Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris. People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.

Many forms of hyperpigmentation are caused by an excess production of melanin. Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing colour in the body in places such as the eyes, skin, and hair. As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.

Hyperpigmentation is associated with a number of diseases or conditions, including the following:

- Addison's disease and other sources of adrenal insufficiency, in which hormones that stimulate melanin synthesis, such as melanocyte-stimulating hormone (MSH), are frequently elevated.

- Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production, because MSH production is a byproduct of ACTH synthesis from proopiomelanocortin (POMC).

- Acanthosis nigricans—hyperpigmentation of intertriginous areas associated with insulin resistance.

- Melasma, also known as "chloasma"—patchy hyperpigmentation

- Acne scarring from post-inflammatary hyperpigmentation

- Linea nigra—a hyperpigmented line found on the abdomen during pregnancy.

- Peutz-Jeghers syndrome—an autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.

- Exposure to certain chemicals such as salicylic acid, bleomycin, and cisplatin.

- Smoker's melanosis

- Coeliac disease

- Cronkite-Canada syndrome

- Porphyria

- Tinea fungal infections such as ringworm

- Haemochromatosis—a common but debilitating genetic disorder characterized by the chronic accumulation of iron in the body.

- Mercury poisoning—particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.

- Aromatase deficiency

- Nelson's syndrome

- Grave's disease

- As a result of tinea cruris.

Hyperpigmentation can sometimes be induced by dermatological laser procedures.

The symptoms of this condition include:

- Occasional fine scaling of the skin producing a very superficial ash-like scale

- Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient is overheated, such as in a hot shower or during/after exercise. Tanning typically makes the affected areas contrast more starkly with the surrounding skin.

- Sharp border

Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer.

The yeasts can often be seen under the microscope within the lesions and typically have a so-called "spaghetti and meatball appearance" as the round yeasts produce filaments.

In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of color) are common, while in those with lighter skin color, hyperpigmentation (increase in skin color) is more common. These discolorations have led to the term "sun fungus".

Many other conditions can lead to localized scaling or hyperpigmentation.

This condition should firmly be distinguished from dermatitis artefacta, which is the "factitious" creation of a skin lesion, whereas dermatosis neglecta results from unconscious avoidance of cleaning due to pain or immobility.

Other skin conditions which should not be mistaken for dermatosis neglecta include: terra firma-forme dermatosis (in which there is no history of inadequate cleaning); confluent and reticulated papillomatosis of Gougerot and Carteaud; several forms of ichthyosis; acanthosis nigricans; and Vagabond's disease.

It is a condition that may present a cosmetic nuisance, yet it poses no health risks on its own.

Dermatosis neglecta is a skin condition in which accumulation of sebum, keratin, sweat, dirt and debris leads to a localized patch of skin discoloration or a wart-like plaque. It is caused by inadequate hygiene of a certain body part, usually due to some form of disability or a condition that is associated with pain or increased sensitivity to touch (hyperesthesia) or immobility.

Dermatosis neglecta typically develops several months after a disability or other affliction leads to improper cleaning. Patients may deny that negligence is the cause of the lesion, even though it completely resolves on vigorous rubbing with alcohol swabs or water and soap (which provides both diagnosis and treatment). Recognizing the diagnosis avoids unnecessary skin biopsies.

Examples of case reports from the literature include a man who avoided washing the skin area surrounding an artificial pacemaker out of fear it might be damaged; a woman who didn't clean the right side of her chest due to hyperesthesia following an amputation for breast cancer (mastectomy); a girl who was afraid to wash the area around an abdominal scar; and a man with multiple fractures, shoulder dislocation and radial nerve palsy which significantly reduced his mobility.

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus "Malassezia globosa", although "Malassezia furfur" is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

The condition pityriasis versicolor was first identified in 1846. Versicolor comes from the Latin, from "" to turn + color. It is also commonly referred to as Peter Elam's disease in many parts of South Asia.

PVA can be characterized by speckled, combined hyper- and hypopigmentation in the plaques or patches of affected skin. Hyperpigmentation is excess coloration, or darkening of the skin, while hypopigmentation is a diminished or pallid coloring to the skin. Pigmentation changes in PVA, apparent in the epidermal (outermost) skin layer, may be attributed to incontinence (leaking out) of melanin from melanocytes into the dermal skin layer below. Inflammation of the skin and cutaneous tissue, common with PVA, also contributes to color changes in the skin, typified by redness. Telangiectasia, the visible "vascular" element of PVA, is the of small blood vessels near the skin surface. Skin atrophy, a wasting-away of the tissue comprising the skin, is a prominent part of PVA and effects the dermal, and particularly the epidermal layer. This, in part, is the result of degenerative of the stratum basale (bottom cell-layer) of the epidermis. Atrophy of the skin gives it a thin, dry and wrinkled appearance, which in PVA-affected individuals has been described as "cigarette paper". Hyperkeratosis, a thickening of the stratum corneum (top cell-layer of the epidermis), has also been reported.

