Hyperpigmentation & Dark Spots
Freckles, age spots, dark patches around your face, spots where acne used to be. What are they, what causes them, and most importantly, how do I get rid of them?
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Freckles
Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color and severity can vary.
Types of Hyperpigmentation
Melasma
Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors.
Post-Inflammatory
Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation.
Age Spots
Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure.
There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:
What Causes Hyperpigmentation?
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Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:
Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors.
Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.
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In addition to genetic determination of melanin production, UV exposure is the leading environmental cause of hyperpigmentation and the formation of dark spots. Melanin is the pigment that provides color to our skin, hair, and eyes. It acts as a natural sunscreen, absorbing UV radiation to protect the skin from damage.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
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In addition to genetic determination of melanin production, hormones and hormonal sensitivity is the leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
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Inflammation or injury to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury.
In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
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Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:
Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
Hormonal medications: Hormonal medications, such as birth control pills, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
If you are taking any medications and are concerned about the risk of hyperpigmentation, it is important to speak with your healthcare provider. They can provide you with more information on the potential side effects of your medication and advise you on how to best manage any skin concerns.
How to Treat Hyperpigmentation
The treatment of hyperpigmentation depends on the severity and type as well as your individual skin. There isn’t a one-size-fits-all solution, but there are a few ways to help prevent and treat hyperpigmentation and dark spots.
Proper protection.
Aside from your genetics, the number one cause of hyperpigmentation is UV exposure from the sun. Caring for and protecting your skin is the most important way to prevent hyperpigmentation as well as heal prior dark spots that have already formed.
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Sun Protection
Damage from UV exposure is the number one cause of hyperpigmentation. After moisturizing, make sure to apply sunscreen with an SPF of 15 or more to your face, neck, shoulders, and any exposed skin. This is essential even during the winter and cloudy days. You can also opt to avoid the sun during peak hours or wear protective clothing to shield from direct exposure.
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Treat Underlying Causes
If you find that you are prone to hyperpigmentation after acne, cuts, bug bites, or other injuries to the skin, it’s important to try to reduce instances where that occurs such as taking steps to prevent acne. Allow skin injuries heal without disruption and keep them covered from the sun. Avoid picking, popping, poking, scratching, or other interference with injuries as this can trigger melanin production.
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Moisturizing
Keeping the skin hydrated helps to maintain its overall health and function and reduces inflammation, which can prevent hyperpigmentation caused by irritation, injury or damage to the skin. Moisturizing also strengthens the skin barrier, protecting the skin from harmful environmental factors and promoting an even skin tone by reducing dryness and flakiness, which can lead to an uneven distribution of pigmentation in the skin.
2. Hyperpigmentation Actives.
Active ingredients intended to specifically address the causes of hyperpigmentation can help prevent and protect the skin against the formation of dark spots. Whether they increase the rate of skin cell turnover, exfoliate away dead skin cells, or kill off the bacteria, these are some of the most effective ways to treat and prevent hyperpigmentation and dark spots.
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Antioxidants
Antioxidants can be effective in preventing and treating hyperpigmentation by neutralizing free radicals, which are unstable molecules that can damage skin cells and lead to the formation of dark spots and other types of skin discoloration. Antioxidants can help increase the efficacy of SPF by mitigating free radicals from UV exposure, they reduce inflammation which can contribute to dark spots, and inhibit the enzyme involved in the production of melanin.
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Retinoids & Chemical Exfoliants
To improve your skin tone and reduce discoloration, consider using a chemical exfoliant peel/mask that contains AHAs (such as glycolic acid or lactic acid) or topical retinoids once or twice a week in the evening, after cleansing. These exfoliants can effectively remove discolored dead skin cells that are trapped on the surface while promoting new skin cell growth. This can help reveal a smoother, more even skin tone by reducing discoloration caused by melanin buildup in dead skin cells.
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Tyrosinase Inhibitors
Tyrosinase inhibitors, also referred to as skin brightening agents, hinder and decelerate the production of melanin in the skin by obstructing the supply of tyrosine, which the skin uses to create melanin. By topically inhibiting melanin production, they have the capacity to lighten hyperpigmentation, diminish age spots and dark spots, and restore an even skin tone, particularly when coupled with peeling and exfoliating agents like AHAs and/or azelaic acid to enhance their penetration.
3. Hyperpigmentation Extras.
Hyperpigmentation and dark spots can be particularly difficult to treat. As a result, it might be necessary to explore professional treatments that are done in person by dermatologists or estheticians. Some of the most common in-office treatments for addressing hyperpigmentation and dark spots include:
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Chemical Peels
Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA peels are also commonly used. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
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IPL Therapy
Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option.
