Any hyperpigmentation not responding to creams has to be reviewed. Skin biopsy may be needed to understand the condition and treat accordingly. Sometimes oral medications may also be necessary along with procedural treatments like chemical peels, qsyag laser etc may be needed to get rid of the pigmentation once the diagnosis is established. Understanding the cause and making a proper diagnosis is essential to resolve the hyper pigmentation. For more information please visit dermatologist near you.