Hypo vs Hyper Pigmentation

Your skin is my canvas, what I do is an art and a science because I work on a living, breathing, multi-colored/tonal canvas. I can do the same thing to 10 people and get 10 different results because everyone’s skin/body/genetic makeup/lifestyle is different and unique. Here is some helpful information regarding skin discoloration issues many face daily and the solutions! Live in the solution.

Definitions & How it Effects My Work:

Hyperpigmentation: A common, usually harmless condition in which patches of skin are darker than the surrounding skin. It occurs when special cells in the skin make too much of the pigment called melanin. Hyperpigmentation may appear as freckles, age spots, or larger areas of darkened skin. Hyperpigmentation may be caused by injury or inflammation of the skin, sun damage, abnormal skin growths, hormone changes, pregnancy, or other medical conditions. Certain medicines, including some anticancer drugs, can also cause hyperpigmentation. If you fall on the Fitzpatrick scale 3-6 (darker complexion; have more melanin in your skin naturally than a Fitz 1-2,) you have a higher risk of hyperpigmentation. I cannot tattoo darker things lighter, only darker things lighter due to pigment composition and how it heals/ages.

Hypopigmentation: is the loss of skin color (melanocytes, melanin, pigment) due to a disease or trauma. It can affect people from birth or develop later in life. There are not many effective treatment options for hypopigmentation. Sometimes needling the area can cause some of the natural pigmentation to come back, sometimes in conjunction with UV Therapy. Or scar/skin/stretch mark camouflage is an effective & popular option recommended by many MD’s that Elsa works with; since hypopigmentation is so hard if not impossible to treat/correct without literally implanting the color back in with a paramedical tattoo; Scar/Skin Camouflage.

What causes hypopigmentation?

Problems with melanin production are linked to a variety of causes. Some are genetic conditions or autoimmune disorders that may result in lighter skin throughout the body. Others are related to previous injuries/traumas such as burns.  It’s also possible for hypopigmentation from an injury to develop into an associated condition.

Some of the most common conditions include:


Albinism is best known for extremely pale skin that may have little to no color. This genetic condition can also make your hair white and your eyes light blue in color. People with albinism are born with this condition because of a genetic mutation.


Like albinism, vitiligo is characterized by lighter skin. However, this occurs in patches that cover your skin, rather than a widespread lack of color. The exact cause of vitiligo is unknown. People who have this condition can develop lighter patches of skin anywhere on the body. This is a fairly common autoimmune disorder that I cannot work on- by doing so can make the hypopigmentation spread.

Pityriasis alba

Pityriasis alba refers to leftover white spots from previous cases of red, scaly skin patches. This condition tends to heal on its own over time. There’s no definitive cause for pityriasis alba, though it’s thought to be related to eczema. Children with this condition may outgrow it in adulthood.

Tinea versicolor

Tinea (pityriasis) versicolor stems from a fungal infection that occurs from overactive yeast on the skin. Though it doesn’t lead to complications, the resulting scaly spots can become a nuisance.

According to the American Academy of Dermatology (AAD), this is one of the most prevalent skin diseases among people living in tropical or subtropical regions because these environments help fungus thrive. You may also be more prone to tinea versicolor if you sweat a lot or have oily skin.

Lichen sclerosus

Lichen sclerosus causes white patches that may eventually enlarge, bleed, and scar. These patches occur in the anal and genital areas. They can also develop on the breasts, arms, and upper body. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), lichen sclerosis is most common in women experiencing menopause.

Other causes

Widespread hypopigmentation is often genetic. That said, it’s possible for acquired conditions to result in temporary and even long-term discoloration.

This includes:

Atopic dermatitis. Also known as eczema, this skin condition causes red patches that are extremely itchy. As the skin heals, the patches may turn white.

Contact dermatitis. Touching chemicals may lead to this type of eczema and may cause lightened skin.

Healed blisters. As blisters heal, the affected skin flattens and may turn darker or lighter in color.

Infections of the skin. As your skin heals, lighter pigments may appear in areas affected by the infection.

Psoriasis. This autoimmune disorder causes your skin to produce new cells at an accelerated rate. Resulting silver and red patches may eventually heal and look lighter than the rest of your skin.

Scars and burns. These can lead to scar tissue that’s lighter than the surrounding skin.

