Hyperpigmentation in Skin of Colour#

Hyperpigmentation is patches of skin that are darker than the surrounding skin. The darkening comes from extra melanin, the pigment your skin makes to protect itself from UV and other stress. When something repeatedly triggers your melanocytes - sun, inflammation, hormones - extra melanin builds up and shows as dark spots or patches.

"Skin of colour" generally refers to Fitzpatrick skin types IV to VI - skin that rarely or never burns and tans easily and deeply. This includes people of African, Hispanic/Latin American, South Asian, East Asian, Southeast Asian, Middle Eastern, and Indigenous backgrounds. These skin types have more active melanocytes, which makes them more prone to hyperpigmentation when irritated.

The Fitzpatrick skin type is a way of classifying skin by how it reacts to sun exposure. There are six types:

• Type I - Very fair, always burns, never tans
• Type II - Fair, usually burns, tans minimally
• Type III - Light to medium, sometimes burns, gradually tans
• Type IV - Olive or light brown, rarely burns, tans easily
• Type V - Brown, very rarely burns, tans easily and deeply
• Type VI - Deeply pigmented brown to black, almost never burns, tans easily

Types IV-VI have more active melanocytes and a higher risk of hyperpigmentation after sun, inflammation, or skin trauma.

Look at two things:

1. How does your skin react to sun without protection? Always burns; usually burns; sometimes burns; rarely burns; almost never burns; never burns.
2. What is your natural skin tone without a tan? Very pale; light; light-medium; olive/light brown; brown; deep brown to black.

Match your most common answer:

• Mostly "always burns / very pale" - Type I
• "Usually burns / light" - Type II
• "Sometimes burns / light-medium" - Type III
• "Rarely burns / olive or light brown" - Type IV
• "Almost never burns / brown" - Type V
• "Never burns / deep brown to black" - Type VI

A clinician can confirm during your consultation.

• Melasma - large, often symmetrical patches on the face, usually triggered by hormones and sun. See Melasma for the dedicated page.
• Post-inflammatory hyperpigmentation (PIH) - dark spots that appear at the site of a previous skin problem (acne, eczema, a cut, an insect bite, a burn). PIH can happen anywhere on the body.
• Sun spots - smaller, well-defined dark spots from cumulative sun exposure.

• Melasma is usually symmetrical, large, on sun-exposed parts of the face (forehead, cheeks, upper lip), and tied to hormones and sun.
• Post-inflammatory hyperpigmentation appears where you previously had a pimple, scratch, rash, or other injury. It tends to be smaller, can be anywhere on the body, and is directly linked to a previous skin event.

There is a genetic component. People of African, Hispanic, South Asian, East/Southeast Asian, and Middle Eastern descent more often have Fitzpatrick IV-VI skin and a stronger melanin response. Melasma in particular runs in families.

• Sun exposure - UV light is the single biggest driver
• Visible light - including blue light from screens (smaller effect, but real in melasma)
• Inflammation or skin injury - acne, eczema, cuts, bug bites, burns, even aggressive cosmetic treatment
• Hormones - pregnancy, birth control, hormone therapy
• Some medications that increase sun sensitivity, such as certain antibiotics, anti-inflammatories, and diuretics

Yes. After a pimple heals, the inflammation can leave a dark spot - this is post-inflammatory hyperpigmentation. It can take months to a year or more to fade on its own, especially without consistent sun protection.

Estrogen and progesterone can stimulate melanocytes to make more pigment. This is why hyperpigmentation - especially melasma - is common during pregnancy, on combined hormonal birth control, and during hormone therapy.

Yes. Hyperpigmentation that develops during pregnancy is sometimes called the "mask of pregnancy" (chloasma). It usually shows up in the second or third trimester and may improve after delivery, though it can persist or recur.

Yes - particularly in skin of colour. Even small inflammation can leave a dark spot at the site. Avoiding scratching, picking, and aggressive scrubbing helps.

A lot. UV light is the most consistent driver. Even short, daily sun exposure (the walk to work, lunch outdoors) accumulates. Daily broad-spectrum sunscreen is one of the most effective things you can do.

