Editing Hyperpigmentation

{{Short description|Darkening of an area of skin or nails due to increased melanin}}
{{Use dmy dates|date=April 2025}}
{{Infobox medical condition
| name            = Hyperpigmentation 
| image           = Familial acanthosis nigricans2.jpg 
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| field           = [[Dermatology]] 
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| causes          = Melanogenesis
| risks           = 
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}}{{Lead rewrite|date=February 2025}}
'''Hyperpigmentation''', also known as the '''dark spots or circles''' on the skin, is the darkening of an area of [[Human skin|skin]] or [[nail (anatomy)|nails]] caused by increased [[melanin]].

==Causes==
[[File:BlackChicken.jpg|thumb|The distinctive solid black colour of the [[Ayam Cemani]] (rooster shown) chicken breed is due to hyperpigmentation, with the bird's feathers, skin, beak, and internal organs all being affected.]]
Hyperpigmentation can be caused by sun damage, [[inflammation]], or other skin injuries, including those related to [[acne vulgaris]].<ref>{{cite web | url = https://www.aocd.org/skin/dermatologic_diseases/hyperpigmentation.html | title = Hyperpigmentation | publisher = American Osteopathic College of Dermatology | work = Dermatalogic Disease Database | access-date = 2006-03-08}}</ref><ref name="Bolognia">{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref><ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. {{ISBN|0-7216-2921-0}}.</ref>{{rp|854}} People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.<ref name="Chandra2012">{{cite journal|last1=Chandra|first1=M|last2=Levitt|first2=J|last3=Pensabene|first3=CA|title=Hydroquinone therapy for post-inflammatory hyperpigmentation secondary to acne: not just prescribable by dermatologists|journal=Acta Dermato-Venerologica|date=May 2012|volume=92|issue=3|pages=232–5|doi=10.2340/00015555-1225|pmid=22002814|doi-access=free}}</ref>

Many forms of hyperpigmentation are caused by an excess production of melanin.<ref name="Chandra2012"/> Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by [[melanocytes]] at the lower layer of the [[epidermis]]. Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair. The process of melanin synthesis (melanogenesis) starts with the oxidation of {{sm|l}}-tyrosine to [[L-DOPA|{{sm|l-dopa}}]] by the enzyme [[tyrosine hydroxylase]], then to [[L-dopaquinone|{{sm|l}}-dopaquinone]] and [[dopachrome]], which forms melanin.<ref name="Kim Kang 2015 pp. 607–612">{{cite journal | last1=Kim | first1=Ji Hye | last2=Kang | first2=Nam Joo | title=Potent whitening effects of rutin metabolites | journal=Korean Journal of Food Preservation | volume=22 | issue=4 | date=2015-07-14 | issn=2287-7428 | doi=10.11002/kjfp.2015.22.4.607 | pages=607–612 | url=http://www.ekosfop.or.kr/archive/view_article?pid=kjfp-22-4-607 | language=la | access-date=2022-03-15| doi-access=free }}</ref>

As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post-inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.<ref>[https://www.beskinformed.com/skin-conditions/how-to-treat-hyperpigmentation/ Hyperpigmentation on Face (Acne Scars) ] ''Hyperpigmentation, Dark Spots, Acne Scars, Meladerm''.</ref>

===Diseases and conditions===
Hyperpigmentation is associated with a number of diseases or conditions, including the following:

*[[Addison's disease]] and other sources of [[adrenal insufficiency]], in which hormones that stimulate melanin synthesis, such as [[melanocyte-stimulating hormone]] (MSH), are frequently elevated.
*[[Cushing's disease]] or other excessive [[adrenocorticotropic hormone]] (ACTH) production, because MSH production is a byproduct of ACTH synthesis from [[proopiomelanocortin]] (POMC).
*[[Acanthosis nigricans]]—hyperpigmentation of [[intertriginous]] areas associated with [[insulin resistance]].
*[[Melasma]], also known as '[[chloasma]]' or the “mask of pregnancy,” when it occurs in pregnant women.— It is a common skin problem that causes dark discolored patchy hyperpigmentation. It typically occurs on the face and is symmetrical, with matching marks on both sides of the face. The condition is much more common in women than men, though men can get it too. According to the [[American Academy of Dermatology]], 90 percent of people who develop melasma are women.<ref>{{cite web | url = https://www.aad.org/public/diseases/color-problems/melasma | title = Melasma | publisher = American Academy of Dermatology, Inc.}}</ref>
*[[Acne vulgaris|Post-acne marks]] from post-inflammatory hyperpigmentation.
*[[Linea nigra]]—a hyperpigmented line found on the [[abdomen]] during [[pregnancy]].
*[[Peutz–Jeghers syndrome]]—an [[autosomal dominant]] disorder characterized by hyperpigmented [[macules]] on the lips and oral mucosa and gastrointestinal [[polyp (medicine)|polyps]].
*Exposure to certain chemicals such as [[salicylic acid]], [[bleomycin]], and [[cisplatin]].
*[[Smoker's melanosis]]
*[[Coeliac disease]]
*[[Cronkhite–Canada syndrome]]
*[[Porphyria]]
*[[Tinea]] fungal infections such as [[ringworm]].
*[[Haemochromatosis]]—a common but debilitating genetic disorder characterized by the chronic accumulation of [[Iron (element)|iron]] in the body.
*[[Mercury poisoning]]—particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.
*[[Aromatase deficiency]]
*[[Nelson's syndrome]]
*[[Graves' disease]]
*Schimke immunoosseous dysplasia (SOID).<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/4984/schimke-immunoosseous-dysplasia|title=Schimke immunoosseous dysplasia {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|access-date=2019-03-13|archive-date=2017-10-25|archive-url=https://web.archive.org/web/20171025181658/https://rarediseases.info.nih.gov/diseases/4984/schimke-immunoosseous-dysplasia|url-status=dead}}</ref>
*As a result of [[tinea cruris]].
* Due to [[B12 deficiency]].<ref>{{Cite journal| title=Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link, Rajendran Kannan, MB BS MD| year=2008| pmc=2294086| last1=Kannan| first1=R.| last2=Ng| first2=M. J.| journal=Canadian Family Physician| volume=54| issue=4| pages=529–532| pmid=18413300}}</ref>
* [[Atopic dermatitis]] as a result of inflammation.<ref>{{Citation |last1=Lawrence |first1=Elizabeth |title=Postinflammatory Hyperpigmentation |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK559150/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32644576 |access-date=2022-03-27 |last2=Al Aboud |first2=Khalid M.}}</ref>