There are not many effective treatment options for hypopigmentation. Sometimes needling the area can cause some of the natural pigmentation to come back, sometimes in conjunction with UV Therapy. Or scar/skin/stretch mark camouflage is an effective & popular option recommended by many MD’s that Elsa works with; since hypopigmentation is so hard if not impossible to treat/correct without literally implanting the color back in with a paramedical tattoo; Scar/Skin Camouflage.

Hyperpigmentation is a common issue many are faced with.  Luckily there are many treatment options & topicals available to remedy Hyperpigmentation vs Hypopigmentation.  Anyone Fitzpatrick 3-6 have a higher risk of Hyperpigmenting.    

Common Hyperpigmentation:


Freckles are usually small brown spots caused by sun exposure. They can occur anywhere, at any age, but are most common on the face, neck, chest, and hands. These are nothing to worry about unless asymmetry, irregular borders, or changes in color develop.


As their name suggests, these pigmentations are present at birth. They can be caused by clusters of pigmented cells or malformed blood vessels. Birthmarks may go away without treatment, stay the same, or change over time. They also may be present in different colors or contain different types of tissue.


Melasma is the darkening of skin tone due to hormonal changes, such as those associated with pregnancy. Patches of melasma are often gray-brown and occur on the cheeks, forehead, bridge of the nose, chin, and upper lip. This can also be a side-effect of taking birth control pills. Melasma may be worsened by sun exposure.


Patchy areas of redness that occur for no apparent reason, and which can flare up for weeks or months and go away. Common on the cheeks, chin, nose, or forehead, rosacea can be exacerbated by sunlight, temperature extremes, and an increase in blood flow to the skin. Rosacea can resemble blushing but more advanced stages are characterized by visible blood vessels, and an enlarged nose, chin, and oil glands.


Also known as age spots, liver spots, and solar lentigines, photoaging often results from years of prolonged sun exposure. Clusters of dark spots may appear in one’s late thirties or early forties. Sunlight affects the production of melanin, which results in uneven skin tone.

Post-Inflammatory Hyperpigmentation (PIH)

It is often associated with acne; once a pimple heals, a dark spot may be left behind. PIH can happen due to any trauma to the skin. Even if you get a scratch or an insect bite, melanocytes, or pigment cells, can create more pigment in response to the injury. Inflammatory conditions such as lupus and eczema can lead to PIH as well.

How to Treat Hyperpigmentation

There are many types of treatments, depending on the condition, its severity, and the person’s preferences. These range from medications to chemical peels, to surgical procedures. Radiofrequency laser therapy has become a common treatment option as well. Requiring little recovery or downtime, it is available in several options. Skin discoloration can be improved with fractionated RF energy, while intense pulsed light, acoustical lasers, and 1064 nm lasers can also be very effective.

Intense pulsed light is especially useful at treating freckles, sun damage, and rosacea, as well as a host of pigmented or vascular lesions. Melasma and brown spots can be reduced with acoustic lasers. For pigmentation issues deep in the skin, a 1064 nm laser is effective without touching the skin surface.

Contact an LDI Dermatologist Near You Today

Contact the Laser & Dermatology Institute of California for the latest in hyperpigmentation treatments. Providing skin treatment services throughout Southern California, we are located at LDI of Los Angeles, LDI of Newport Beach, and LDI of Covina. Call us at 866-888-5416 to schedule a free consultation or use our online appointment self-scheduler today.

IPL Laser stands for intense pulsed light. It’s a type of light therapy used to treat wrinkles, spots, and unwanted hair. You can use IPL to minimize or remove: age spots.

Chemical peels can also be effective at pulling out the hyperpigmentation.  As can the use of topicals such as retinoids, hydroquinone, & certain acids be effective.  This will be a slower, gentler approach to pull out the hyperpigmentation.

What you can do

Hyperpigmentation is a medical term used to describe darker patches or areas of skin in comparison to the rest of the normally pigmented skin. These areas result from excess melanin production, which can be caused by everything from acne scars and sun damage to hormone fluctuations.

If you’re dealing with hyperpigmentation, know that you aren’t alone. Hyperpigmentation is a common skin condition, and there are a number of different treatment options available.

Keep reading to learn more about your options, including products you can try at home, what to expect from procedures like microdermabrasion, and more.

1. Lightening creams

Lightening creams are over-the-counter (OTC) treatments that work with select ingredients to help decrease pigmentation. Many of these creams are available in stronger prescription forms. They’re usually applied once or twice a day to help lighten the skin over time. Topical treatments for lightening also come in gel form.

