It is not unusual for hyperpigmentation to respond differently. In fact, two people can follow the same hyperpigmentation treatment faithfully and see very different outcomes. This difference in response is often blamed on treatment choice, strength or compliance. However, it usually reflects differences in pigment biology and individual response. The good news is that hyperpigmentation that doesn’t respond to treatment is not untreatable. In this article, we’ll explore the main reasons why hyperpigmentation won’t go away despite the correct treatment.
Pigment Depth Affects Speed & Ceiling of Results
Where excess pigment sits in the skin affects the speed and response. Epidermal pigment sits in the more superficial parts of the skin and can clear more quickly through exfoliation once melanocyte stimulation is suppressed. This form of hyperpigmentation can fade by itself, though it usually needs topical treatments for best results. Dermal hyperpigmentation does not normally fade by itself. This is because the melanin sits in the deeper layers of the skin. It usually needs topical or professional hyperpigmentation treatments, and even then clearance is slow and may not be complete. This distinction explains why some patches fade predictably while others remain stubborn despite correct treatment. Most people have a mix of dermal and epidermal hyperpigmentation, which results in patchy fading and response whereby:
- Some dark patches fade completely
- Others improve partially then stall
- There’s a different speed of response to treatment
- Increasing the strength of the same treatment may yield diminishing returns in stubborn lesions
Response Varies Between People
Even if two people have the same hyperpigmentation and treatment, their response can still differ. This is because the pigment-producing cells (melanocytes) in the skin do not behave uniformly. In some people they are highly reactive, responding vigorously to minor inflammation, friction, hormones or UV exposure. In others they are comparatively stable. The relevance of this is that highly reactive melanocytes can continue producing pigment despite treatment. This baseline melanocyte sensitivity can be why hyperpigmentation is slow to respond and won’t go away in one person. The same treatment may work well in another. Older age, female sex and darker skin tones are associated with higher melanocyte sensitivity.
Main External Reasons Why Your Hyperpigmentation Won’t Go Away
The individual responses and pigment depth we mentioned previously are the main intrinsic reasons that your skin biology affects how stubborn hyperpigmentation is. There is not much you can usually do about them, other than ensure your hyperpigmentation treatment is appropriate. However, there are equally important external influences that can also limit treatment success. Luckily, these extrinsic factors can usually be addressed, which is why it is important to know about them. The most common external reasons your hyperpigmentation won’t go away include:
- Ongoing inflammation: All types of hyperpigmentation are driven or made worse by inflammation. This is because low-grade inflammatory or vascular signals can continue to stimulate melanocyte activity. This is why post-inflammatory hyperpigmentation from acne, eczema, injury, surgery or irritation often improves slowly or stalls if the inflammation persists.
- Skin barrier damage: Effective hyperpigmentation treatments can be irritating and require consistent use for a long time. Skin barrier disruption reduces tolerance to treatment, which may lead to spacing, pauses or abandonment. This often leads to incomplete treatment and slow progress.
- Ongoing hormonal signalling: Hormones play a significant role in hyperpigmentation conditions like melasma. Even with appropriate melasma treatment, ongoing hormonal stimulation can keep driving the condition, especially in those with greater melanocyte sensitivity. This is why melasma hyperpigmentation can improve partially but never fully clear. It is also why relapse is common, especially without maintenance.
- Inadequate sun protection: If UV and visible light exposure continue, hyperpigmentation will keep forming. This can slow and limit progress.
- Impatience: Hyperpigmentation treatment is slow and can take months to clear. This is because the response depends on your individual biology, the depth and type of hyperpigmentation, and whether there are any ongoing triggers. A lot of the time, when people complain that hyperpigmentation won’t go away, the real issue is that treatment has not had enough time to work. On average, a minimum of 12 weeks of consistent use is necessary before you start to see progress, though it can take 6 to 12 months. Switching and changing treatments after less than 12 weeks often disrupts progress and can even set you back.
What to Do if Your Hyperpigmentation Won’t Go Away
If your hyperpigmentation isn’t improving, try not to panic. The worst thing you can do is escalate treatment intensity or dramatically change treatment as a knee-jerk reaction. It is best to pause and check that you are on the correct treatment. Look at whether any external or internal factors are limiting progress, and whether your timeline is realistic. It is also crucial to work out whether your hyperpigmentation has made no progress at all or, as is usually more likely, improved a little. This will help ensure your next steps are appropriate. It may also be useful to get professional advice if you have not made much progress despite long-term consistent use. The same applies if your hyperpigmentation is worsening, or you are currently using prescription hyperpigmentation treatments.
It can be incredibly disheartening when hyperpigmentation won’t respond even with consistent treatment. However, this is actually quite common. Hyperpigmentation is a complex skin condition that has many causes and takes a long time to clear even with the right treatments. There are a number of internal factors that help determine the right treatment, although there is not a lot you can do to change them. A number of external factors are modifiable and can severely limit progress if you ignore them. As with everything in life, it is important to take the time to understand your hyperpigmentation and ensure you are consistently using the correct treatment. It is also vital to set realistic expectations in terms of results and timelines.
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 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.
