Hyperpigmentation around the mouth is incredibly common, especially in women and people with more pigmented skin tones. Despite this, it can be quite hard and take a long time to treat. One of the reasons for this is a failure to understand the underlying causes. This matters, because the cause dictates the best treatment and the timeline for fading the hyperpigmentation. In this article, we’ll explore what causes hyperpigmentation around the mouth and the best treatments to get rid of it.
Why Do You Get Hyperpigmentation Around the Mouth?
Perioral hyperpigmentation is the medical term for darkening of the skin around the mouth. It occurs due to excess melanin (the pigment that gives skin its colour) deposition in the surrounding skin. The hyperpigmentation can take many forms. It may appear as a diffuse shadow, patchy discolouration or well-defined darker areas. It may affect large areas of skin surrounding the mouth. Alternatively, it may be confined to just above the upper lip or the corners of the mouth. Whilst hyperpigmentation can affect any part of the face or body, the area around the mouth is particularly vulnerable. This is because the skin is thin, highly reactive and exposed to a unique combination of triggers. These include friction, inflammation, hormonal influence and chronic sun exposure.
What are the Causes of Perioral Hyperpigmentation?
Hyperpigmentation around the mouth can occur for many reasons. It rarely occurs due to a single cause. More often, several factors combine, such as inflammation, hormonal influences, skin barrier disruption or mechanical stress. Understanding the underlying cause is essential, as it influences the optimal hyperpigmentation treatment. The most common causes of perioral hyperpigmentation include:
- Genetics: Some people are more prone to developing hyperpigmentation around the mouth due to genetically higher melanocyte activity or more reactive pigment cells. This predisposition is more common in medium to darker skin tones, where hyperpigmentation around the eyes and mouth is particularly common.
- Post-inflammatory hyperpigmentation (PIH): This is one of the most common causes of hyperpigmentation around the mouth, particularly in medium to darker skin tones. It commonly develops after inflammation or skin injury, including acne breakouts, perioral dermatitis, eczema and allergic reactions. PIH can also occur following very strong actives, chemical peels, lasers or hair-removal methods such as shaving, waxing, threading or epilation. This condition is a response to inflammation, whereby the pigment-producing cells in the skin (melanocytes) overproduce melanin to try to protect it. Even when the cause stops, the remaining hyperpigmentation can persist for months without treatment.
- Melasma: Frequently affecting the upper lip and perioral area, melasma can create a moustache-like shadow. It is strongly influenced by hormonal changes (like pregnancy and menopause), genetic predisposition and cumulative exposure to UV and visible light. Melasma typically presents symmetrically and often worsens in summer or with heat. It is usually chronic and relapsing, which requires long-term melasma management.
- Irritation: Repeated low-grade irritation can gradually drive hyperpigmentation around the mouth, even without obvious redness or rash. Common contributors include toothpaste ingredients such as sodium lauryl sulphate, prolonged saliva exposure and overuse of exfoliating acids or retinoids in this fragile area. These ongoing irritants can cause skin barrier disruption, which stimulates melanocyte activity over time.
- Friction: Regular mechanical stress can contribute significantly to perioral pigmentation. This may result from frequent hair removal, prolonged use of tight face masks or habitual rubbing or resting the hand against the mouth area. This repeated friction can activate melanocytes and cause hyperpigmentation, especially in those prone to it.
- Sun exposure: Chronic exposure to UV radiation and blue light is a key driver of perioral pigmentation. This is because the mouth area is frequently under-protected with sunscreen, and cumulative exposure can cause new hyperpigmentation and worsen existing patches.
Although the above are the most common causes, hyperpigmentation can sometimes develop due to systemic conditions or medications. This includes conditions like Addison’s disease, insulin resistance or drug eruptions. It is also important to be wary of moles and similar skin lesions, as these may be cancerous. As such, it is very important to seek medical advice, especially if your hyperpigmentation is rapid in onset, progressively worsening or looks or feels abnormal.
How to Get Rid of Hyperpigmentation Around the Mouth
It can be very hard to get rid of hyperpigmentation around the mouth. This is because the skin is highly reactive, which limits how aggressive you can be. There is also a strong tendency toward rebounding even after effective treatment. Effective treatment requires a multi-focal approach that combines stopping the trigger, sun protection, skin barrier support and targeted treatments. As such, the best ways to help prevent and get rid of hyperpigmentation around the mouth include:
- Addressing the driving trigger: Treating visible pigment alone is futile. Long-term improvement depends on identifying and correcting contributing factors like acne, perioral dermatitis, sun damage, friction or chronic barrier disruption. Failure to address these drivers commonly leads to relapse and limits progress.
- Sun protection: The perioral area is continuously exposed to both UVA and visible light, which can trigger melanocyte activity, deepen existing hyperpigmentation and undermine all other treatments. Without strict sun protection, improvement is unlikely and relapse is common.
- Topical treatments: Careful, consistent use of the right actives can reduce hyperpigmentation over time by suppressing melanocyte activity and normalising cell turnover. Chemical exfoliants like azelaic acid and over-the-counter retinoids or prescription forms like tretinoin can help increase cell turnover and lift pigment from the skin. Pigment suppressors like niacinamide, tranexamic acid, cysteamine and prescription agents like hydroquinone help fade existing hyperpigmentation. The optimal treatment usually pairs an exfoliating agent with a pigment-suppressing active. Which is best depends on the type, depth and severity of your hyperpigmentation. The key is to start gently, as any irritation can worsen the problem and make it harder to clear.
- Professional treatments: For persistent or severe perioral hyperpigmentation, it may be necessary to add in-clinic procedures such as lasers or chemical peels. However, the mouth area is high risk for post-inflammatory hyperpigmentation, so these must be performed by a highly trained and experienced practitioner. You will usually also need to use topical treatments like hydroquinone alongside these.
- What to avoid: Certain things can prolong or worsen hyperpigmentation around the mouth. This includes over-exfoliating this delicate area, using DIY peels or unregulated skin lightening products or misusing topical steroids. These can damage the skin and, in the case of unsupervised hydroquinone use, lead to permanent hyperpigmentation (ochronosis). It is also crucial to exercise patience and use your treatment consistently. A big cause of treatment failure is not using it for long enough.
How Long Does It Take to See Improvement?
Even with the right treatment, any improvement to hyperpigmentation around the mouth is gradual. So you should have realistic expectations from the outset. In most cases, even early changes can take 8 to 12 weeks of consistent treatment to appear. Depending on the depth and cause of the hyperpigmentation, clearance can take 6 to 9 months. In the case of melasma or recurrent post-inflammatory pigmentation, progress can take much longer and often requires longer-term maintenance. If your hyperpigmentation persists or worsens despite consistent treatment, it is important to seek professional help.
Hyperpigmentation around the mouth is common and, although it can be hard to get rid of, it is treatable. The most effective results come from understanding and targeting the cause and taking a gentle approach. This is important to avoid worsening or prolonging the hyperpigmentation. You also need to be patient and consistent, since treatment takes time to work.
At City Skin Clinic, we strongly believe that skincare is personal and should always centre around your needs. Our doctors provide custom topical skin treatments for hyperpigmentation and melasma using ingredients like tretinoin, hydroquinone, azelaic acid, tranexamic acid and niacinamide where appropriate. If you would like 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 professional with any concerns about your skin or treatment options.
