Shifting trends in treating hyperpigmentation

Hyperpigmentation, a condition that causes dark patches on the skin, can significantly affect self-esteem, but it is treatable. 

Dr Jacques du Toit, a dermatologist at Mediclinic Louis Leipoldt, explains why it’s important to seek expert medical advice and adhere to treatment.

Understanding pigment-related conditions

“Pigmentation refers to discolouration of the skin, primarily caused by melanin, a pigment produced by melanocytes or mole cells. When melanin is overproduced or unevenly distributed, it can result in hyperpigmentation—areas of skin that appear darker than the surrounding areas,” explains Dr Du Toit, who recently attended an international symposium on the subject in Germany.

Melasma, a common type of hyperpigmentation characterised by brown or grey-brown patches, most often on the face, affects women – particularly those of childbearing age – nine times more than men. “Pigmentation is commonly triggered by hormonal changes or the use of the birth control pill together with sun exposure,” says Dr Du Toit. It is also more common during pregnancy, and is often known as ‘the mask of pregnancy.’”

Another skin discolouration disorder is post-inflammatory hyperpigmentation (PIH), a skin darkening that occurs after inflammation or injury – such as acne, eczema, or a burn. “Unlike melasma, PIH is not hormonally driven. It can affect anyone but tends to be more noticeable and persistent in people with darker skin tones. PIH can fade over time but often benefits from targeted treatment.”

Aside from hormones, underlying conditions that can lead to different types of hyperpigmentation include diabetes and haemochromatosis – an excess of iron in the body.

The emotional side of melasma

Melasma isn’t physically harmful, but it can take a serious toll on mental wellbeing. Research shows how significant the impact can be. A large study published in the Frontiers of Psychiatry Journal in 2025 found that more than 40% of melasma patients showed signs of clinical depression.

“Melasma can have a significant impact on self-esteem and emotional wellbeing,” confirms Dr Du Toit. “As it appears on visible areas like the face, many people feel self-conscious or distressed. The condition’s chronic nature and tendency to relapse can be frustrating, and studies show that melasma can impair quality of life similarly to other visible skin conditions like acne or eczema.”

Combination treatment

While there’s no miracle cure and it can take two to three months to see results – depending on severity – melasma treatment usually involves a combination of topical agents like hydroquinone, tretinoin (a prescription cream closely related to Vitamin A), corticosteroids, and azelaic acid. “Chemical peels and certain laser treatments may also help, though results can vary,” Dr Du Toit says.

However, such treatments are often less effective for PIH as they cause some trauma to the skin, which may exacerbate the skin trauma that initially caused the hyperpigmentation, he adds. “Especially if you have a darker skin type and you shine a laser on it, which is a type of light, you can create pigmentation or worsen existing issues.” Treatments should be approached carefully and only with guidance from an experienced dermatologist.Top of FormBottom of Form

Sun exposure is a major aggravating factor for both melasma and PIH, says Dr Du Toit, and strict protection is crucial to prevent recurrence and improve results. “UV radiation stimulates melanin production, worsening existing pigmentation and triggering new patches. Even minimal sun exposure can undo weeks of treatment progress, so daily sun protection is essential.”

Hydroquinone concerns

A key discussion point at the what symposium? recent symposium in Germany was around hyperpigmentation treatment, says Dr Du Toit. Leading international experts highlighted the efficacy of Thiamidol, which was developed as a safe alternative to hydroquinone, a bleaching agent.

“Hydroquinone is widely regarded as the gold standard for treating hyperpigmentation due to its ability to inhibit melanin production. When used correctly under medical supervision, particularly in concentrations of 2-4%, it’s generally safe and effective.

“However, long-term use or use of high concentrations above 4% – especially those purchased from unregulated sources or informal shops – can lead to a rare but serious condition called exogenous ochronosis. This causes bluish-black discoloration of the skin that is very difficult to treat.”

In South Africa, hydroquinone is only available by prescription, but illegal distribution is a problem. That’s why Thiamidol – a patented molecule that inhibits tyrosinase and has shown excellent results in reducing hyperpigmentation with a low risk of irritation – is a good alternative, says Dr Du Toit. “Thiamidol is available in several over-the-counter (OTC) formulations and is safe for long-term use.”

Products containing Vitamin C, glycolic acid and liquorice root extract are also good OTC options depending on the severity of the condition. Always buy skincare products from trusted retailers, check chemical concentrations and ensure items are properly labelled with a list of ingredients. When in doubt, consult your dermatologist.

“Consistent sun protection with a broad-spectrum sunscreen – SPF 50 or higher – applied even when indoors, and gentle skincare are the best defences against future pigmentation issues,” Dr Du Toit advises.