Hyperpigmentation on the lips is very common and has a variety of causes. It is normally harmless and occurs when excess melanin forms deposits in the skin, causing dark patches on the lips. If the hyperpigmentation is extensive or stark compared to the rest of the lip then this can be a source of cosmetic concern for some people. There is no shortage of beauty products that offer to lighten dark lips but not all are as effective as they claim to be. In this article we take a deep dive into the causes of lip hyperpigmentation and review all effective treatment options.
What Causes Hyperpigmentation on Lips?
Lip hyperpigmentation is a condition where certain parts of the lips develop a darker colour compared to the nearby areas. This can either be a diffuse darkening or more localised dark spots on the lip. This is a not harmful condition usually and is mainly a cosmetic issue. However, sometimes lip hyperpigmentation can sometimes be a sign of an underlying health condition. That’s why its important to be aware of the causes and seek medical advice if there are any worrying changes.
The hyperpigmentation occurs when there’s an over production of melanin. This is the pigment responsible for the colour of our skin including the lips. When the lips become hyperpigmented, it’s usually a gradual process. The areas of higher melanin can form patches, spots, or cover the entire lip. The colour can range from light brown to nearly black, depending on the amount of melanin produced and the your natural skin tone. Several factors can trigger this excess melanin production and leading to darker areas on the lips. Below we take a closer look at the most common causes of uneven darkening of the lips.
Hereditary factors can play a significant role in the pigmentation of the lips. Genetic predispositions may cause an increase in melanin production in the lip area and often you will have a naturally darker lip colour. This type of lip hyperpigmentation is more common in people with a family history of darker lips and is more likely in people with skin of colour. Unlike hyperpigmentation triggered by external factors such as the ones we discuss below, hereditary pigmentation is usually uniform in colour and distribution. It has a natural lip colour and does not require treatment. However, sometimes when there is a stark difference in lip colour, usually a much darker upper lip than the lower, some people try to reduce this difference with lip lightening treatments.
This is one of the main causes of lip hyperpigmentation. The lips, with their delicate skin, are particularly vulnerable to the sun’s ultraviolet (UV) rays. When exposed to UV light, the pigment making cells (melanocytes) produce more melanin. That’s because melanin is a defence mechanism to protect the deeper layers of the skin from UV damage. As an aside, this is why you develop a tan if exposed to excess sun! This increase in melanin can lead to a darkening of the skin on the lips.
Moreover, the skin of the lips lacks the protective hair and sweat glands that help shield other parts of the skin, and it also has fewer melanocytes to begin with. This makes any increase in melanin more noticeable. Additionally, the lips often do not receive the same level of sun protection as the rest of our skin. Many people neglect to apply a lip balm with SPF, leading to unchecked sun exposure. Over time, this can result in the chronic accumulation of melanin on the lips, presenting as darkened patches or an overall darker tone that can be difficult to reverse.
Fluctuations in hormones can have a significant impact on skin pigmentation. This includes the delicate skin on the lips. Conditions such as melasma, which are triggered by changes in hormone levels, can lead to the overproduction of melanin. This causes darkened patches on the skin that are most common on the face but can extend to the lips. Melasma is particularly common during pregnancy, known colloquially as the “mask of pregnancy,” and can also occur as a result of taking hormonal contraceptives or hormone replacement therapy. The raised levels of oestrogen and progesterone during these periods can trigger melanocytes in the lips to produce more melanin. This hormonal-induced hyperpigmentation often presents as blotchy dark areas. These can spread or become more pronounced with sun exposure which exacerbates melasma. Whilst the discolouration can fade after pregnancy or when you stop hormone treatments, in some cases hyperpigmentation on the lips can persist.
In general vitamin deficiencies can have a wide range of effects on the body including the health and appearance of our skin. A deficiency in vitamin B12, in particular, can lead to visibal changes in skin pigmentation. This is because it plays a crucial role in the production of DNA and red blood cells. When the body lacks sufficient vitamin B12, one of the less commonly known consequences can be hyperpigmentation, which may also affect the lips. It is thought that the decrease in red blood cell production leads to an increase in homocysteine levels. This in turn may cause an increase in melanin production in the skin.
On the lips, hyperpigmentation due to vitamin B12 deficiency can appear as dark spots or a general darkening of the lip colour. It’s particularly noticeable in individuals with naturally lighter lip tones, where contrast with the pigmented areas is more pronounced. Fortunately, in many cases, correcting the vitamin deficiency through dietary changes or supplementation can lead to a gradual lightening of the hyperpigmented areas.
Certain medications may have side effects can that can affect the skin including causing changes in pigmentation. Lip discolouration is a lesser known but not uncommon side effect of some medications. Chemotherapy drugs, for instance, are known to cause an array of side effects, including those affecting the skin and mucous membranes. The chemicals within these drugs can interact with the body’s cells and may trigger an over production of melanin. This can lead to darker patches or a generalised darkening of the lip area. Other medications that can also cause this include antimalarials, antipsychotics, anticonvulsants and heavy metals.
The extent of lip discolouration due to medication can vary from faint, barely noticeable changes to more marked widespread darkening. It’s a reaction that can add emotional distress to patients who are already coping with other side effects and underlying medical conditions. The hyperpigmentation is normally more pronounced in individuals with darker skin tones due to the higher baseline melanin levels in their skin. Some medication-induced lip pigmentation may resolve on its own once the drug is stopped. However, this is not always the case and may persist in some cases.