Poikiloderma is a skin condition that consists of areas of hypopigmentation, hyperpigmentation, telangiectasias and atrophy.

Poikiloderma is most frequently seen on the chest or the neck, characterized by red colored pigment on the skin that is commonly associated with sun damage.

Perifollicular erythema and scarring white patches are seen on dermoscopy. On scalp biopsy, lymphocytic and granulomatous perifolliculitis with eccentric atrophy of follicular epithelia and perifollicular fibrosis are visualized.

Important diagnoses to consider include female pattern hair loss (FPHL), chronic telogen effluvium (CTE), and alopecia areata (AA). FPHL is a non-scarring progressive miniaturization of the hair follicle with one of three different characteristic patterns. CTE is an idiopathic disease causing increased hair shedding and bi-temporal recession, usually in middle aged women. AA is an autoimmune attack of hair follicles that usually causes hair to fall out in small round patches.

Symptoms include:

1. yellow-brown, banana-shaped fibers

2. caviar-like papules

3. brown-grey or blue-black hyper-pigmentation

The majority of the lesions will be seen on areas of the body that get the most sun.

Drug-induced pigmentation of the skin may occur as a consequence of drug administration, and the mechanism may be postinflammatory hyperpigmentation in some cases, but frequently is related to actual deposition of the offending drug in the skin.The incidence of this change varies and depends on the type of medication involved. Some of the most common drugs involved are NSAIDs, Antimalarials, psychotropic drugs, Amiodarone, cytotoxic drugs, tetracyclines and heavy metals such as silver and gold (must be ingested not just worn).

Although lichen planus can present with a variety of lesions, the most common presentation is as a well defined area of purple-coloured, itchy, flat-topped papules with interspersed lacy white lines (Wickham's striae). This description is known as the characteristic "6 Ps" of lichen planus: planar (flat-topped), purple, polygonal, pruritic, papules, and plaques. This rash, after regressing, is likely to leave an area of hyperpigmentation that slowly fades. That said, a variety of other lesions can also occur.

Variants of cutaneous lichen planus are distinguished based upon the appearance of the lesions and/or their distribution. Lesions can affect the:

- Extremities (face, dorsal hands, arms, and nape of neck). This is more common in Middle Eastern countries in spring and summer, where sunlight appears to have a precipitating effect.

- Palms and soles

- Intertriginous areas of the skin. This is also known as "Inverse lichen planus."

- Nails characterized by irregular longitudinal grooving and ridging of the nail plate, thinning of the nail plate, pterygium formation, shedding of the nail plate with atrophy of the nail bed, subungual keratosis, longitudinal erthronychia (red streaks), and subungual hyperpigmentation. A sand-papered appearance is present in around 10% of individuals with nail lichen planus.

- Hair and Scalp. The scalp is rarely affected by a condition known as lichen planopilaris, acuminatus, follicular lichen planus, and peripilaris, characterised by violaceous, adherent follicular scale with progressive scarring alopecia. While lichen planus and lichen planopilaris may occur together, aside from sharing the term ‘lichen’ and revealing inflammation on skin biopsy, there is neither established data on their co-occurrence nor data to suggest a common etiology. Lichen planopilaris is considered an orphan disease with no definitive prevalence data and no proven effective treatments.

Other variants may include:

- "Lichen planus pemphigoides" characterized by the development of tense blisters atop lesions of lichen planus or the development vesicles de novo on uninvolved skin.

- "Keratosis lichenoides chronica" (also known as "Nekam's disease") is a rare dermatosis characterized by violaceous papular and nodular lesions, often arranged in a linear or reticulate pattern on the dorsal hands and feet, extremities, and buttock, and some cases manifest by sorrheic dermatitis-like eruption on the scalp and face; also palmo plantar keratosis has been reported.

- "Lichenoid keratoses" (also known as "Benign lichenoid keratosis," and "Solitary lichen planus") is a cutaneous condition characterized by brown to red scaling maculopapules, found on sun-exposed skin of extremities. Restated, this is a cutaneous condition usually characterized by a solitary dusky-red to violaceous papular skin lesion.

- "Lichenoid dermatitis" represents a wide range of cutaneous disorders characterized by lichen planus-like skin lesions.

Drug induced pigmentation may take on many different appearances, one of the most common being a change in the color, or pigmentation, of the skin.

Poikiloderma vasculare atrophicans, or PVA, indicates that extra or altered skin pigmentation ("poikiloderma") is occurring, associated with heightened visibity of capillaries ("", referring to telangiectasia) under the skin, related to thinning and wasting away ("") of the skin and its tissue. Telangiectasia is an enlargement of capillaries underneath the skin.