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Laser Therapy
Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
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Ingredients to Look for
When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, block melanin production, and block harmful UV rays. Some of the key ingredients to look for include:
Tretinoin
A Retinoid that increases cell turnover
Tretinoin, a prescription topical retinoid, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface.
SPF
Sun Protection that stops UV damage
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential.
Arbutin
A Tyrosinase Inhibitor that blocks melanin production
Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids.
Tranexamic Acid
A Tyrosinase Inhibitor that blocks melanin production
The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma
Kojic Acid
A Tyrosinase Inhibitor that blocks melanin production
Kojic acid is a natural skin lightener that is derived from various fungi. It is a tyrosinase inhibitor, which prevents the enzyme tyrosinase from producing melanin in the skin. Kojic acid can also help to exfoliate, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance.
Azelaic Acid
An Anti-Inflammatory & Antiseptic that disrupts melanin production
Azelaic acid works by inhibiting the production of melanin in the skin. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation.
Niacinamide
A Skin Soother that decreases inflammation
Niacinamide is a form of vitamin B3, and it has been shown to have a number of benefits for the skin, including the ability to treat hyperpigmentation. Niacinamide works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone.
L-Ascorbic AcId
An Antioxidant that fights free radical damage
L-ascorbic acid, or vitamin C, treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover.
Glycolic Acid
A Chemical Exfoliant that resurfaces skin
Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates deep into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging.
Lactic AcId
A Chemical Exfoliant that resurfaces skin
Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract
A Plant Extract that inhibits melanin production
Licorice root extract contains a compound called glabridin, which has been shown to have skin lightening and brightening effects as a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation.
Soy Proteins
A Plant Extract that inhibits melanin production
Soy proteins contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.
FAQs
Does hyperpigmentation fade on its own?
It's possible for dark spots and hyperpigmentation to fade away similar to when a tan fades over time due to the natural process of skin turning over. Treatment options to expedite that process include vitamin C, AHAs (like glycolic acid or lactic acid), skin lightening agents (like kojic acid, arbutin, or licorice extract, or hydroquinone as a last resort), and different facial treatments to improve skin tone. Unfortunately, if your skin has suffered significant sun damage, some hyperpigmentation may never fully disappear. Freckles for example can almost never be fully eradicated.
How does melanin form?
Melanin is a pigment that is responsible for the color of our skin, hair, and eyes. It is produced by melanocytes, specialized cells that are found in the basal layer of the epidermis, which is the outermost layer of the skin. Melanocytes produce melanin by a process called melanogenesis, in which an amino acid called tyrosine is transformed into melanin through a series of chemical reactions. This process is stimulated by various factors, including exposure to sunlight, hormonal changes, and certain medications. The amount of melanin produced by the melanocytes determines the color of our skin, with darker skin having more melanin than lighter skin.
Are people with darker skin more prone to hyperpigmentation?
Hyperpigmentation can affect people of all skin tones, but those with darker skin tones are more prone to certain types of hyperpigmentation, such as post-inflammatory hyperpigmentation (PIH), melasma, and lentigines. This is because people with darker skin tones have more active melanocytes, which are the skin cells that produce melanin. When the skin is injured or inflamed, these melanocytes can produce more melanin than necessary, leading to hyperpigmentation. Additionally, people with darker skin tones are more likely to experience hyperpigmentation after exposure to the sun or certain chemicals or medications.
What are the red or dark spots left after my pimples heal?
You may find that even after a pimple heals there will be a red spot left behind on the skin. This is post inflammatory erythema (PIE) or damaged capillaries that can look like a small pink or red dot. You may also experience post inflammatory hyperpigmentation (PIH) which is when an acne spot becomes pigmented from melanin due to UV exposure during the healing process. This will look like a dark red or brown spot. Bot PIE and PIH are temporary but they can take a long time to fully heal and disappear on their own.
Why does pregnancy or other hormonal influences like birth control trigger melasma?
Pregnancy can cause melasma, also known as "pregnancy mask," due to hormonal changes. Specifically, the increase in estrogen and progesterone levels during pregnancy or from hormonal birth control can stimulate the production of melanin in the skin, leading to the development of hyperpigmentation. Melasma during pregnancy is more common in women with darker skin tones, as they tend to produce more melanin in response to hormonal changes. Sun exposure can also worsen melasma during pregnancy. Melasma usually resolves on its own after delivery or with a change in birth control, but it can persist in some cases.
When should I talk to a dermatologist?
Whenever you want a professional medical opinion on your condition! Aside from yearly skin checks, which are essential for catching and treating serious conditions like skin cancer, you can talk to a dermatologist about healthy skin aging, fighting acne, evening out your texture, or whatever you need answers to! We get it though, it can be tough to get in with a dermatologist for basic concerns.
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With shop-able product recommendations, daily routine outline, tips & tricks to help you correct and prevent hyperpigmentation!