The Ultimate Guide To Dark Spots And Hyperpigmentation

January 11, 2022

From sun spots to melasma and everything in between, we're breaking down what you need to know about the most common pigmentation conditions and how to treat them.

Hyperpigmentation is a lively topic these days - and for good reason. From post-acne inflammation to age spots, there are so many different types of dark marks. As such, it can be difficult to identify exactly what kind of pigmentation you're dealing with. And, from there, it may take some trial and error to figure out the best course of treatment for it. Here, we tapped three top dermatologists to talk about what exactly hyperpigmentation is, the difference between the various types, and how to deal with it in the best way for your skin type.

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What Is Hyperpigmentation?

In simplest terms, "hyperpigmentation refers to darkening of the skin because of an accumulation of melanin," says Joshua Zeichner, MD, a board certified dermatologist in New York City. While it looks different on everyone, very few are immune to unwanted pigmentation. "Hyperpigmentation is a common condition that many people, at all ages, suffer from," says Paul Jarrod Frank, MD, a NYC-based board certified dermatologist, adding that the discoloration leads to an uneven skin tone that leaves many patients frustrated.

One cause of the frustration may be that it can be difficult to pin down exactly where the pigmentation is coming from. As Dr. Zeichner explains, there are many causes of hyperpigmentation and a variety of ways to help treat it. Very often, it's the result of too much sun exposure. But the reality is that it can be caused by almost disruption to the skin, including acne, rashes, and even hormonal changes (think: pregnancy, birth control), Dr. Frank shares.

While an at-home skincare routine that includes daily sunscreen (a non-negotiable) and a smattering of brightening and exfoliating active ingredients can go a long way, hyperpigmentation often requires professional intervention. "It can be difficult to treat with at-home or over-the-counter remedies, especially for patients with stubborn and extensive situations," Dr. Frank says. "However, the appearance of hyperpigmentation can often be greatly reduced by treatments available at dermatologists' offices."

Another important thing to know about hyperpigmentation? Treatment is rarely one and done. Pigmentation concerns tend to be ongoing and require a combination of at-home skincare and in-office treatments to manage. Patience and diligence are key, as is identifying exactly what type of hyperpigmentation you have...

Types of Hyperpigmentation

Since 'hyperpigmentation' is an umbrella term, it's important to drill down a little further and figure out what is causing your dark spots. While there are some treatments that will work across types, others can actually make matters worse. Consulting with a board certified dermatologist is the best way to determine what type of hyperpigmentation you have and how to treat it, but below is a primer to kickstart your conversation:

1. SUN SPOTS

Whether you call them 'sun spots,' 'liver spots,' or 'lentigines,' these small, flat brown spots are caused by damaging ultraviolet (UV) rays. "Under the microscope, these spots actually show an increase in the number of the pigment producing cells," Dr. Zeichner says. This is in contrast to freckles, "which have a normal number of pigment producing cells that are just overactive," he adds. The common locations for this type of hyperpigmentation are the face, chest, arms, and hands, says Mona Gohara, MD, a board certified dermatologist in Hamden, CT. It's also more likely to occur in light skin.

The fact of the matter is that it's just about impossible to avoid sun spots. "If we lived in a bubble, we would never have these!" Dr. Gohara quips. To prevent this type of hyperpigmentation from cropping up uninvited, she recommends wearing a broad spectrum sunscreen with an SPF of 30 or higher and reapplying every two hours (or more often if swimming or sweating) "365 days a year, regardless of weather."

The earlier you treat lentigines, the better. "Spots that have been present for extended periods of time often can only be treated effectively with lasers," Dr. Zeichner says. But that doesn't mean a solid skincare regimen doesn't have value. Nighttime is the best time to use products and those to help with hyperpigmentation, such as retinoids and alpha hydroxy acids (AHAs). "These products will encourage cell turnover and leave the skin smooth and exfoliated," Dr. Frank says.

2. MELASMA

"Melasma is brown blotches that most commonly occur on the face, cheek, or around the jaw," Dr. Gohara says. It's also possible to see it on the temples and upper lip, the latter of which can make it appear like a mustache, Dr. Zeichner adds. While it's quite common, its exact cause is unknown. "Melasma is determined by your genetics and is influenced by hormonal fluctuations," Dr. Zeichner explains. "It often gets worse in times when estrogen levels increase, such as during pregnancy or when taking a birth control pill." This is why melasma is often referred to as the 'mask of pregnancy.' Other potential culprits? Heat exposure, UV rays, and blue light from computers, cell phones and light bulbs.

Melasma is more common in melanated skin, and, to treat it, Dr. Gohara recommends a variety of brightening and lightening topicals - including retinoids, antioxidants, licorice root extract, and hydroquinone - and, of course, sunscreen. "SPF is non-negotiable, preferably mineral with an element of iron oxides to protect against blue light," she says. Dr. Zeichner agrees: "Sunscreen is always important because even small amounts of UV light exposure can undo weeks of improvement with topicals."

There are also in-office procedures, such as peels and lasers, that can help, though it's important to be treated by a provider who is well versed in treating melasma because it's easy to exacerbate the condition.

3. POST-INFLAMMATORY HYPERPIGMENTATION (PIH)

Dr. Zeichner says to think of post-inflammatory hyperpigmentation (PIH) like a stain in the skin. "Any type of inflammation in the skin, ranging from a burn to acne, can heal with a dark blotch in that area," he explains. These marks can last for several months or even years - making them, in some cases, even more bothersome than the original condition. Generally speaking, lighter skin types experience PIH that is more pink or red in color, while darker skin types have purple, brown, or black marks.

Because this type of discoloration occurs after the skin is somehow inflamed, Dr. Gohara advises treating the underlying condition first. Even though PIH tends to fade over time, Dr. Frank says it's always best to treat the spots right after they occur with an energy-based device. For red marks, he likes to use a vascular laser (either the Vbeam or the Excel® V, to be exact). For brown PIH, he likes to use the Pico Genesis™. It all depends on the color of the post-inflammatory hyperpigmentation, he says.

When it comes to topical skincare, Dr. Frank says AHAs and retinoids can be helpful in treating red marks on lighter skin. "For darker skin types, where the mark is more brown, I recommend AHAs, hydroquinone, kojic acid, arbutin, or a combination of these ingredients," he shares. His PFRANKMD Vanishing Stick, for example, is formulated with arbutin, kojic acid, and vitamin C. "The ingredients work synergistically to help visibly brighten, lighten, and tighten skin for a more even, glowing appearance," he says.

Similarly, Dr. Zeichner says to look for ingredients that disrupt melanin production. "Retinol enhances cell turnover and hydroxy acids, like glycolic acid, have an exfoliating effect," he explains. Niacinamide, licorice root extract, and tranexamic acid, meanwhile, "help calm inflammation," he adds. He likes the Bliss Bright Idea Vitamin C + Tri-Peptide Serum, Rodan + Fields Reverse Tone Correcting Treatment, and Pond's Clarant B3 Dark Spot Correcting Cream for at-home care.

The Takeaway

No two hyperpigmentation cases are the same, but Dr. Zeichner says there are some basic treatment tenets that remain true regardless of what's causing it. "First, you want to reduce inflammation in the skin; second, you want to block production of abnormal pigmentation; and third, you want to enhance cell turnover to help the skin shed the darkly pigmented cells," he says. This can be achieved through a combination of professional solutions and topical skincare, so it's important to consult with a board certified dermatologist to develop the best treatment protocol for your needs.

 


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