Hyperpigmentation can sometimes be induced by [[dermatological]] [[laser]] procedures.

==Diagnosis==

* Skin examination including [[Wood's lamp]] examination.
* Viewing [[medical history]].

==Treatment==
There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.<ref name=Gupta2005rev>{{cite journal|last1=Gupta|first1=AK|last2=Gover|first2=MD|last3=Nouri|first3=K|last4=Taylor|first4=S|title=The treatment of melasma: a review of clinical trials.|journal=Journal of the American Academy of Dermatology|date=December 2006|volume=55|issue=6|pages=1048–65|pmid=17097400|doi=10.1016/j.jaad.2006.02.009}}</ref>

Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.<ref name=":0">{{Cite web|url=https://www.aad.org/media/news-releases/variety-of-options-available-to-treat-pigmentation-problems|title=Variety of options available to treat pigmentation problems {{!}} American Academy of Dermatology|website=www.aad.org|access-date=2017-02-12}}</ref>

===Topical treatments===
Many topical treatments disrupt the synthesis of melanin by inhibiting the enzyme [[tyrosine hydroxylase]].<ref name="Kim Kang 2015 pp. 607–612"/>

Several are prescription only in the US, especially in high doses, such as [[hydroquinone]], [[azelaic acid]],<ref>{{Cite journal|last1=Mazurek|first1=Klaudia|last2=Pierzchała|first2=Ewa|date=2016-09-01|title=Comparison of efficacy of products containing azelaic acid in melasma treatment|journal=Journal of Cosmetic Dermatology|volume=15|issue=3|pages=269–282|doi=10.1111/jocd.12217|issn=1473-2165|pmid=27028014|s2cid=25303091}}</ref> and [[kojic acid]].<ref>{{Cite journal|last1=Monteiro|first1=Rochelle C.|last2=Kishore|first2=B. Nanda|last3=Bhat|first3=Ramesh M.|last4=Sukumar|first4=D.|last5=Martis|first5=Jacintha|last6=Ganesh|first6=H. Kamath|date=2013-03-01|title=A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma|journal=Indian Journal of Dermatology|volume=58|issue=2|pages=157|doi=10.4103/0019-5154.108070|issn=1998-3611|pmc=3657227|pmid=23716817 |doi-access=free }}</ref> Some are available without prescription, such as [[niacinamide]],<ref>{{Cite journal|last1=Hakozaki|first1=T.|last2=Minwalla|first2=L.|last3=Zhuang|first3=J.|last4=Chhoa|first4=M.|last5=Matsubara|first5=A.|last6=Miyamoto|first6=K.|last7=Greatens|first7=A.|last8=Hillebrand|first8=G.G.|last9=Bissett|first9=D.L.|date=2002-07-01|title=The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer|journal=British Journal of Dermatology|volume=147|issue=1|pages=20–31|doi=10.1046/j.1365-2133.2002.04834.x|pmid=12100180|s2cid=39489580}}</ref><ref>{{Cite news|url=https://www.futurederm.com/spotlight-on-niacinamide/|title=Spotlight On: Niacinamide - FutureDerm|date=2007-10-30|newspaper=FutureDerm|access-date=2017-02-12|language=en-US}}</ref> {{sm|l}}-[[ascorbic acid]],{{cn|date=March 2022}} retinoids such as [[tretinoin]],<ref name="Callender Baldwin Cook-Bolden Alexis pp. 69–81">{{cite journal |last1=Callender |first1=Valerie D. |last2=Baldwin |first2=Hilary |last3=Cook-Bolden |first3=Fran E. |last4=Alexis |first4=Andrew F. |last5=Stein Gold |first5=Linda |last6=Guenin |first6=Eric |date=2021-11-09 |title=Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice |journal=American Journal of Clinical Dermatology |publisher=Springer Science and Business Media LLC |volume=23 |issue=1 |pages=69–81 |doi=10.1007/s40257-021-00643-2 |issn=1175-0561 |pmc=8776661 |pmid=34751927}}</ref> or [[cysteamine hydrochloride]].<ref>{{Cite journal|last1=Mansouri|first1=P.|last2=Farshi|first2=S.|last3=Hashemi|first3=Z.|last4=Kasraee|first4=B.|date=2015-07-01|title=Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial|journal=The British Journal of Dermatology|volume=173|issue=1|pages=209–217|doi=10.1111/bjd.13424|issn=1365-2133|pmid=25251767|s2cid=21618233}}</ref><ref>{{Cite news|url=http://www.scientispharma.ch/product/cysteamine-cream/|title=Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment|newspaper=Scientis Pharma|access-date=2017-02-12|language=en-US|archive-date=2016-12-24|archive-url=https://web.archive.org/web/20161224031421/http://www.scientispharma.ch/product/cysteamine-cream/|url-status=dead}}</ref> Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,<ref>{{Cite journal|last=Draelos|first=Zoe Diana|date=2007-09-01|title=Skin lightening preparations and the hydroquinone controversy|journal=Dermatologic Therapy|volume=20|issue=5|pages=308–313|doi=10.1111/j.1529-8019.2007.00144.x|issn=1529-8019|pmid=18045355|s2cid=24913995|doi-access=free}}</ref> and the use of it became more regulated in several countries and discouraged in general by [[World Health Organization|WHO]].<ref>{{Cite book|title=Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization|hdl = 10665/39218|isbn = 9789241571579|publisher = World Health Organization|year = 1994}}</ref> For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.<ref>{{Cite web|url=https://echa.europa.eu/information-on-chemicals/evaluation/community-rolling-action-plan/corap-table/-/dislist/details/0b0236e1807e3dff|title=Hydroquinone - Substance evaluation - CoRAP - ECHA|website=echa.europa.eu|language=en-GB|access-date=2017-02-12}}</ref>