Common ingredients found in OTC lightening products include:


licorice extract


vitamin B-3 (niacinamide)

Who should try this?

Lightening creams or gels work best for flat spots, such as melasma or age spots. They’re effective for patches of discoloration on most skin types too.

OTC products are accessible (and sometimes more affordable) options for hyperpigmentation, but these can take longer than professional treatments.

The American Academy of Dermatology recommends using caution when purchasing OTC skin lighteners, as they may contain traces of mercury.

2. Face acids

Face acids, or skin acids, work by exfoliating, or shedding, the top layer of your skin. Whenever you exfoliate your skin, new skin cells emerge to take the place of the old ones. The process helps even out your skin tone and makes it smoother overall.

Many face acids are available OTC at beauty stores and drugstores. Popular options include:

alpha hydroxy acids, such as glycolic, lactic, citric, malic, or tartaric acid

azelaic acid

kojic acid

salicylic acid

vitamin C (in the form of l-ascorbic acid)

Who should try this?

Face acids work well for mild hyperpigmentation on fairer skin tones.

What products can you try?

Look for an acid content of 10 percent or less. Higher concentrations can increase your risk of side effects and are best left to professional peels performed in-office.

The following products can also be effective:

Malic acid

Glycolic acid

Salicylic acid

3. Retinoids

Derived from vitamin A, retinoids are among some of the oldest OTC skincare ingredients used. Their small molecular structure allows them to penetrate deep into the skin and treat the layers below your epidermis.

Retinoids can come in either a prescription or OTC formula. However, OTC versions tend to be weaker. If you don’t see any results after a couple of months, talk to your dermatologist about the prescription retinoid tretinoin (Retin-A).

If you don’t already have a dermatologist, the Healthline FindCare tool can help you find a physician in your area.

Who should try this?

OTC retinoids may be safe for all skin tones, but you should double-check with your dermatologist if you have darker skin and plan on using these products long term.

It’s also important to note that retinoids are more often used to treat wrinkles than hyperpigmentation. This means that retinoids may not be the best first-line treatment.

4. Chemical Peel *Elsa Offers PCA Skin Skin Care Products & Chemical Peels

A chemical peel uses acids at stronger concentrations to treat the desired area of skin. They reduce the appearance of hyperpigmentation by removing the epidermis. Deeper versions may also penetrate the middle layer of your skin (dermis) to produce more dramatic results.

Although many chemical peels are available OTC, you might consider getting a professional-grade peel at your dermatologist’s office. These are more powerful, and they yield quicker results.

Due to their strength, in-office peels may also increase your risk for side effects. Talk to your dermatologist about your individual risks.

Possible risks with both at-home and in-office chemical peels include redness, irritation, and blistering. When used improperly, blisters or scars may also develop.

If you’re out in the sun on a regular basis, chemical peels may not be the best treatment option for you. Chemical peels cause your skin to be more sensitive to the sun’s rays. If you don’t adequately apply sunscreen and use other UV protection, the sun may worsen your hyperpigmentation. You’ll need to take extra precautions for at least one week after your last chemical peel.

Who should try this?

Chemical peels may work if you have:

age spots

sun damage


blotchy skin

They also work best for fairer skin tones, and they may provide faster results than face acid products.

5. Laser peel (skin resurfacing, aka fractional laser)

A laser peel (resurfacing) treatment uses targeted beams of light to reduce hyperpigmentation.

There are two types of lasers: ablative and non-ablative. Ablative lasers are the most intense, and they involve removing layers of your skin. Non-ablative procedures, on the other hand, target the dermis to promote collagen growth and tightening effects.

Ablative lasers are stronger, but they may cause more side effects. Both destroy elements in your skin to ensure that new skin cells grow back tighter and more toned.

Who should try this?

There isn’t a one-size-fits-all approach to skin resurfacing. Ablative lasers may work better for people with fair skin. For some people, non-ablative versions may cause the skin to darken instead of lighten. Your dermatologist will work with you to assess your discoloration and overall skin tone to select the best option for your skin.

6. Intense pulse light therapy (IPL)

IPL therapy is a type of non-ablative (fractional) laser treatment. Also known as a photofacial, IPL therapy stimulates collagen growth within the dermis. It usually requires multiple sessions.

IPL is used for overall pigmentation issues, but flat spots especially respond to this treatment. It may also help reduce the appearance of wrinkles, spider veins, and enlarged pores.

Who should try this?

According to Emory Healthcare, IPL works best for people with fair skin.

