Epidermal vs Dermal Hyperpigmentation

Hyperpigmentation is one of the most common skin concerns in dermatology. It appears as dark patches or uneven tone caused by excess melanin pigment in the skin. Although most people are familiar with the fact that there are different causes of hyperpigmentation, there’s an assumption that the differences end there. However, there is another important distinction even between the same types of hyperpigmentation. Even if the cause is the same, not all hyperpigmentation lies in the same layers of the skin or responds to the same treatments. Knowing whether your hyperpigmentation is epidermal, dermal or mixed can help determine what kind of treatments will be most effective. In this article, we explain the difference between epidermal vs dermal hyperpigmentation, how to recognise each type and the best ways to treat and prevent them.

The Layers of Hyperpigmentation

Melanin is the pigment that gives your skin its colour and is produced by specialised cells called melanocytes in the bottom layer of the epidermis of the skin. It is then transferred to neighbouring cells to protect against environmental harms such as trauma and UV damage. When this process becomes unbalanced due to inflammation, hormonal changes, medications or sun exposure, excess pigment builds up. This is what we refer to as hyperpigmentation. The layer in which this pigment settles in the skin determines the depth of the hyperpigmentation and how easy it is to treat:

• Epidermal Hyperpigmentation: Here pigmentation sits in the uppermost layer of the skin. It tends to appear light to dark brown in colour and often has well-defined borders. Because it lies close to the surface, it usually responds well to topical treatments.
• Dermal Hyperpigmentation: In this form, the pigment sits deeper within the skin. It often appears grey, blue-grey or slate coloured because the light scatters differently through the dermis. This type of hyperpigmentation can be stubborn and slower to fade because treatments must penetrate deeper to reach it.
• Mixed Hyperpigmentation: This is a combination of both epidermal and dermal hyperpigmentation. It is very common especially in conditions like melasma. It presents as uneven tone that may look brown in some areas and greyish in others.

How to Diagnose Epidermal vs Dermal Hyperpigmentation

To be clear, the only way to truly distinguish between epidermal vs dermal hyperpigmentation is to see a dermatologist. Even then, they’re unlikely to rely on eye exam alone and may use a Wood’s lamp or dermatoscope to assess the depth of pigment. In extremely challenging cases, they may perform a biopsy though this is rare. However, all is not lost and there are some clues that can sometimes help you tell the two apart. Features of epidermal hyperpigmentation usually include:

• Light to dark brown patches often on the face, chest or hands.
• Sharp or distinct borders.
• More pronounced after sun exposure but responsive to brightening products and sunscreen.

Dermal hyperpigmentation also has distinct features which usually include:

• Appears grey, blue-grey or ashy in tone.
• Blurred or ill-defined edges.
• Persists even after months of using brightening skincare.
• Often follows deeper inflammation such as acne scars, eczema or laser-induced trauma.

To make matters more difficult is that often someone may have mixed hyperpigmentation. As such, it is quite difficult as you may see features of both types of hyperpigmentation as the pigment sits in both layers.

Causes of Epidermal, Dermal & Mixed Hyperpigmentation

The depth and behaviour of hyperpigmentation depend on what triggers it and how the skin responds. Understanding whether pigment sits in the upper, deeper or both layers can help guide expectations and treatment options. Epidermal hyperpigmentation develops when excess melanin is produced and retained in the outer layer of the skin. It is the most common type and usually responds well to topical treatments and sun protection. Common causes of epidermal hyperpigmentation include:

• Post-Inflammatory Hyperpigmentation (PIH): This usually follows things like acne, eczema, insect bites, injury or any other type of inflammation near the surface of the skin. During healing, pigment production increases, leaving brown marks once the irritation resolves.
• Sun Exposure: Repeated or prolonged UV radiation stimulates melanocytes to produce extra melanin as a defence mechanism. Over time, this leads to freckles, sun spots and general unevenness especially on sun-exposed areas such as the face and hands.
• Hormonal Influences: Changes in oestrogen and progesterone during pregnancy, menopause, oral contraceptive use or hormone replacement therapy can overstimulate pigment cells. This can lead to epidermal or mixed hyperpigmentation.

Dermal hyperpigmentation occurs when pigment leaks or is deposited deeper into the dermis, beneath the protective outermost layer of the epidermis. Because it lies further away from the surface, it is often more stubborn and fades slowly. Common causes of dermal hyperpigmentation include:

• Deep or Long-standing Inflammation: Conditions like cystic acne, trauma or chronic irritation can push pigment deeper into the skin.
• Underlying Conditions: Skin disorders such as lichen planus pigmentosus or Hori’s naevus can create bluish-grey or slate patches that persist for months or years.
• Procedures or Medicines: overly strong peels, aggressive microneedling or inappropriate laser treatments may damage the basal layer and drive pigment into the dermis, resulting in persistent or uneven discolouration. Prolonged uninterrupted use of hydroquinone can also lead to this.