===Oral===
Oral medication with [[procyanidin]] plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.<ref>{{Cite journal|last=Handog|first=Evangeline|date=2009-07-20|title=A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women|journal=International Journal of Dermatology|volume=48|issue=8|pages=896–901|doi=10.1111/j.1365-4632.2009.04130.x|pmid=19659873|s2cid=28886093|doi-access=free}}</ref> Other treatments that do not involve topical agents are also available, including fraction lasers<ref>{{Cite web|url=http://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|title=Laser Skin Whitening - Advantages and Disadvantages {{!}} Skin Whitening News|website=skinwhiteningnews.org|language=en-US|access-date=2017-02-12|date=2014-04-05|archive-date=2021-09-19|archive-url=https://web.archive.org/web/20210919172154/https://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|url-status=dead}}</ref> and dermabrasion.<ref name=":0" />

===Laser treatments===
Laser toning using [[Yttrium aluminium garnet|YAG]] lasers<ref name="Kim Suh Choi Jung pp. 1599–1606">{{cite journal | last1=Kim | first1=Young Jae | last2=Suh | first2=Hyun Yi | last3=Choi | first3=Myoung Eun | last4=Jung | first4=Chang Jin | last5=Chang | first5=Sung Eun | title=Clinical improvement of photoaging-associated facial hyperpigmentation in Korean skin with a picosecond 1064-nm neodymium-doped yttrium aluminum garnet laser | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=35 | issue=7 | date=2020-04-17 | issn=0268-8921 | doi=10.1007/s10103-020-03008-z | pages=1599–1606| pmid=32300974 | s2cid=215794622 }}</ref> and [[Intense pulse light|intense pulsed light]] have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation.<ref name="Arora Sarkar Garg Arya 2022 p. ">{{cite journal | last1=Arora | first1=Pooja | last2=Sarkar | first2=Rashmi | last3=Garg | first3=Vijay K | last4=Arya | first4=Latika | title=Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation | journal=Journal of Cutaneous and Aesthetic Surgery | volume=5 | issue=2 | date=2022-01-27 | pages=93–103 | pmid=23060704 | doi=10.4103/0974-2077.99436 | pmc=3461803 | doi-access=free }}</ref>

==See also==
* [[Drug-induced pigmentation]]
* [[Hypopigmentation]]
* [[List of skin conditions]]

==References==
{{Reflist}}

== External links ==
{{Medical resources
|   DiseasesDB     = 24638 
|   ICD10          = L81.0-L81.4 
|   ICD9           = {{ICD9|709.0}} 
|   ICDO           = 
|   OMIM           = 
|   MedlinePlus    = 
|   eMedicineSubj  = 
|   eMedicineTopic = 
|   MeshID         = D017495 
}}
{{Commons category|Hyperpigmentation}}

{{Pigmentation disorders}}

[[Category:Dermatologic terminology]]
[[Category:Medical signs]]
[[Category:Pigmentation]]