Acquired Dermal Macular Hyperpigmentation Treatment in London
Acquired dermal macular hyperpigmentation, or ADMH, describes persistent slate-grey or brown patches where pigment has settled deeper in the skin. At Skinhorizon Clinic in Maida Vale, we focus on careful diagnosis, trigger control and pigment-safe treatment planning for medium to deeper skin tones.
Reviewed by Dr Mohammad Ghazavi, Consultant Dermatologist. CQC-registered clinic
Private dermatology care in Maida Vale, London. Pigment-safe care
Careful diagnosis, trigger control and conservative treatment sequencing. Central London access
Convenient for St John’s Wood, Paddington and West London.
What is ADMH?
Acquired dermal macular hyperpigmentation is an umbrella term for conditions where pigment sits deeper in the skin, creating slate-grey, ash-brown or brown patches. It includes patterns such as lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact dermatitis. Because pigment is deeper, treatment must be gradual and pigment-safe.
ADMH at a glance
| What is ADMH? | A group of conditions causing slate-grey or brown macules from pigment dropping into the dermis. |
|---|---|
| Common patterns of ADMH | Lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact dermatitis. |
| Key signs of ADMH | Smooth grey-blue, ash-brown or brown patches on the face, neck, upper trunk or flexures. |
| Who gets ADMH? | It can affect all skin types but is more frequently recognised in medium to deeper skin tones. |
| Why treatment of ADMH matters? | Dermal pigment fades slowly, and aggressive treatment can worsen colour. A careful diagnosis and pigment-safe plan are essential. |
| Appointments | 7 days a week (subject to availability). |
Understanding acquired dermal macular hyperpigmentation
ADMH describes pigmentation that has settled in the dermis rather than only in the surface skin. This deeper pigment often looks cooler in tone — grey, slate or ash-brown — and tends to fade slowly.
ADMH may follow subtle inflammation, irritation, friction or contact exposure. Correct diagnosis is important because treatments used for other types of pigmentation, such as melasma or superficial post-inflammatory hyperpigmentation, may not always be suitable.
How ADMH differs from melasma and PIH
ADMH
Often grey, slate or ash-brown because pigment has dropped into the dermis and is harder to clear.
Melasma
Usually presents as warmer brown patches on sun-exposed areas and may sit more superficially.
Post-inflammatory hyperpigmentation
Often follows acne, eczema or insect bites and may respond differently depending on pigment depth.
Get specialist care for dermal hyperpigmentation
Persistent grey-brown pigmentation needs a careful diagnosis and a cautious, pigment-safe treatment plan.
Why ADMH happens
After inflammation, friction or a contact trigger, melanocytes may increase pigment production. If the junction between the epidermis and dermis is disrupted, melanin can drop deeper into the skin.
Immune cells called melanophages then hold this pigment in the dermis. Because everyday skin turnover does not clear dermal pigment efficiently, the colour may persist for months or years.
Common triggers and patterns
Contact exposures
Fragrances, hair dyes, cosmetics or occupational chemicals may trigger pigmented contact dermatitis.
Friction and heat
Rubbing from clothing, masks or devices can drive low-grade inflammation.
Inflammatory rashes
Eczema or subtle dermatitis may precede patches that later appear as pigment.
Sunlight
UV exposure deepens existing pigment and prolongs fading, even if sunlight was not the original cause.
Getting the diagnosis right
We review timing, spread, itch, previous rash, new cosmetics, hair dye exposure and sun habits. Examination looks at colour, edges, distribution and signs of active dermatitis.
Where helpful, assessment may include dermoscopy, Wood’s lamp assessment or patch testing. Biopsy is rarely needed but may be considered if the pattern is unusual.
Treatment principles: calm, protect, then correct
Trigger control and photoprotection
Identify irritants or allergens, reduce friction and use daily broad-spectrum SPF with shade habits.
Anti-inflammatory care
When active dermatitis is present, short targeted anti-inflammatory treatment may help reduce ongoing pigment drive.
Pigment-balancing skincare
Azelaic acid, niacinamide, retinoids or selected brightening agents may be used cautiously and gradually.
Cautious procedures
Lasers or peels may be considered only when suitable, usually with test patches and conservative settings.
Pigment-safe care for deeper skin tones
In Fitzpatrick IV–VI skin tones, both the tendency to develop pigment and the risk of rebound darkening are higher. We therefore prioritise anti-inflammatory control, gentle actives and longer intervals between procedures when needed.
Harsh scrubs and untested “lightening” products are avoided because irritation can worsen pigmentation.
At-home routine
Cleanse gently
Use a mild, fragrance-minimal wash once or twice daily.
Treat gradually
Introduce prescribed actives slowly to minimise stinging, dryness or irritation.
Protect daily
Daily SPF and shade habits are central because UV deepens existing pigment.
Timelines and expectations
Because pigment is deeper, improvement is usually measured in months rather than days. Many people notice early brightening or softer borders within 8–12 weeks, with continued gains over 6–12 months.
Procedures, when used, are approached slowly and safely. The goal is steady improvement without triggering rebound pigmentation.
When to seek prompt review
Sudden spreading pigment
Especially if associated with itch or rash, as this may indicate active dermatitis.
New product or dye trigger
New hair dye, fragrance or cosmetic exposure may suggest contact allergy.
Post-procedure darkening
Darkening after treatment should be reviewed early to reduce further irritation.
Why choose Skinhorizon Clinic?
Consultant dermatologist-led diagnosis
Your pigmentation is reviewed with attention to depth, pattern, triggers and skin tone.
CQC-registered private clinic
Skinhorizon Clinic provides private dermatology care in Maida Vale, London, convenient for St John’s Wood, Paddington, West London and Central London.
Careful, pigment-safe sequencing
We avoid aggressive treatment and instead use calm, staged plans designed to reduce setbacks and support gradual improvement.
Your first visit — what to expect
History
Review timing, spread, products, hair dyes, irritation and sun habits.
Assessment
Examine colour, borders, distribution and signs of active dermatitis.
Plan
Trigger control, photoprotection, anti-inflammatory care and pigment-safe actives.
Review
Monitor progress, adjust treatment and consider procedures only when safe.
Frequently asked questions
Is ADMH the same as melasma?
What causes ADMH to start?
How long does ADMH take to improve?
Are lasers safe for ADMH?
Which skincare ingredients help?
Will sunscreen make a difference?
Do I need patch testing?
Take the first step towards more even-toned skin
A careful consultant-led plan can help identify triggers, reduce inflammation and support gradual pigment-safe improvement.
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
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