Understanding Hyperpigmentation: Causes, Types & the Power of Medical-Grade Skincare
by Dr Caroline Warden NHS GP, cosmetic dermatology and aesthetic doctor in Hale, Cheshire
Concerns over Hyperpigmentation is one of the most common skin concerns I see in my Hale, clinic. It can show up as dark patches, post-acne marks, or general unevenness that makes skin look tired or blotchy, even when it’s perfectly healthy underneath. I personally have struggled with this post pregnancy and after having acne.
There is good news though!
Pigmentation can be treated safely and effectively when we identify why it’s happening and use evidence-based medical skincare tailored to your skin type and lifestyle.
In this guide, I’ll walk you through the science behind pigmentation, the most common causes, a real case study from my Hale clinic, and my honest thoughts on the Obagi Nu-Derm System and hydroquinone.
What Is Hyperpigmentation?
Hyperpigmentation means there’s more melanin (your skin pigment) in one area than another. Melanin is produced by cells called melanocytes to protect your skin from UV and visible light BUT when those cells become overstimulated, pigment collects unevenly.
Depending on where the pigment sits, it can be:
Epidermal: in the top layer (easier to treat, responds faster)
Dermal: deeper in the skin (more stubborn and slower to shift)
The Main Causes
1. Sun and visible light exposure
The number-one driver of pigmentation worldwide. Even indoor lighting and device screens emit visible light that can worsen hyperpigmentation, particularly in darker skin tones.
2. Hormones
Oestrogen and progesterone can overactivate melanocytes, leading to melasma which is especially during pregnancy or when using hormonal contraception.
3. Inflammation and injury
Acne breakouts, eczema, waxing, and even scratches can leave dark marks as the skin heals known as post-inflammatory hyperpigmentation (PIH) which is worse in darker skin tones.
4. Age and cumulative UV damage
Years of unprotected sun exposure can lead to solar lentigines (“sun spots”), most often on the face and hands.
5. Medication and systemic illness
Certain antibiotics, antimalarials, and metabolic conditions can occasionally cause diffuse pigmentation changes.
The Different Types of Hyperpigmentation
Post-Inflammatory Hyperpigmentation (PIH)
Those stubborn marks left behind after acne, eczema, or injury. They’re not scars but just overactive pigment cells reacting to inflammation.
Treatment: hydroquinone, azelaic acid, retinoids, kojic acid, niacinamide, and SPF 50 daily. Gentle chemical peels or microneedling (once skin is calm) can help accelerate fading.
Melasma
Melasma typically shows as symmetrical brown or grey-brown patches across the cheeks, forehead, or upper lip. It’s strongly hormone- and heat-triggered, so it flares easily.
Treatment: short courses of combination therapy (often including hydroquinone and tretinoin), oral or topical tranexamic acid (in suitable patients), and strict broad-spectrum sun protection with iron-oxide-based tinted SPF to block visible light.
Solar Lentigines (“Sun Spots”)
These are discrete, flat, darker patches from long-term UV exposure.
Treatment: brightening agents, consistent SPF, and (if appropriate) targeted in-clinic treatments like chemical peels or light-based devices.
Case Study: “Sofia’s Skin Transformation”
Background:
Sofia, aged 43, came to our Hale clinic concerned about dark patches across her cheeks and upper lip that developed after pregnancy. She also had a few lingering acne marks.
Assessment:
Symmetrical brown patches (melasma) plus post-inflammatory marks (PIH). Fitzpatrick IV skin type which meant a higher melanin baseline and a tendency to pigment after inflammation.
Plan:
1️⃣ Photoprotection: daily broad-spectrum SPF 50 with iron oxide; reapply midday.
2️⃣ Topical course (12 weeks):
- Hydroquinone 4% under medical supervision.
- Tretinoin 0.05% at night for cell turnover and penetration.
- Supportive actives: vitamin C 15% AM, a gentle cleanser and barrier-supporting moisturiser.
3️⃣ Lifestyle: reduce heat exposure, avoid fragrance scrubs, manage stress and sleep.
4️⃣ Maintenance: reduce frequently of hydroquinone after 12 weeks; continue retinoid and never skip SPF.
Outcome:
At 16 weeks, her pigmentation had lightened by around 70%. The biggest difference came from consistency, particularly with sunscreen and gentle maintenance once the intensive phase ended.
The Obagi Nu-Derm System
The Obagi Nu-Derm System is one of the most researched, doctor-led pigment correction programmes in medical aesthetics. It combines:
Prescription hydroquinone 4% to suppress overactive melanocytes.
Tretinoin (vitamin A derivative) to speed turnover and enhance penetration.
Supportive skincare: cleanser, toner, exfoliating lotion, moisturiser, and SPF.
