Is body pigmentation really an ‘issue’ that needs to be fixed?

Dark underarms, patchy elbows, uneven knees—body pigmentation is normal. So why are we out to treat it?

Harper's Bazaar India

Raise your hands if you’ve ever been asked about your dark underarms, or have been provided with unsolicited advice for your patchy elbows and knees? You’re not alone—body pigmentation is absolutely normal and common. Looking back, I remember a 13-year-old me being told to try ‘bleaching’ agents to fix my darker-than-usual underarms. The question on my mind was: was it broken that it required fixing?

Let’s be honest, our society hasn’t been quite fair to those born with extra melanin, even if it comes in parts. While the perception is changing, there are times where ‘darker skin’ seems to be an issue that needs to be addressed. But, is it true? Dr Kiran Sethi, MD and founder ISYA Aesthetics, breaks down the causes of hyperpigmentation on the body and throws light on whether it is a major issue that really needs fixing.

Hyperpigmentation explained

Hyperpigmentation is what happens when your body overproduces melanin, the pigment that gives your skin its colour. Regular melanin production can be hindered thanks to sun damage, skin trauma, inflammation of the skin, or other underlying health factors such as hormonal fluctuations. Hyperpigmentation occurs to people of all skin colours, but is more prevalent for those with darker skin. This is because the pigment producing skin cells called melanocytes work overtime and produce excess melanin in order to protect your skin from any sort of damage. 

When talking about body pigmentation, the areas that often get impacted include your underarms, inside of your thighs, the back of neck, knees, knuckles, and elbows. For example, your underarms experience trauma every time you wax or shave. If you’re wondering why you see random patches in these areas, even if they aren’t inflamed or exposed to any sort of damage, there’s an explanation for that too.

“Dark elbows, knees, or pigmentation around the bikini area is pretty normal, and not actually a disease. It can even occur due to friction,” Dr Sethi explains. Your inner thighs rubbing and chaffing together is probably the biggest case of friction-caused pigmentation.

The treatment

The market is saturated with topical products that brighten the skin and help treat pigmentation instantly. While a lot of products contain skin-loving active ingredients that can help fade the patchiness and even out your skin tone, some products do contain bleaching agents that aren’t very skin friendly if not used properly. As a matter of fact, the use of bleaching agents like hydroquinone has been said to have serious side effects and can be counterintuitive to your skin’s health. 

Dr Sethi adds, “Most creams are fine to use if under supervision of a doctor with minimal to no long-term side effects. Some people use strong bleaching creams without oversight—causing problems. But, doctors know how to use them while protecting you.”

To fix or not to fix…

…that is the main question. Dr Sethi says that it is important to note that hyperpigmentation is not a disease, but can be a symptom of one. For example, she explains that pigmentation around the underarms,

neck, knuckles, and even groyne area, can often be acanthosis nigricans, an early sign that you are predisposed to or are likely to develop diabetes. “If you have this, then it’s your body’s way of telling you to eat better. This is more important to look into than fixing the discolouration,” she says.

Other than this, Dr Sethi feels that if you have pigmentation and it bothers you, feel free to treat it, if not then it’s alright to let it be. She adds, “Body acceptance is the first step to actually healing. Once you love yourself and accept yourself is when you can improve things in a healthy and peaceful way, or accept them and let them go. My advice is, to focus on loving and appreciating your body, listen to how it speaks to you, and then see what and if anything needs to be done.”