Donna Gould, a 43-year-old aesthetics student in Cocoa Beach, Fla., can’t remember a time when bug bites and scrapes didn’t leave her with dark spots on her skin.

“The doctor told me my skin type is prone to hyperpigmentation,” Gould said, “and that the spots were my increased melanin reacting to inflammation.”.

Hyperpigmentation is an umbrella term used to define common skin conditions — including post-inflammatory hyperpigmentation (PIH), melasma and sun spots — in which patches of skin become darker than the surrounding area.

 In Gould’s case, the spots were the result of PIH, in which inflammation to the skin (caused by acne, bug bites, scrapes, cuts, eczema, psoriasis or dermatitis) results in darkened marks.

“So, if you compare two people with similar skin tones that have been bitten by an insect, the one that did the most scratching and rubbing is going to have subsequent darker hyperpigmentation, than the one that just left it alone.”.

Mitchell said that some patients come in to see her because they are concerned about the hyperpigmentation rather than the underlying inflammatory condition: “They don’t go to a dermatologist’s office to treat their acne; they are there to treat their uneven skin tone.” Education, she said, is key.

“It’s definitely tougher for my darker patients to believe the hype about why they should use sunscreen,” said Tiffany Clay, a dermatologist in Atlanta.

 Yet once her patients with hyperpigmentation find a sunscreen they like and start using it regularly, she said, they are happy with their more even skin tone.

 Zeichner advises his patients with all kinds of hyperpigmentation to layer a topical vitamin C serum such as Skinceuticals C E Ferulic or BeautyStat Universal C Skin Refiner under sunscreen every morning: “Vitamin C is your go-to ingredient if you have hyperpigmentation.” A true multi-tasker, it protects the skin from UV light and free-radical damage, and blocks production of abnormal pigmentation, he said.

 Nighttime skin care for all hyperpigmentation is all about hydration, repair and speeding up cell turnover, according to Zeichner, which can be done with hydroxy acids such as glycolic acid or “I am currently using AlphaRet Overnight Cream, which combines a retinoid with lactic acid (an alpha hydroxy acid).” Zeichner said he also likes PCA Skin Clearskin Moisturizer with niacinamide and Vitamin A and the Ponds Rejuveness line because “it’s affordable and has brightening vitamin B3 and a retinol complex.”.

You can’t talk about hyperpigmentation treatments without mentioning hydroquinone — a controversial depigmenting agent that can bleach dark patches on the skin — which has been used for more than 40 years to treat hyperpigmentation.