The system is designed as a 12–24-week protocol to normalise cell function and even skin tone, followed by a maintenance phase.
Results: Clinical studies consistently show significant improvements in melasma, PIH, and photodamage when used under medical supervision. Patients report smoother texture, clarity, and brightness within 8–12 weeks.
Supervision matters: Because hydroquinone and tretinoin are potent actives, it’s essential that the treatment is guided by a doctor to monitor tolerance, adjust strength, and prevent irritation or rebound.
Hydroquinone: The Gold Standard (When Used Properly)
Hydroquinone remains the benchmark ingredient for targeted pigment suppression.
How it works
It blocks tyrosinase, the enzyme your skin uses to make melanin, effectively “turning down” pigment production while other skin cells renew.
Evidence & effectiveness
Countless studies show 4% hydroquinone outperforms most non-prescription brighteners for melasma and PIH, particularly when combined with retinoids.
How to use it safely
Short courses (8–12 weeks) under medical supervision.
Apply to affected areas only.
Reduce to maintenance afterwards.
Daily SPF 50 is essential to prevent rebound.
Side effects (rare but possible)
Temporary redness, dryness, or irritation. With long-term unsupervised use, very rare cases of exogenous ochronosis (bluish-grey discolouration) can occur which is why medical oversight is so important.
Summary:
Hydroquinone is incredibly effective but should be respected like any prescription medicine, powerful in skilled hands, problematic if misused.
Non-Hydroquinone Alternatives
For sensitive or maintenance phases, these ingredients can also work well:
Azelaic acid – anti-inflammatory and pigment-reducing; safe in all skin types.
Kojic acid & arbutin – natural tyrosinase inhibitors.
Vitamin C (L-ascorbic acid) – antioxidant that brightens and protects.
Niacinamide – prevents pigment transfer between cells.
Retinoids – improve turnover and enhance efficacy of other actives.
Tranexamic acid – reduces melasma severity via vascular and hormonal pathways.
My Doctor’s Take
At my clinic in Hale, Cheshire I treat hyperpigmentation the same way I approach injectables: with a medical eye, evidence-based products, and a personalised plan.
There’s no one “miracle cream.” Lasting improvement comes from:
Correct diagnosis (melasma vs PIH vs sun damage).
Photoprotection every single day.
Medical-grade skincare designed for your skin.
Professional supervision, so your plan evolves safely.
Frequently Asked Questions
Q1: How long does it take to see results?
Usually within 6–8 weeks, with steady improvement up to 12 weeks. Dermal or deeper pigment takes longer.
Q2: Will my pigmentation come back?
It can, particularly melasma. Maintenance products and consistent sunscreen help keep it under control long-term.
Q3: Is hydroquinone safe?
Yes, when used under medical guidance.
Q4: I have darker skin, can I still treat pigmentation?
Absolutely. We tailor actives and treatments carefully to minimise post-inflammatory pigmentation and support barrier health.
Q5: Do I need in-clinic treatments?
Not always. Many patients achieve great results with medical skincare alone. In-clinic treatments like chemical peels can be added once the skin barrier is calm.
Q6: What if my skin is sensitive?
We’ll start gently before introducing stronger actives once your barrier is strong.
Final Thoughts
Hyperpigmentation isn’t something you have to live with. With the right diagnosis, a targeted skincare plan, and consistent SPF, you can achieve clear, even, glowing skin again.
If you’re struggling with dark patches or uneven tone, book a consultation at my clinic in Hale, Cheshire where i’ll assess your skin thoroughly, discuss options like Obagi Nu-Derm, and create a plan that’s medically sound, gentle, and effective.
Book now for a consultation
Dr Caroline Warden is an experienced NHS GP and aesthetic doctor. She has been a medical doctor for over 18 years. Her main Skin and Aesthetic Clinic is located in Hale, Cheshire but she also runs clinic in Disley, Stockport.
Whether you're new to aesthetic treatments or ready to refine your routine, her bespoke skin assessments are the best place to start. She’ll design a tailored plan based on your skin goals, lifestyle, and timeline.
Book your consultation at the clinic in Hale, Cheshire and experience aesthetic medicine.
You’ll be guided through your medical history, goals, and expectations so you can make an informed choice.
Our main Hale clinic is local To:
Alderley Edge, Altrincham, Bowdon, Bramhall, Hale Barns, Knutsford, Manchester, Mobberley, Sale, Timperley, Urmston, Wilmslow, Handforth, Poynton, Cheadle, Didsbury, Warrington
Our satellite Disley clinic on Thursday nights at Scott, Skin & Co, is local to:
New Mills, High Lane, Marple, Mellor, Whaley Bridge, Hayfield, Stockport
