What to Do if Your Hyperpigmentation Plateaus

As well all know, hyperpigmentation treatment takes a long time to work. When it does, you gradually and steadily see dark marks fading and skin evening out. This positive much awaited period sees steady and cumulative progress. So it’s easy to think that the hyperpigmentation will continue to fade at this rate until it clears fully. Unfortunately, that’s not always the case. In fact it’s quite common for progress to severely slow down or even completely stall. When this happens it can be quite the gut punch. The immediate instinct is to assume treatment has stopped working so you search for something else. However, that can actually be the wrong move. In fact, this can reverse your progress or even make the hyperpigmentation come back worse. In this article, we’ll review why hyperpigmentation can plateau and what to do when it happens.

What is a Hyperpigmentation Plateau?

A hyperpigmentation plateau refers to a period during treatment where progress stalls. Prior to this, there’s usually a steady reduction of hyperpigmentation. Following this success, the rate of of progress then severely slows down or halts completely. It usually occurs after 8-12 weeks of the treatment starting to work. However, it can be sooner or later than this. It varies from person to person and depends on the type of treatment and hyperpigmentation.

Whilst a plateau in hyperpigmentation treatment is normal and very common, the exact cause varies. It may be as simple as the remaining pigment is deeper or that there’s been such huge improvement from the baseline that it’s harder to appreciate new gains. Other possibilities may be that the treatment is only addressing one aspect of the hyperpigmentation or there is ongoing excess pigment production. Whatever the cause is, it is rarely because the treatment is no longer working. That’s why it’s crucial to confirm that there is actually a plateau, what the cause is before making any changes or adjustments. If you’re using a medical treatment, then your clinician will decide the next steps at follow-up once you have finished the course. This will ensure that you give the treatment time to work and any action is based on how your skin responded.

Why Do Hyperpigmentation Plateaus Happen?

In order to understand how plateaus happen, it’s important to appreciate that hyperpigmentation treatment is a lengthy multi-stage process. Optimal treatment depends on the type, cause, depth, location and severity of the hyperpigmentation. Most hyperpigmentation treatments work in two stages. The first stage involves suppressing excess pigment formation with an agent like hydroquinone. This can happen relatively quickly and may bring about obvious improvements early on in the treatment. The second stage which is concurrent involves gradual removal of existing excess pigment using retinoids like tretinoin and exfoliating acids. This stage is often slower and depends on skin cell turnover, immune clearance and depth of the pigment. A plateau at this stage usually signals:

• There’s only been partial suppression of pigment production
• There are ongoing triggers like UV exposure, heat, friction, irritation or hormonal influence causing new hyperpigmentation
• Suppression of excess pigment has been successful but clearance is still at an early stage or is inadequate

How Do Hyperpigmentation Plateaus Look?

First of all, hyperpigmentation does not behave as a single condition and as such timelines for treatment are very variable. This makes it difficult to tell if there is a plateau. As a general rule, successful hyperpigmentation treatment generally progresses as follows:

• 0–6 Weeks: There is often very limited visible change in true hyperpigmentation during this phase. Some brightening may occur due to surface exfoliation or increased cell turnover but the amount of underlying pigment is usually unchanged.
• 6–12 Weeks: Superficial epidermal hyperpigmentation like what you see in post-inflammatory hyperpigmentation (PIH) may start to look gradually lighten and the skin overall may appear brighter. This is the earliest point at which it makes sense to talk about a plateau and only in the sense of significantly slowed or stalled visible changes despite consistent treatment.
• 3–6 Months: This is where meaningful, meaningful improvement usually occurs. However, linear progress remains non-linear and is highly sensitive to interruption from inflammation, irritation or UV exposure.
• 6–12+ Months: It usually takes longer for deeper or or more persistent hyperpigmentation, particularly in melasma, darker skin tones or where inflammatory triggers continue to fade.

What to Do if You’ve Hit a Plateau?