• Daily broad-spectrum sunscreen (SPF 30+) - including on cloudy days and in winter. Tinted formulas with iron oxide also block visible light, which is relevant for melasma in skin of colour.
• Do not pick, scratch, or aggressively exfoliate - this is the most common avoidable trigger for new dark marks.
• Treat acne, eczema, and other inflammation early - the less and shorter the inflammation, the less hyperpigmentation afterwards.
• Gentle skincare - avoid harsh acids, scrubs, and fragranced products if your skin is already sensitive.

Yes. Tinted mineral sunscreens (containing iron oxide alongside zinc oxide or titanium dioxide) blend into deeper skin tones without the chalky/grey cast, and they also block visible light - useful for melasma and post-inflammatory hyperpigmentation on the face.

• Hat and sun-protective clothing when outdoors for extended periods
• Avoid peak UV hours (roughly 10 AM to 4 PM) when possible
• Manage acne, eczema, and folliculitis early to limit dark marks afterwards
• Use a daily moisturizer to keep the skin barrier healthy

You can reduce them. Do not squeeze or pick, treat the active acne with an appropriate regimen, wear sunscreen daily, and consider gentle pigment-supportive ingredients such as topical niacinamide (over the counter) or a clinician-prescribed regimen for stubborn dark marks.

• Prescription brightening creams - reduce how much melanin your skin makes. Used in short courses with breaks, typically up to 12 weeks at a time. See Prescription brightening creams.
• Anti-inflammatory brightening creams - calm inflammation, fade dark marks, and reduce small bumps. Can be used long-term. See Anti-inflammatory brightening creams.
• Prescription retinoids - speed up skin-cell turnover so pigmented cells are replaced faster. Not safe in pregnancy.
• Antioxidants - the most common is topical vitamin C; helps neutralize UV-driven oxidative stress.
• Niacinamide - well-tolerated, helps with mild dark marks and supports the skin barrier; safe in pregnancy.
• Triple-therapy compounded creams - combine a prescription retinoid, a prescription brightening agent, and a mild prescription steroid. Faster than single agents but used for time-limited courses. See Triple therapy for pigmentation.
• AHA and BHA exfoliating products - alpha-hydroxy acids and beta-hydroxy acids can help with fading surface pigment as part of a routine. See Alpha-hydroxy acid (AHA) treatments and Beta-hydroxy acid (BHA) treatments.

Daily sunscreen is part of every topical regimen - without it, the gains plateau or reverse.

Most show meaningful change at 8 to 12 weeks of consistent daily use, with continued improvement over several months. Stubborn or deeper pigment can take longer. Results plateau without daily sunscreen.

Yes - as a supportive or maintenance layer. Topical niacinamide and topical vitamin C are common over-the-counter ingredients that can help with mild dark marks and maintain results after a prescription course. They are slower than prescription regimens.

Stronger actives applied too aggressively can themselves cause inflammation, which in skin of colour can lead to new post-inflammatory hyperpigmentation - the opposite of what you want. Starting at a lower strength, building tolerance, and using a barrier-supporting moisturizer reduces this risk.

Mild to medium-depth peels are generally safe in skin of colour when done by an experienced provider. Deeper peels carry a higher risk of post-inflammatory hyperpigmentation, burns, or lighter patches in Fitzpatrick IV-VI and should be approached with caution.

Common safer options include peels using alpha-hydroxy acids or beta-hydroxy acids at appropriate strengths.

No - peels are an in-person procedure. The clinician can give you a written, unbiased overview of what type of peel is reasonable for your skin type and what to ask about when you book.

• Non-ablative fractional lasers - generally the safer category in skin of colour; they treat below the surface without removing the top layer.
• Q-switched lasers - can target pigment particles; useful in selected cases.
• Ablative fractional lasers (CO2, erbium) - remove layers of skin and carry higher risk of darkening, scarring, or lighter patches in Fitzpatrick IV-VI; used with caution and only by experienced operators.

They deliver heat to the deeper layers of skin without removing the surface. The skin's natural healing response stimulates new tissue and reduces pigment. Because the top layer is left intact, the recovery is faster and the risk of new dark spots is lower.

Ablative lasers (CO2, erbium) remove the outer layer of skin in a controlled way. The healing process replaces it with newer skin and can improve pigmentation, scarring, and texture. The trade-off is more downtime and a higher risk - in skin of colour - of post-inflammatory hyperpigmentation, scarring, or lighter patches.

