skin care

Put Down the Lemon Slice. Hyperpigmentation Treatments That Actually Work, According to the Derms

By June 18, 2021 No Comments

With endless options, finding the right hyperpigmentation treatment can be exhausting. Dozens of treatments are recommended on skincare blogs, from topicals to in-office procedures to DIY remedies. So to cut through the noise, we got advice from a couple of expert derms.

Hyperpigmentation, or uneven skin tone, is an increase in melanin that results in flat brown spots or patches on the skin that are darker than your usual complexion.

Melanin is the natural pigment that determines your skin, hair, and eye color. But when it’s overproduced, the skin can look spotty or patchy. Sun exposure, air pollution, hormonal changes, and skin inflammation from acne or skin damage can all be culprits for an uneven skin tone.

Before you dab your face with a lemon slice or jump on the latest buzzy solution from Allure, slow down and think about the options. Some treatments can cause more harm than good. We chatted with board-certified dermatologists Dr. Lana Kashlan and Dr. Sheila Krishna to get the 411 on hyperpigmentation treatments that actually work.

At-home hyperpigmentation treatments approved by dermatologists

If you want a fresher-looking complexion, Dr. Kashlan recommends that you start with a topical hyperpigmentation treatment for six to eight weeks. “If you’re still not happy with improvements in the skin tone,” she says, “doing an office procedure like peeling would make sense.” So try out dermatologist-approved skincare products before getting a more involved in-office procedure.

Before you choose a treatment option, though, talk to your dermatologist. “Uneven skin tone can mean a lot of different things,” Dr. Kashlan tells us. “Sometimes it’s related to environment, sometimes it’s related to genetics, sometimes it’s related to hormonal changes.” So work with your dermatologist to rule out underlying medical causes to get the right solution for your skin. Then consider these skincare topicals recommended to treat hyperpigmentation.

Retinoids

Retinoids like retinol and tretinoin are essential wrinkle smoothers and acne fighters. But they also treat hyperpigmentation. They’re chemical exfoliants—working their magic at a deeper level than facial scrubs, which only touch the surface.

According to Dr. Kashlan, retinoids work by dispersing melanin granules that are “clumping together under the skin surface causing the discoloration.”

Our favorite retinoid is tretinoin. It’s the only FDA-approved retinoid for photoaging (aka premature skin aging)—which could be causing your hyperpigmentation. It’s also 20 times more potent than over-the-counter retinol1 and has over 50 years of research to prove its safety and efficacy.


One study shows that tretinoin is more effective at exfoliating and stimulating new cell growth than glycolic acid, another chemical exfoliant, and shows results faster2.

Night Shift is a dermatology-grade tretinoin serum tailored to your skin and prescribed by doctors online; no in-office visit required.


Use retinoids at night, as they can make your skin more sensitive to the sun if used in the morning.

Glycolic acid

Glycolic acid is a chemical exfoliant that works similarly to retinoids to brighten the complexion.

You can buy low-concentration glycolic acid over the counter. It may be less irritating than derm-strength retinoids but also less potent. You can get higher-strength glycolic acid peels from a dermatologist. These are more likely to cause irritation and should be done occasionally, as long-term use can damage collagen in the skin.

We don’t recommend using glycolic acid and retinoids (or other chemical exfoliants) together unless directed by a dermatologist. Most people will get what they need out of one of them. If you do use them together, it’s best to use them on different days to avoid redness and sensitivity.

Glycolic acid can make skin more susceptible to sun damage, so use it at night to reduce sensitivity. And don’t skip your SPF.

Salicylic acid

Salicylic acid is an effective chemical exfoliant that won’t make you more sensitive to the sun3, so you can use it whenever it’s convenient for you. Well known for its acne-fighting abilities4, salicylic acid can be your one-two punch for reducing acne while treating and preventing uneven skin tone from acne scars. Salicylic acid is proven to be effective for treating hyperpigmentation, including for patients with darker skin5.

Salicylic acid and tretinoin are comparable for fighting acne6. But you’re better off combatting other signs of photoaging, like fine lines and wrinkles, with tretinoin.

Niacinamide

Niacinamide is a powerful hyperpigmentation treatment that has a low risk of irritation. “Niacinamide,” says Dr. Kashlan, “blocks the transport of melanin from the melanocytes, or the pigment-producing cells, to the keratinocytes, or the skin cells.”

As a bonus, niacinamide prevents UV damage7 and repairs DNA after sun exposure8. So it’s an ideal skincare sidekick to prevent dark spots from coming back.