Obviously there are many serious risks of smoking and it is also a possible cause of lip hyperpigmentation. This is due to the presence of nicotine and a myriad of other harmful chemicals in tobacco. These substances can trigger an increase in melanin production. Over time, the chronic exposure to the heat from the smoke and the tobacco itself can cause the lips to darken, often leading to an uneven, blotchy appearance. This lip hyperpigmentation is more pronounced in long-term smokers. Additionally, smoking also affects the blood vessels and leads to poorer circulation that can also cause a darkening of the lips.
Known as allergic contact dermatitis is a lesser known yet common cause of lip hyperpigmentation. When the delicate skin on the lips comes into contact with an allergen (e.g fragrances, preservatives or colouring agents in lipsticks, balms or dental care products), it can provoke an immune response. This reaction usually causes inflammation, which can lead to darkening of the affected area as part of the healing process. Individuals with sensitive skin are particularly at risk and may notice that their lips take on a darker shade after using certain lip or oral hygiene products.
How To Prevent Darkening of Lips
There isn’t much you can do to prevent hyperpigmentation on the lips that is genetic. However, you can prevent lip darkening due to the external factors mentioned above. The best way to prevent lip hyperpigmentation is protecting the lips from the sun, avoiding smoking and using hypoallergenic lip products if you have sensitive skin. Your regular lip care routine should include moisturiser, gentle exfoliation and a daily lip SPF. This will help maintain the health of lip skin and prevent darkening. If you are starting any new medications and notice lip darkening, check with you doctor as they may change the type or dose of the treatment to halt this.
Hyperpigmentation on Lips Treatment Options
Addressing hyperpigmentation on the lips is a delicate process that demands careful selection of treatment methods. This is because the lips are a highly functional part of the body and this means that any treatment needs to be gentle and non toxic if accidentally swallowed. In general, most people will do well with a topical treatment however in some cases professional treatments will be necessary. Regardless of the treatment path chosen, SPF protection for the lips is a must. Apply a broad-spectrum lip balm daily to protect against UV rays as these can worsen pigmentation issues. It’s also crucial to treat any underlying issues contributing to lip hyperpigmentation.
Topically, skin lightening or exfoliating treatments can help even out lip hyperpigmentation. However, their usage on the delicate skin of the lips should be approached with caution and under medical supervision.
- Hydroquinone: As the gold standard in skin lightening, hydroquinone works by inhibiting an enzyme necessary for melanin production. It is a prescription only medicine and whilst effective care is needed to treat hyperpigmentation on lips as it can cause irritation. It is often limited to short courses due to risks of rebound hyperpigmentation and ochronosis.
- Arbutin: This is a gentle skin-brightening agent that can effectively reduce lip hyperpigmentation. Arbutin targets the same pathway as hydroquinone but is less potent and not as irritating. It is availabel over the counter and best suited for people with moderate hyperpigmentation and lighter skin tones.
- Kojic Acid: Another over the counter option, kojic acid can help lighten hyperpigmentation on the lips. It is often combined with other ingredients like vitamins C and E. This can enhance its efficacy and provide antioxidant benefits.
- Tranexamic Acid: This has skin-brightening and anti-inflammatory properties. Tranexamic acid can treat lip hyperpigmentation especially if the darkening is due to melasma or sun damage.
- Azelaic Acid: This exfoliating acid reduces inflammation and can help fade pigmentation. Azelaic acid is also gentle so it is particularly useful for people with sensitive skin.
- Retinoids: From over-the-counter retinol to prescription tretinoin, retinoids speed up cell turnover and can help fade hyperpigmentation on lips. However, retinoids can cause irritation and aren’t suitable for everyone. If you are using an over the counter retinoid, look for a product designed specifically for the lips. With regards to more stubborn lip hyperpigmentation, you will need to speak with a skin specialist. They can advise whether Tretinoin can help and advise how to use it carefully.
Chemical peels and laser therapy are the main professional treatments that can help fade hyperpigmentation on the lips. However, due to the sensitivity of lip skin, these treatments must be performed by experienced dermatologists. In all cases, strict sun protection is vital to prevent further pigmentation and protect the lips during and after treatment. It’s also essential to address any underlying causes.
- Chemical Peels: Mild chemical peels containing alpha hydroxy acids can be effective in treating lip hyperpigmentation. These peels gently exfoliate the surface layers of the skin. Over time and with repeated treatments, they can help lightening pigmentation on the lips.
- Laser Therapy: Lasers such as the Q-switched or fractional lasers can target melanin specifically to help treat lip hyperpigmentation. They break it down without damaging surrounding tissue. Due to the precision required in treating the lip area, such procedures should only be performed by a qualified professional.
Lip hyperpigmentation is usually a benign cosmetic concern. However, you should consult with a doctor to check if there is an underlying health condition or medication. There are also certain lifestyle factors like smoking and sun exposure that can cause or worsen hyperpigmentation on the lips. When it comes to lip hyperpigmentation treatments, you have several good options. However, due to the the sensitive and functional nature of the lips you should proceed with care. Only use over the counter products designed for use on the lips. These should have been tested for safety in that area. For prescription only medicines, see a doctor that can help evaluate which treatments are best for you. They will also provide you with a safe and effective protocol. Regardless of your option, it’s important to note that individual responses to treatments can vary. It also often takes time as well as consistency.
At City Skin clinic, we are committed to personalised skincare. Through our online skin clinic our doctors offer safe and effective treatments like Tretinoin and Hydroquinone. We treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.