Hyperpigmentation and Dark Spots - Treatment with Skin Care
By Cynthia Bailey MD.
Hyperpigmentation and dark spots don’t stand a chance against skin care products with clinically-proven ingredients that fight uneven skin pigment. Whether you’re struggling with dark spots from sun damage, age spots, hyperpigmentation left behind from acne scars or other skin injuries, patchy discoloration on the sides of your neck due to Poikiloderma of Civatte, or symmetric facial brown blotches from melasma, there are dermatologist-approved pigment-fighting products that can help.
Start by adding one of the best dark spot correctors to your existing skin care routine. Or, for even better results, create a targeted Complete Skin Care Routine that fights all of the root causes of skin hyperpigmentation; use clinically-proven ingredients at concentrations that work, combined with penetration enhancing products, and get the greatest control over uneven skin hyperpigmentation.
What causes dark spots?
Dark spots are caused by discrete areas where melanin is overproduced and then held in different layers of the skin.
The most common examples of hyperpigmentation and dark spots on your skin include:
Also called solar lentigines, which are freckles due to sun damage. Here flat dark patches of excess melanin are held in the epidermis (dead stratum corneum layer and living squamous and basal cell layers).
Melasma is a complex form of patchy facial skin hyperpigmentation located symmetrically and due to hormones, genetic predisposition and sun damage. Pigment may reside in the dermis or epidermis.
Poikiloderma of Civatte involves patches of dark brown/reddish skin discoloration on the sides of the neck due to sun damage. It's common once you start looking for it. This hyperpigmentation skin problem strikingly spares the skin under the chin. Pigment resides in both epidermis and dermis.
Healed skin injuries including pimples, rashes, and wounds such as a simple scratch can leave skin pigment behind after healing. Pigment is often present in the dermis and epidermis.
Dark skin in the folds of the neck, armpits and groin. Thickened epidermis and dead cell stratum corneum layers hold melanin pigment to cause hyperpigmentation.
Thickened skin on areas such as the back of the knuckles or rough elbows can look brown by holding excess melanin.
These skin growths happen with age and are often rough dark spots.
All of these causes of hyperpigmentation and dark spots get worse with sun exposure and many are also connected to skin sun damage.
Although dark spots and skin hyperpigmentation are generally harmless, they are destressing.
All skin types, genders, ethnicities and ages can be affected by skin hyperpigmentation problems. Hyperpigmentation is often a stubborn and difficult to treat skin problem – unless you get at the cause.
Skin care products that stop the overproduction of melanin and encourage skin to shed excess melanin are the best way to fight dark spots. Know that treating hyperpigmentation often takes time, especially if it covers a large area, if the melanin pigment is held deeper in the dermis, or the color is much darker in tone than the rest of your complexion. - Dermatologist Dr. Cynthia Bailey
Start now and see results; combine products that lower the overproduction of melanin with those that exfoliate and stimulate cellular renewal in the skin and get even faster and better results. This is what I have done in my Ultimate Pigment and Sun Damage Repair kit.
My Ultimate Pigment and Sun Damage Repair Kit is made from the best clinically-proven ingredients to build a skin care routine that addresses skin hyperpigmentation and dark spots.
The Ultimate Pigment and Sun Damage Repair Kit has made an amazing difference in my longstanding Poikiloderma of Civatte skin condition. I've tried so many products that never made much difference. IPL and Microneedling were of no benefit. I'd almost given up after ten years of trying to find relief for this condition while spending a few thousand dollars doing so. The combination of these products has reduced my symptoms by 50% in two months! I've reduced the amount of heavy coverage makeup on the lower face and neck areas. as the discoloration fades. Plus, the kit has improved the overall texture and appearance of my entire face. I anticipate even more improvement over the next few months. Very grateful I took the chance on this kit as it has exceeded expectations and is helping me regain confidence in my appearance. Ms. Green Eyes
What exactly causes hyperpigmentation and dark spots on the skin?
Skin pigment is called melanin. It is made by skin cells called melanocytes that are scattered in the epidermis and clumped deeper in the skin in moles (melanocytic nevi).
What causes skin pigment to form?
- Skin naturally makes more or less melanin depending on your skin color tone.
- UV exposure stimulates melanin synthesis, which you see as tanning.
Melanocytes make melanin by a complex series of steps, the most important of which is controlled by an enzyme called tyrosinase.
Inhibiting the tyrosinase enzyme is an important way to treat dark spots.
Melanocytes package melanin into granules and transfer these granules to the main cells that make up the epidermis called keratinocytes. This process can be even, as in a tan, or irregular, as in dark spots. Interestingly, the skin pigment that you see when you look at your skin is mostly the melanin that is inside the keratinocytes, not the melanocytes. As the keratinocytes age they become the dead cells of the stratum corneum, still holding melanin.
Melanin can also drop into the lower layer of skin called the dermis. This happens with post inflammatory hyperpigmentation when a skin injury, such as an acne lesion, scratch, burn or other skin injury, damages the barrier between the epidermis and dermis and melanin enters the dermis. It also happens with melasma. Melanin is not normally present in the dermis. The skin tries to remove it with clean-up cells called melanophages (the name sort of translates to 'cells that eat melanin'). Sometimes the dermal melanin is stubborn and does not entirely get removed.