7. Microdermabrasion

Microdermabrasion is an in-office procedure used to treat hyperpigmentation that affects the epidermis only (superficial scarring).

During the procedure, your dermatologist will use a drill-like handheld tool with a wire brush or other abrasive attachment. The tool is then swiped across your skin to rapidly — but gently — to remove the epidermis. You may need multiple sessions to achieve your ideal result.

Who should try this?

Microdermabrasion works best on superficial scars. Your dermatologist can help you determine whether this treatment is right for you. It also works well for people with fairer skin.

8. Dermabrasion

Dermabrasion also involves the removal of your epidermis, but its effects continue down to part of your dermis.

While dermabrasion is sometimes used to smooth out wrinkles, the procedure has been historically used to address texture concerns. These include:

acne scars

age spots

chickenpox scars

injury scars

sun damage

As with microdermabrasion, your dermatologist will use a drill-like handheld tool with a wire brush or other abrasive attachment. They’ll move the tool across your skin to rapidly — but gently — to remove your entire epidermis and the top part of your dermis.

Who should try this?

Dermabrasion may be a good option if you’re looking to decrease pigmentation at a faster rate than microdermabrasion.

It works best for fairer skin. People with medium skin tones may go on to develop further hyperpigmentation as a result of the procedure. The new patches of hyperpigmentation may lighten after about eight weeks.

9. Microneedling *Elsa Offers This Treatment Option

Small needles penetrate the upper layer of the dermis to boost collagen, even skin tone, help reduce hyperpigmentation, fine lines/wrinkles, and increase elasticity/skin tightness.  However this procedure can increase or cause hyperpigmentation to worsen by over stimulating the melanocytes found in epidermis layer of skin.  Be cautious if you are a Fitzpatrick 3-6, as you have a higher risk of hyperpigmentation in general.

What works best for each skin tone/type?

Skin tone/type can play a role in the intensity and length of hyperpigmentation treatments. As noted by Dr. Cynthia Cobb, DNP, APRN, WHNP-BC, MEP-C, people with fair, medium, and dark skin tones can use some of the same therapies, but people with darker skin need more time for the treatment to work and cannot do many of the lasers ect due to increased risk of hyperpigmentation occurring or getting worse.  Peels and topicals are safest for darker skin tones/types or people who fall 3-6 on the Fitzpatrick scale. Fair skin responds well to most hyperpigmentation procedures/lasers.

The following might be off limits if you tan easily or have darker skin:

high-beam lasers

IPL therapy

Medium skin tones may find the following options helpful:

chemical peels


Darker skin might benefit from:

glycolic acid

kojic acid

OTC lightening creams


lower-strength chemical peels

laser treatments, but only when used at lower intensities over a larger number of sessions

Topical treatments generally take longer to produce visible results. Patience is key with any treatment option.

Talk to your Dermatologist or Skin Care Provider.

Your provider can help you identify the cause of your hyperpigmentation or hypopigmentation and work with you to develop an appropriate treatment plan or a referral to a provider who can properly assist.

No matter what treatment you ultimately choose, it’s important to protect your skin from further sun damage and hyperpigmentation. Wearing sunscreen every day is a must. You should apply sunscreen every morning — even when it’s cloudy! — and reapply as needed throughout the day. Be sure to use a sunscreen with SPF 30 or higher.

We most commonly deal with PIH hyperpigmentation in my work.  Elsa can tattoo lighter things darker, not darker things lighter due to how the T.D in the pigment ages in the skin found in all flesh pigments, it heals and age very poorly.  It looks opaque not like natural skin, chalky, and yellowish over time.  Only lighter scar/skin/tattoos may be made darker with certain techniques &/or diluting.  We also don’t tattoo darker brows/lips/eyes ect lighter because of how pigment ages and color theory works.  The only way to make a darker tattoo lighter is by letting it fade or using Li-FT Pigment Lightening solution to lighten the tattoo and once healed we can then retattoo it the lighter color-meanwhile toning the whole tattoo. The good news is there are treatment options and solutions for you regardless if you suffer from Hypopigmentation or Hyperpigmentation. Elsa offers Pca Skin Chemical Peels, Pca Skin topicals/skincare products (NYC or Shop Online), Microneedling, Microchanneling, Dry Needling, PRP (NYC only), Microdermabrasion (NYC only), Skin/Scar/Stretch Mark Camouflage Paramedical Tattoo & Revision Treatments to help treat hypopigmentation or hyperpigmentation.