. Sun and visible light can deepen some patches, while medicines, hormonal changes and certain medical conditions can also alter pigment. The colour, border, location and timing help a clinician narrow the possibilities. A new, changing, one-sided or unusual dark mark should not automatically be treated as cosmetic pigmentation; it may need examination first. Darker skin tones can be more prone to prolonged pigment change after irritation, so overly aggressive treatment may worsen the contrast.

Use broad-spectrum sunscreen on exposed areas and reapply as directed, especially outdoors. Avoid picking, harsh scrubs, unregulated lightening products and treatments that sting or burn. Treating an active cause such as acne or dermatitis helps reduce new pigment. A dermatologist may discuss topical hydroquinone, a chemical peel, IPL photofacial, picosecond laser treatment or another skin brightening treatment, depending on the pattern and skin type. These options differ in how deeply they act and can cause temporary irritation or further darkening, so a supervised plan and a test area may be sensible. Improvement is gradual, and maintenance may be needed.

Arrange a dermatology assessment for rapidly changing pigmentation, a mark that bleeds or crusts, persistent itching or pain, or pigment affecting the eyes or mouth. Seek advice when darkening appears suddenly without an obvious skin injury, follows a new medicine, or occurs with other changes in health. Review is also appropriate when pigment worsens after a peel, laser or lightening product.

Ask what is causing the pigment, whether any medicine or active rash needs treatment first, and which option fits your skin type. Ask about preparation, downtime, irritation, sun protection and how recurrence will be managed.