Can medication make pigmentation worse with BBL?

For the ultimate correction of hyperpigmentation, it often takes multiple BBL treatments. The majority of patients require of treatment series of 3-5 treatments occurring 1 month apart. With that being said, it sounds like you're endorsing the hyperpigmentation is worse than before you started the treatments. There are some patients who are at risk for post inflammatory hyperpigmentation (PIH) and this can occur with laser treatments. Patients with more melanin in their skin are at higher risk for PIH. Generally speaking, methotrexate can make you more sensitive to sun exposure and may be contributing. How affected you may be depends on many factors including the dose, frequency, and duration of the medication use. Timing your treatments around your methotrexate will be imperative and your skin may benefit from pretreatment with additional skincare to help prevent post inflammatory hyperpigmentation. Avoiding sun and ensuring proper SPF with reapplication will also be essential.