Disorders of hyperpigmentation appear more pronounced in individuals with skin of color and tend to be more challenging to treat. The exaggerated response of melanocytes in these individuals to cutaneous trauma is seen as a hallmark of skin of color (Grimes in Seminars in cutaneous medicine and surgery. WB Saunders, pp. 77–85, 2009). A study with 1076 dermatology patients in Saudi Arabia found pigment disorders to be the fourth most common skin disease (Alakloby in Saudi Medical Journal 26(10):1607–1610, 2005). A study of 2000 Black patients in Washington, DC, found pigment disorders to be the third most common skin disorder (Halder et al. in Cutis 32(4):388, 390, 1983). The majority of these patients were noted to have post-inflammatory hyperpigmentation, with melasma being the second most frequent disorder (Halder et al. in Cutis 32(4):388, 390, 1983). The most common causes of hyperpigmentation are post-inflammatory hyperpigmentation, melasma, lichen planus pigmentosus, erythema dyschromicum perstans, drug-induced hyperpigmentation, and metabolic causes of hyperpigmentation, which will all be discussed in this chapter.