PVA also has common names that include parapsoriasis-related terminology (i.e. parapsoriasis variagata, or "" parapsoriasis). Parapsoriasis is a term first used by Brocq in 1902, intended to represent a group comprising a number of uncommon skin disorders, under a once used, now antiquated classification scheme for all inflammatory dermatoses (skin diseases known to be associated with or cause inflammation). Brocq chose the term "parapsoriasis" to illustrate that the dermatoses placed in this group had or would have commonalities with psoriasiasis, including appearance and chronicity (lifelong or indefinite duration). This poorly designated grouping has led to confusion in establishing a nosology (a method of classifying diseases and disorders) that associated or distinguished these disorders, and through the years differing opinions and uses regarding parapsoriasis by both authors and physicians has caused further confusion. In more recent times, after much discussion and growing consensus, parapsoriasis and its terminology has been revisited and re-examined often. Newer thought on parapsoriasis, such as by Sutton (1956) all the way to that by Sehgal, "et al." (2007) has cleared much of the confusion and has sparked increased understanding of parapsoriasis and its constituents.

PVA fits within this updated view of parapsoriasis as a syndrome often associated with large plaque parapsoriasis and, or including its variant form, retiform parapsoriasis. Additionally, it may be considered a precursor or variant of the lymphomatous skin disorder mycosis fungoides, which is also associated with large plaque parapsoriasis. Large plaque parapsoriasis consists of inflamed, oddly discolored (such as yellow or blue), web-patterned and scaling plaques on the skin, or larger in diameter. When the condition of the skin encompassed by these plaques worsens and becomes atrophic, it is typically considered retiform parapsoriasis. PVA can occur in either the large plaque or retiform stage, but it can only be considered PVA when its three constituents (poikiloderma, telangiectasia, atrophy) are present. PVA is therefore considered an independent syndrome identified by its constituents, wherever it occurs.

In modern consideration and usage, the solitary term "poikiloderma" has also come to represent all three elements of PVA. When skin diseases and disorders or skin conditions described as dermatoses contain the term poikiloderma in their assessment or diagnosis (such as with Bloom syndrome), this can sometimes be an erroneous usage of the term. Discretion has been advised. Usage of the entire term "poikiloderma vasculare atrophicans" may also be reserved to indicate it as the primary condition affecting the skin in cases where the disorder associated with it is secondary.

Symptoms include lack of sweat glands, thin hair, brittle nails, mottled skin, and lack of fingerprints.

Typical features of acne include increased secretion of oily sebum by the skin, microcomedones, comedones, papules, nodules (large papules), pustules, and often results in scarring. The appearance of acne varies with skin color. It may result in psychological and social problems.

Dyschromia refers to an alteration of the color of the skin or nails.

"Hyperchromia" can refer to hyperpigmentation, and "hypochromia" can refer to hypopigmentation.

"Dyschromatoses" involve both hyperpigmented and hypopigmented macules.

The severity of acne vulgaris (Gr. ἀκµή, "point" + L. vulgaris, "common") can be classified as mild, moderate, or severe as this helps to determine an appropriate treatment regimen. Mild acne is classically defined by the presence of clogged skin follicles (known as comedones) limited to the face with occasional inflammatory lesions. Moderate severity acne is said to occur when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body. Severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.

Large nodules were previously referred to as cysts, and the term "nodulocystic" has been used in the medical literature to describe severe cases of inflammatory acne. True cysts are in fact rare in those with acne and the term "severe nodular acne" is now the preferred terminology.

"Acne inversa" (L. invertō, "upside down") and "acne rosacea" (rosa, "rose-colored" + -āceus, "forming") are not true forms of acne and respectively refer to the skin conditions hidradenitis suppurativa (HS) and rosacea. Although HS shares certain common features with acne vulgaris, such as a tendency to clog skin follicles with skin cell debris, the condition otherwise lacks the defining features of acne and is therefore considered a distinct skin disorder.

Prurigo pigmentosa is a rare skin condition of unknown cause, characterized by the sudden onset of erythematous papules that leave a reticulated hyperpigmentation when they heal.

Lick granuloma is a form of self-trauma and skin disorder in which most commonly dogs, but also cats, continuously lick a small area of their body until it becomes raw and inflamed. The most common areas affected are the lower (distal) portions of their legs, such as the carpus (wrist), or sometimes another part of their body such as the base of their tail.

The lesion can initially be red, shiny, swollen, hairless, irritated, and bleeding, similar to a hot spot (wet eczema). Eventually a raised hard plaque forms.

Haber syndrome is a cutaneous disorder of hyperpigmentation characterized by reticulated pigmentation of the person's skin. A rare genodermatosis, its key features include "rosacea-like facial eruption[,] reticulated hyperpigmentation of major flexures, comedones on the back and neck, and pitted facial scars."

Hydroquinone-induced exogenous ochronosis is an avoidable dermatosis that is exceedingly difficult to treat.

However, some studies show that treatment may be possible with a Q-switched alexandrite (755 nm) laser.

It is recommended that individuals with this disorder stop using hydroquinone-containing compounds. It is important to be aware of this as dermatologists may think the symptoms a patient is exhibiting are a melasma, and prescribe a hydroquinone-containing cream.