One study proves niacinamide’s effectiveness for treating melasma (hyperpigmentation associated with hormonal changes). It’s a first-class alternative to hydroquinone, a traditional melasma treatment, with fewer side effects 9.

You can use niacinamide as part of your morning and evening routines.

Arbutin

Arbutin is a lesser-known skin-brightening serum that earns its place on your bathroom shelf. With few side effects, it’s a great option for dry or sensitive skin types.

Arbutin treats skin discoloration by inhibiting tyrosinase—an enzyme used to produce melanin.

It plays well with your other skincare actives and can be used morning or night.

Vitamin C

Vitamin C is key for preventing sun damage that can lead to dark spots and other signs of photoaging.

Add a vitamin C serum to your morning skincare routine to boost your skin’s antioxidant protection against the sun’s free radicals.

Vitamin C can be drying, but that can be easily counteracted by following up with a hydrating moisturizer.

Azelaic acid, kojic acid, and licorice extract

These three often come as a combined formula, and Dr. Kashlan recommends using them together to reap their benefits. Like arbutin and vitamin C, azelaic acid, kojic acid, and licorice extract inhibit tyrosinase to keep dark spots at bay. They’re worth considering if you want an effective, natural solution.

These three “are all safe to use during pregnancy, as well,” according to Dr. Kashlan. So they can be an ideal treatment for melasma, which is common during pregnancy. Of course, check with your OB-GYN before starting any kind of treatment.

Hydroquinone

Hydroquinone is an effective skin brightener that acts as a bleach by decreasing the pigment-producing cells in your skin. It’s generally okay for lighter skin tones but may worsen hyperpigmentation on darker skin tones. And it’s more intense than most people need.

We share this skincare active with caution. The FDA has gone back and forth on the safety of this skincare active, and it’s banned in several countries. So consult with your dermatologist before using hydroquinone.

In-office hyperpigmentation treatments to get from a dermatologist

Not getting the results you want at home? Talk to your dermatologist about the in-office procedures they offer. Some are more expensive than others or require more recovery time, so it’s worth knowing your options before you settle on a solution.

Microdermabrasion

Microdermabrasion is a cost-conscious in-office treatment for hyperpigmentation that requires several visits. It removes the outer layer of your skin to stimulate new cell growth.

Side effects are minor, and most go away in a few hours. It will make you more sensitive to the sun, so limit time in the direct sun and use sunscreen while your skin recovers.

Chemical peels

Chemical peels typically use higher concentrations of actives like glycolic acid than you can get at the store.

Like microdermabrasion, chemical peels remove the outer layer of skin to make way for new skin growth. The number of sessions, side effects, and recovery time depend on the intensity of the chemicals used and your skin goals. Light peels will cause mild irritation, while deep peels require painkillers after treatment and can take months for the redness to subside.

Intense pulsed light (IPL) treatments

IPLs target individual dark spots, while microdermabrasion and chemical peels typically address the entire face. So IPL treatments are ideal for large dark spots versus all-over patchiness. Depending on your goals, you may need to go in for three to five sessions.

Side effects usually include minor sensitivity after treatment.

Laser resurfacing

Laser resurfacing is more painful and intensive than other in-office treatments but usually only requires one session. Like IPLs, laser treatments target individual dark spots to make room for new skin growth.

You’ll get an anesthetic or sedative for treatment and a painkiller afterward. Depending on the intensity of the treatment, redness can take anywhere from a couple of months to a year to go away completely, so talk to your derm about what the healing process will look like for your specific treatment.

Laser treatments can cause skin to darken in patients with darker skin tones. But that can be counteracted with a lightening agent after the procedure.

Hyperpigmentation remedies to avoid

Facial scrubs

As popular as facial scrubs are, Dr. Krishna warns that physical exfoliants like coffee grounds, nuts, and sugar can “irritate the skin, cause more oil production, or even leave scars and marks on the skin.” That makes it harder for you to reach your skincare goals. With a facial scrub, you can’t guarantee even exfoliation. So you may worsen the texture and appearance of your dark spots.

Opt for a chemical exfoliant instead like retinoids, salicylic acid, or glycolic acid. These cover your face more evenly and penetrate the skin for a more effective exfoliation.