How do you treat hyperpigmentation and dark spots with skin creams and skin care routines?
The best dark spot correctors that really work
First and foremost, you want to lower melanin synthesis using tyrosinase inhibitors in your skin care products.
Tyrosinase is a skin enzyme that is important for making the pigment called melanin. Tyrosinase inhibitors stop the melanocyte cells from making melanin.
The best tyrosinase inhibitor is hydroquinone.
Other tyrosinase inhibitors in skin care include:
- kojic acid,
- bearberry and,
- azelaic acid, among others.
None of these work as well as hydroquinone but can be helpful used with it or for maintenance. There have been concerns about hydroquinone causing a form of black skin pigment deposit called exogenous ochronosis. This is typically linked to mercury and resorcinol added to adulterated preparations found in other countries. That said, most dermatologist's, including myself, do not recommend hydroquinone preparations be used for long term management of hyperpigmentation. My preference is short-term use and to manage and maintain results with a skin care routine using the other ingredients mentioned in this article.
Another product called Cysteamine Cream also inhibits tyrosinase. It is available without prescription but smells like rotten eggs.
Best serums for hyperpigmentation
Vitamin C inhibits the tyrosinase enzyme when used in professional products, meaning those with made with the stable L-ascorbic acid form of vitamin C at 10% or higher concentration. The product must have an acid pH of around 3.0 and ideally should be protected from air and light such as my Vitamin C Professional Treatment Serum. The effect of vitamin C on pigment control is mild but it is a potent antioxidant with other age fighting benefits. Vitamin C is also a great skin brightener and boosts collagen renewal to fight wrinkles and crepey skin. Vitamin C can be applied daily or as little as every 4 days.
The bottom line is that hydroquinone is the most effective topical tyrosinase inhibitor that we have. Most dermatologists include it in a pigment correcting skin care routine. You can get 2% hydroquinone products in the US without a prescription. This is an effective level of hydroquinone for many people and is available in my Pigment Fading Pads, which also contain botanical tyrosinase inhibitors.
Most dermatologists, including myself, recommend using hydroquinone twice a day for only a limited period of time (3 to maximum of 6 months), and then tapering off. We use it again if the pigment problem worsens. If long term use is contemplated then medical supervision is necessary.
I have melasma on my cheeks and have been looking for product to prevent and help fade hyperpigmentation. This product has natural arbutin and kojic acid, which help prevent more skin hyperpigmentation. The pads did not irritate my skin and helped fade the melasma. - Loan
Another method to fight dark spots is to prevent the transfer of melanin out of melanocytes.
The uneven transfer of melanin to keratinocytes can be slowed by ingredients such as niacinamide. In my observation, the improvement in hyperpigmentation with niacinamide is mild.
Altering how melanin is arranged and held in keratinocytes helps get rid of hyperpigmentation and here is where retinoids come in as a treatment option.
Retinoic acids (such as tretinoin/RetinA and retinol) are the most important treatment products in this context and act by disrupting pigment transfer by inhibiting the dispersion of pigment granules in keratinocytes, by accelerating epidermal cell renewal and exfoliating skin to shed retained melanin.
Retinol, such as my Retinol Night Cream, acts on a cellular level to fight skin sun damage that can accompany hyperpigmentation, helping to even-out the distribution of melanin in the skin to get rid of dark spots.
Penetration enhancing medicines and cosmeceuticals such as retinoids (tretinoin or non-prescription retinol) and AHA's (such as glycolic acid) also help to treat melasma and dark spots by enhancing the penetration of tyrosinase inhibitors into the skin.
Like retinoids, the AHA glycolic acid also helps to more evenly disperse melanin in the epidermis to even-out hyperpigmentation
I combine an "all of the above" approach to fighting dark spots and hyperpigmentation because it is usually a very stubborn skin problem.
How do dermatologist’s treat dark spots and hyperpigmentation?
By combining the best and most effective clinically-proven ingredients into a skin care routine that fights uneven skin pigmentation. I designed my Ultimate Pigment and Sun Damage Repair Kit to deliver the best non-prescription ingredients to target really tough skin hyperpigmentation problems such as melasma, sun damage and acne scarring. It's the synergy of this product combination that works the magic!
In this skin care kit, I use 5 key strategies to fight skin pigment problems:
- Skin tyrosinase inhibitors including arbutin, kojic acid and hydroquinone to turn down melanin production.
- Retinol and the AHA glycolic acid enhance penetration and have their own unique mechanisms for controlling skin pigment.
- High concentration green tea polyphenol antioxidants help neutralize free radicals that are one of the signals that start melanin formation. Antioxidants also help fight inflammation that's seen in skin suffering from these pigment problems. They also help skin tolerate a powerful professional skin care routine like this.
- Sheer Strength Pure Physical SPF 50+ Broad Spectrum Sunscreen blocks UV induced skin pigment formation (I recommend you select the tinted product with iron oxide).