Mixed hyperpigmentation occurs when both epidermal and dermal layers contain excess pigment. It is most frequently seen in:

• Melasma: This is a symmetrical condition that is very common which mainly affects the face and neck. Hormonal triggers, sun exposure and inflammation can all cause hyperpigmentation to occur at different layers of the skin. It appears as irregular patches that look brown in some areas and grey or ashy in others.
• Chronic Irritation: Ongoing use of harsh actives, uncontrolled skin diseases like eczema or inadequate sun protection can repeatedly damage both surface and deeper pigment pathways. This produces a blend of epidermal and dermal changes.

Treatments for Different Layers of Hyperpigmentation

The best way to treat hyperpigmentation depends on a number of factors including causes, triggers, how your cells responds and the layer the excess pigment lies. Regardless of whether you have epidermal vs dermal hyperpigmentation (or both), it is important to keep in mind that improvement takes time. Epidermal hyperpigmentation can fade within weeks to months, whilst dermal and mixed forms often require longer and need ongoing maintenance. Epidermal hyperpigmentation typically responds topical treatments such as:

• Brightening Agents: Hydroquinone, cysteamine, arbutin, niacinamide, kojic acid, vitamin C and tranexamic acid can suppress melanin activity.
• Retinoids:Prescription retinoids like tretinoin or over the counter ones like retinol help speed up cell turnover and enhance pigment dispersion. They can also improve overall texture and boost the penetration of other active ingredients. Introduce them slowly to avoid irritation or purging and always pair with adequate hydration and sunscreen.
• Gentle Exfoliants: Azelaic acid as well as mild AHAs or BHAs like as lactic, mandelic or salicylic acid help exfoliate the surface of the skin to speed up pigment removal. Start with low concentrations and avoid layering them with retinoids to reduce the risk of irritation and skin barrier damage.

Dermal hyperpigmentation lies deeper and whilst it can respond to topical therapy, it may also need additional treatments. Often, the best results come from combining treatments which may include:

• Topical Skincare: As above, brightening agents like hydroquinone, tretinoin and high strength azelaic acid can help bring up some of the pigment closer to the surface and reduce new pigment formation. All this can help fade the hyperpigmentation and enhance results from in-clinic procedures.
• In-clinic Procedures: Lasers, IPL and medical peels can gradually break up pigment and speed up clearance. These should always be performed by trained professionals with experience in treating hyperpigmentation, especially in darker skin tones.
• Oral Tranexamic Acid: In certain cases, this may help reduce pigment activity. However, oral tranexamic acid is a prescription only medicine that should only be used under medical supervision.

Mixed hyperpigmentation contains both surface and deeper pigment, so a combined approach may work best. Like with dermal hyperpigmentation, it’s worth starting with topical treatments to see how much progress you can make. This will also give professional treatments a better chance of success if you end up needing them. Regardless of type, hyperpigmentation usually fades slowly so a lot of patience and consistency is needed. Strict sunscreen use and avoiding of unnecessary irritation or inflammation are key to maintaining results and preventing relapse.

Prevention & Maintaining Results

Regardless of layers or type, hyperpigmentation prevention and maintenace are necessary. Here are some of our top tips to preserve your results and prevent recurrence:

• Skincare: Protect the skin from UV and visible light. Apply broad-spectrum sunscreen daily, even indoors, and reapply during prolonged exposure. Also add a topical antioxidant such as vitamin C or niacinamide in the morning to reduce oxidative stress.
• Habits: Avoid picking or squeezing spots, as trauma often leads to post-inflammatory pigmentation.
• Health: Treat underlying inflammatory skin conditions like eczema and speak with your doctor if you suspect an underlying hormonal or medical cause. Only use medications (including prescription skincare containing hydroquinone) under medical supervision to avoid side effects.
• Lifestyle: Eat a healthy nutrient rich diet and drink adequate amounts of water, these will support your skin health and barrier whilst you’re undergoing treatments which can sometimes be harsh.

Whilst its often hard to distinguish between epidermal vs dermal hyperpigmentation, its worth being aware of the difference as it can affect treatment options. To confuse matters most, in many cases hyperpigmentation is mixed! The reason hyperpigmentation layers is important is that more deeper pigment deposits may not fully respond to topical treatments. Regardless of the type, cause or depth of your hyperpigmentation, it is important to understand that effective treatment requires time and perseverance, Equally crucial is to adopt a protective skincare routine and preventative measure to support and maintain your treatment efforts.

At City Skin clinic, we are super passionate about personalised skincare. Our online skin clinic offers safe and effective custom skin treatments. Where appropriate our doctors use ingredients such as Tretinoin and Hydroquinone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.