DIY remedies

There are a plethora of DIY remedies on the internet declared to treat hyperpigmentation. Some of these just don’t work, while others can cause more harm to your skin. These are just a few:

  • aloe vera
  • green tea extract
  • apple cider vinegar
  • red onion
  • black tea
  • milk
  • tomato paste
  • red lentils
  • papaya
  • turmeric
  • almond oil
  • yogurt
  • lemon juice
  • potatoes

As far as what to avoid, Dr. Kashlan warns, “I would absolutely, never, ever, ever put lemon juice on the face or on the skin.” It’s very acidic and can cause burns, irritation, and dryness. Red onion, tomato paste, and apple cider vinegar are also very acidic and should stay off your face.

The others are fine and commonly used, and some have known benefits. Aloe vera is known for healing the skin. Green tea extract and turmeric are anti-inflammatory. Yogurt can be helpful for acne. And papaya works for exfoliation. But, Dr. Kashlan says, “I don’t believe in DIY remedies because you really cannot control the concentration of the active ingredients.”

There could be irritating ingredients or natural chemicals in the remedy you’re using, so Dr. Kashlan says, “I really would recommend sticking with regulated formulations instead.”

Rather than relying on a home-brewed concoction, use dermatologist-approved formulations with studies that prove their safety and efficacy.

Keep hyperpigmentation away with a preventive skincare routine

Uneven skin tone itself is generally harmless, though it can be a sign of an increased risk for skin cancer. So it’s worth developing a preventive skincare routine that provides a barrier to skin-damaging elements like the sun and air pollution that are common instigators for hyperpigmentation.

Morning skincare routine

  1. Use a gentle face cleanser to wash away pollutants, dirt, bacteria, and oil buildup that can cause hyperpigmentation.
  2. Treat with an antioxidant like vitamin C or niacinamide to fend off free radicals throughout the day.
  3. Protect the skin with a hydrating moisturizer to maintain skin health.
  4. Shield the skin against the sun’s damaging rays with a broad-spectrum sunscreen with an SPF of 30 or higher.

Evening skincare routine

  1. Use a gentle face cleanser to wash away pollutants and dirt from the day.
  2. Treat with a mild chemical exfoliant like retinoids, glycolic acid, or salicylic acid to keep skin pigmentation even.
  3. Protect the skin with a hydrating moisturizer.

Remember: Skincare is personal. What works for someone else might not work for you. Use this as a base and swap in products as you learn what works for your skin. Talk to your dermatologist about your skin concerns and history so they can guide you to the right treatments.

Be patient with your new regimen. Real results don’t happen overnight. Check in with your dermatologist if you don’t start seeing an improvement in six to eight weeks. And, of course, stop any treatment that’s irritating your skin. Your dermatologist can help fine-tune your routine.


Skincare can be overwhelming, so feel free to reach out with any questions. We’re always happy to help.


  1. Mukherjee, S., et al. (2006, December). Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/
  2. Campos, P., et al. (2015, January 6). Comparative Effects of Retinoic Acid or Glycolic Acid Vehiculated in Different Topical Formulations. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302967/
  3. Kornhauser, A., et al. (2009, May 2). The Effects of Topically Applied Glycolic Acid and Salicylic Acid on Ultraviolet Radiation-Induced Erythema, DNA Damage and Sunburn Cell Formation in Human Skin. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791365/
  4. Decker, A., BS, MA & Graber, E.M., MD (2012, May). Over-the-counter Acne Treatments. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366450/
  5. Desai, S.R., MD, FAAD (2014, August). Hyperpigmentation Therapy: A Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142815/
  6. Babayeva, S., et al. (2011, March). Comparison of tretinoin 0.05% cream and 3% alcohol-based salicylic acid preparation in the treatment of acne vulgaris. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20666879/
  7. Damian, D.L. (2010, April 1). Photoprotective effects of nicotinamide. Retrieved from https://pubs.rsc.org/en/content/articlelanding/2010/PP/b9pp00146h#!divAbstract
  8. Thompson, B.C., et al. (2014, July). Nicotinamide enhances repair of ultraviolet radiation-induced DNA damage in primary melanocytes. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24798949/
  9. Navarrete-Solís, J., et al. (2011, July 21). A Double-Blind, Randomized Clinical Trial of Niacinamide 4% versus Hydroquinone 4% in the Treatment of Melasma. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21822427/
Angela Rollins

Angela Rollins

Angela is a health enthusiast who is passionate about taking care of ourselves inside and out. She believes that by prioritizing our wellness, we can feel more confident in our skin. Angela is devoted to making skincare science accessible for all so that you can make educated decisions for your skin’s health.

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