Generally a reasonable candidate if:

• Topical treatments and sunscreen have not been enough
• A clinician experienced in skin of colour has evaluated your skin
• You can commit to daily sunscreen and the post-procedure care

• Numbing cream is applied
• The device is passed over the treatment area
• You may feel tingling or mild stinging
• Afterwards, the area may be red, mildly swollen, or temporarily darker as the pigment heals

Most laser regimens use 3 to 5 sessions, spaced 4 to 6 weeks apart. Dark spots may initially look darker or scab as they clear. Final results show over weeks to months.

• Daily broad-spectrum sunscreen (SPF 30+)
• Follow the provider's post-treatment skincare regimen
• Avoid exfoliants, scrubs, and strong actives during recovery
• Avoid direct sun for several weeks

Yes - laser is often paired with topical regimens, mild peels, or microneedling. Timing matters: combinations should be sequenced under the supervision of the in-person provider performing the laser.

• Post-inflammatory hyperpigmentation - new dark spots after laser
• Lighter patches - particularly with deeper ablative lasers
• Scarring or texture changes - rare, but more common with incorrect settings

The single biggest risk-reducer is choosing a provider who has documented experience treating Fitzpatrick IV-VI skin.

Without treatment, post-inflammatory hyperpigmentation can take 6 to 12 months or longer to fade on its own. With consistent sunscreen and a topical brightening regimen, most people see meaningful improvement at 8 to 12 weeks and continued fading over the following 3 to 6 months.

For mild post-inflammatory hyperpigmentation, complete fade is possible with treatment and sun protection. For melasma and deeper pigmentation, complete clearance is less common - meaningful improvement and maintenance is the more realistic goal.

In skin of colour, avoid:

• Harsh physical scrubs
• High-strength AHA peels at home unless guided by a clinician
• Hot showers and harsh facial cleansing
• Picking, squeezing, or aggressive extraction of pimples
• Multiple new actives started in the same week (introduce one at a time)

Home rollers and pens carry a higher risk of injury, infection, and new dark marks in skin of colour. Microneedling, if you want it, is better done in an in-person clinic by a provider experienced with darker skin.

Tinted mineral sunscreen with iron oxide (which gives it a slight tint) is the best choice for skin of colour and melasma. The iron oxide blocks visible light in addition to UV. Look for non-comedogenic formulas if you are also acne-prone.

Sometimes. Stronger prescription treatments can work well in skin of colour when introduced slowly and paired with barrier-supporting moisturizer and daily sunscreen. The key is gradual titration - not "go hard from day one".

Treat the acne first. Once the acne is controlled, the dark marks will start to fade on their own. A TeleTest cosmetic-dermatology consultation can prescribe a combination plan that treats acne and post-inflammatory hyperpigmentation at the same time.

For most cosmetic hyperpigmentation, topical treatment plus sunscreen is the foundation. Oral options are sometimes discussed in specialist clinics for certain situations, but for the typical cosmetic-dermatology consultation TeleTest's plans are topical. The clinician will let you know if your situation is one where oral treatment should be discussed with a different specialist.

Once your initial plan is working, a check-in every 3 to 6 months is reasonable to adjust the routine, refresh maintenance, or address any new concerns. Sooner if a new dark spot appears or if you notice an unusual change in your skin.

Sometimes a brightening regimen can lighten the area around the dark spot more than expected, creating new unevenness. Apply more precisely (only to the dark patch, not surrounding skin), reduce the frequency, and message your TeleTest clinician to adjust the plan.

Yes. Tinted mineral sunscreens often double as light coverage. For more coverage, choose foundation labelled non-comedogenic and applied gently - aggressive rubbing during application or removal can worsen hyperpigmentation.

For typical post-inflammatory hyperpigmentation and stable melasma, a TeleTest consultation is enough. See an in-person dermatology or cosmetic clinic (which you would arrange yourself - TeleTest does not arrange referrals) if you are considering laser, if the diagnosis is uncertain, or if a topical regimen has not worked after several months of consistent use.

Cosmetic dermatology consultations and most prescription cosmetic creams (especially compounded ones) are not covered under provincial health plans - they are self-pay. Some private drug plans cover compounded prescriptions in whole or in part.

• Start with an OTC routine (vitamin C, niacinamide, sunscreen) for mild dark marks before moving to prescription
• Price-shop two or three compounding pharmacies before filling a prescription
• If you live in Ontario, the TeleTest home-delivery partner (Pace Pharmacy) ships at pharmacy prices with no markup - worth comparing