Abstract
Background
Pigmentary disorders, including hyperpigmentation, are among the most common dermatologic diagnoses in individuals with skin of color (SOC), particularly individuals with African, Asian, or Hispanic heritage, and often carry a significant quality-of-life burden. Although the evidence base has grown, gaps persist in epidemiology, in pathophysiology-driven treatment selection, and in the appropriate representation of Fitzpatrick skin types III to VI in clinical studies.Methods
A comprehensive review of PubMed and Medline-indexed hyperpigmentation literature published between 2000 and 2026 was reviewed, with priority given to randomized controlled trials, meta-analyses, large epidemiologic series, and consensus statements.Results
Our current understanding of hyperpigmentation has extended well beyond melanocyte hyperactivity alone. Across the major hyperpigmentation disorders, visible light acting through opsin-3 (OPN3), inflammatory and hormonal signaling, and, in melasma, basement-membrane disruption with a senescent dermal microenvironment contribute to pigment formation and treatment resistance, findings that highlight the importance of both UV radiation and visible-light photoprotection. Clinical and meta-analytic evidence supports a multimodal therapeutic approach, consistent with recent international consensus recommendations. Quality-of-life impairment is consistent across populations, a pattern that should inform counseling, while commonly used diagnostic tools and machine-learning algorithms continue to underperform in skin of color.Discussion
Treatment of hyperpigmentation remains a multimodal therapy with the need for routine assessment of patient-reported quality of life impact.Conclusion
Closing the evidence gap for skin of color is the next priority in treatment of hyperpigmentation and will require inclusive trial design, validated diagnostic tools, and standardized outcome measures.  .