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Step 1
Determine the cause of the hyperpigmentation to prevent a recurrence after treatment. Possible causative agents include a post-inflammatory response, drugs, photosensitizing agents, systemic disease or ultraviolet light.
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Step 2
Gather the patient's history to investigate previous exposure to sunlight because this is the most common cause of hyperpigmentation. UV radiation causes a hyperpigmented area to become even darker.
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Step 3
Investigate the skin treatment regimen in cases of a localized hyperpigmentation with sudden onset. An acid-based topical application, enzyme peel, micro-dermabrasion or scrub may darken the skin. This may also be caused by a drug allergy.
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Step 4
Review medication for hyperpigmenting effects. These commonly include birth control pills, some antibiotics (including sulfonamides and tetracyclines) and anti-malarial agents, such as amiodarone, chloroquine and qunacrine. Other drugs that may cause hyperpigmentation include nonsteroidal anti-inflammatory drugs, pain relievers and some psychoactive medication.
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Step 5
Check for conditions that can darken the skin. These include Addison disease, arsenic poisoning, liver disease, pituitary tumors and pregnancy. The "mask of pregnancy" is a brown or tan patch on the face, called a melasma, caused by higher levels of estrogen.