- A pH balanced cleanser, toner and moisturizer to keep skin healthy during treatment.
Adding a mineral powder with iron oxide will also help block visible light from hitting the skin.
Best sunscreens for hyperpigmentation
Sunscreen is the single most important step in preventing and treating hyperpigmentation and dark spots – and it must block both UVA and UVB rays. Without sunscreen, pigment problems will continue because UV rays lead to melanin pigment formation, the first step in a chain of events that leads to pigment problems. Authors of a 2020 scientific review on skin pigment say it this way,
UVR (radiation) is ... the major environmental stress leading to the development of hyper-pigmentation disorders.
Always select a really good broad spectrum sunscreen and wear it every day from sun up to sun down. Even indoors you can be exposed to UVA rays through windows. I only trust zinc oxide for broad spectrum sun protection.
Prevent melasma by wearing a broad spectrum sunscreen with SPF 30+ and products with iron oxide over 3.2% every day.
You also want to use a sunscreen or other product that contains over 3.2% iron oxide, which has been shown to block visible light that can darken hyperpigmentation. My Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen gives you both UV and visible light protection. Top it with mineral powder or my Sheer Strength Pure Physical SPF Refresh Sunscreen for even more mineral particle and iron oxide protection.
How does exfoliation work to get rid of dark spots and hyperpigmentation?
Exfoliation of the dead cell stratum corneum layer removes melanin pigment held in this layer of the skin. Exfoliation will often lighten hyperpigmentation quickly. An exfoliating sponge, gritty scrub or shower cloth is a simple way to physically exfoliate excess pigment in dead cells.
Use an AHA to loosen the ‘glue’ that holds dead cells together in the stratum corneum. This also helps even out skin color and improve hyperpigmentation. Glycolic acid is the best AHA for this job. By loosening the ‘glue' between dead cells, it also enhances physical exfoliation.
Glycolic acid and other ingredients that loosen and remove dead cells are called keratolytics. They include glycolic acid, salicylic acid, and retinoids (prescription tretinoin and non-prescription retinol).
For non-facial skin, glycolic acid is my favorite treatment product for dark spots.
I've used it (glycolic acid cream) for 2 weeks, not every day. I put it on one of my hands too and that one has less age spots now than the other.” RAM
I’ve combined AHA glycolic acid products with physical sponges and scrubs for over 30 years in my practice and my own skin care routine – both face and body. I am one of the first dermatologists to teach people about this combination of chemical and physical exfoliation, which is so uniquely effective at creating smooth skin and fighting dark spots.
My Glycolic Acid Facial Skin Care Kit and Ultra-fast Triple Action Body Smoothing Kit combine strong, professional-level AHA/glycolic acid with the perfect exfoliating facial sponge and shower cloth; the pigment in sunspots and age spots are sloughed and polished, revealing glowing, bright, more youthful-appearing skin that’s soft. Wear a broad-spectrum sunscreen during the day and you’re set for some of the best skin care to fight hyperpigmentation and dark spots.
Skin care routines and products to fight hyperpigmentation are important even if you are considering lasers, skin peels or other in-office procedures.
Dermatologist’s often prepare your skin with hyperpigmentation-fighting products before procedures to help prevent post-procedure hyperpigmentation and improve treatment results. The same skin care products that I just described above are exactly what I’ve used for years in my practice combined with procedures to treat unwanted pigmentation. (Of course, ask your treating physician to supervise your care when you are planning any cosmetic procedure.)
Lasers and Intense Pulsed Light
These procedures use light energy to target the chromophore melanin. Light energy is transferred to the melanin to break it up. The results can be dramatic, but lasers and IPL can also have unwanted side effects, especially on dark or tanned skin.
Typically, a minimum of 3 treatments are needed to treat hyperpigmentation and maintenance treatments are also advisable.
Chemical peels use strong acids to rapidly exfoliate dead skin that holds melanin pigment. Skin is typically brighter and glowing after a chemical peel. Acids include varying strengths of glycolic acid, trichloroacetic acid, salicylic acid and others. They can be harsh and tricky for sensitive skin. Like lasers and IPL, there can be undesirable side effects – including post inflammatory hyperpigmentation.
Typically, peels are done as a series spaced out at 4-week intervals.
I love microdermabrasion because simple physical exfoliation used in a professional setting is often more predictable for sensitive complexions suffering from barrier compromising skin problems such as rosacea or seborrhea. Even melasma can be tricky and prone to hyperpigmentation after skin irritation and injury and microdermabrasion is easier to control in my experience.
I typically recommend microdermabrasion done every 6 weeks as both treatment and maintenance therapy.
No matter what procedure you may be considering to correct hyperpigmentation, a skin care routine that helps to turn-down pigment production and turn up collagen renewal may help.
The bottom line is that a skin care routine that fights pigment is the most important thing you can do to get rid of hyperpigmentation and dark spots. I created my Ultimate Pigment and Sun Damage Treatment Kit as a powerful Complete Skin Care Routine to correct uneven skin hyperpigmentation and fight skin aging.