When someone presents with a plateau, the first step is to determine whether pigment production is ongoing or whether the skin is dealing with the aftermath of previous inflammation. It may seem obvious, but it’s also important to make sure that residual redness or textural change is not being mistaken for persistent hyperpigmentation. Also look carefully for signs of barrier stress, because even mild irritation can sustain melanocyte activity without obvious inflammation. The most useful way to view a hyperpigmentation plateau is as a decision point and to try to identify what is now limiting further improvement. This is the only way to choose the most appropriate next step. If you’re currently using medical treatments then the first step is to have a follow-up with your clinician. The main options include:

• Continue: If hyperpigmentation is significantly lighter than baseline and there is no new darkening is occurring, the most appropriate option is often to continue as is. Plateaus at this stage usually reflect slower clearance of existing pigment rather than lack of treatment effect. Escalating or changing treatment can cause irritation and paradoxically worsen hyperpigmentation.
• Fine-tune existing protocol: Small adjustments can be more effective than changing products altogether. This may include increasing frequency, strength or modifying application technique to improve tolerance and use.
• Simplify skincare: Layering too many active products that do the same thing can increase inflammation, reduce penetration of active treatments and obscure true progress. Streamlining your routine often improves both tolerance and outcomes in hyperpigmentation management.
• Add a complementary treatment: If progress has plateaued despite good tolerance, adherence and adequate duration, it may be helpful to add a treatment that tackles hyperpigmentation from a different angle.

What Not to Do if Your Hyperpigmentation Treatment Plateaus

A plateau often triggers panic and leads to the wrong kind of action. In hyperpigmentation, this is particularly risky, as many of the things people do to “push progress” can actually worsen pigment and undo months of improvement. This is because escalating treatment can cause barrier stress and low-grade inflammation which are among the strongest triggers for melanocyte activation and pigment deposition. Even when irritation is subtle, it can sustain pigment production long enough to cancel out earlier gains. If your hyperpigmentation appears to plateau, the priority is to avoid changes that increase inflammation, reduce tolerance or reverse suppression of pigment production. In particular try to avoid the urge to:

• Self-medicate: If you are undergoing medical treatment or managing more severe or persistent hyperpigmentation, professional review is important. Inappropriate changes, particularly with prescription agents or procedures, can increase irritation and stimulate further pigment production rather than improve outcomes.
• Escalate reflexively: Increasing strength, frequency, or layering actives at the first sign of slowed progress often introduces irritation. In hyperpigmentation, irritation is itself a pigment driver. A plateau should usually be observed over additional weeks before concluding that treatment has stopped working.
• Overload the skin: Using multiple products that target similar pathways increases barrier stress and low-grade inflammation without improving clearance of existing pigment. If new products are introduced, they should be added one at a time and given sufficient time to assess their impact.
• Stop treatment: If hyperpigmentation is lighter or more diffuse than baseline, treatment is exerting an effect. Abruptly stopping allows melanocyte activity to rebound and often leads to darkening or relapse.
• Judge progress day-to-day or week-to-week: Hyperpigmentation fades slowly and unevenly. Short-term fluctuations are common and rarely meaningful. Progress should be assessed against baseline over months, not in response to minor changes from one week to the next.
• Expect the same rate of improvement: Early brightening driven by surface turnover is not sustained. Slower progress later reflects the time required for deeper pigment to clear, not treatment failure. A true plateau is a severe decline or halt in improvement.

A hyperpigmentation plateau is not a sign of treatment failure and nor is it a dead end. It often means that early superficial improvement has passed and the hard-work of tackling the deeper more severe pigment deposits remains.Sometimes, it can mean that the treatment has reached it’s maximal effect or that the improvement from the baseline is so significant that ongoing gains are less noticeable. Regardless of the cause, the key thing is to take a thoughtful and cautious approach when it comes to adjusting your treatment protocol to overcome the plateau.

At City Skin Clinic, we strongly believe that skincare is personal and should always pivot around your needs. Our doctors provide custom topical skin treatments for hyperpigmentation using ingredients like tretinoin, azelaic acid, tranexamic acid and niacinamide where appropriate. If you are interested in a personalised skincare treatment please use our online skin consultation form or book a video consultation. Start your treatment journey today and take your first step towards great skin.

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.