Hyperpigmentation 101: The Best Dark Spot Treatments

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This article first appeared in the Fall 2020 issue of New Beauty. Click here to subscribe

You can call it one of many names: Uneven pigmentation, age spots, liver spots, melasma or hyperpigmentation— while they are relatively harmless, dark spots can be slow to fade and really tough to conceal. Here, top skin-care experts share the best ways to treat and beat those pesky spots.

What Is Hyperpigmentation?

Hyperpigmentation isn’t a condition, explains San Antonio dermatologist Vivian Bucay, MD, but rather a term that describes skin that appears darker than usual. “It can occur in small patches, cover large areas or affect the entire body,” she says. “It’s a chronic problem that’s largely influenced by genetics, and unfortunately, there’s no magic eraser. This isn’t like a stain on the carpet; it requires commitment to treat. All we can do is help the body decrease the amount of pigment it’s producing, which is an ongoing process.”

What Causes Hyperpigmentation?

Hyperpigmentation is commonly caused by an excess of melanin—the pigment that gives skin its color and is produced by skin cells called melanocytes—production in the body. Several conditions or factors can trigger melanin production, and changes in hormone levels that accompany pregnancy or menopause can affect it in some women. “Certain medications, as well as certain chemotherapy drugs, can also cause hyperpigmentation,” adds Dr. Bucay. “Typically, dark spots are located in sunexposed areas like the face, chest, back, and limbs,” says Miami dermatologist Dr. Deborah Longwill. “They can appear as early as the teens and become more noticeable with age and the accumulation of UV radiation.”

Step 1: Prevention

The most effective way to lighten and prevent dark spots is by using a physical sunblock, advises Dr. Longwill. “Use one that contains zinc oxide and titanium dioxide. No topical treatment or in-office procedure can help remove and treat pigmentation or brown spots without serious UV prevention with physical clothing, sunglasses, an umbrella and a hat.

Step 2: Topical Treatments

There are many topical treatments to help decrease melanin production, but it’s crucial to commit to one and maintain it, as results won’t occur overnight. Primary ingredients recommended for lightening dark spots include hydroquinone, retinoids, azelaic acid, glycolic acid, kojic acid, cysteamine, and licorice root extract. “Many of these act as tyrosinase inhibitors, a key enzyme in the production of melanin,” Dr. Bucay says.

Hydroquinone, the gold standard for lightening dark spots, stops about 90 percent of tyrosinase activity. “For topical hydroquinone agents that are compounded stronger, I suggest an 8- or 12-percent formulation,” Baton Rouge, LA dermatologist Ann Zedlitz, MD says. “It works faster than the generic prescription of 4 percent.” However, high concentrations of hydroquinone can only be used for a short period of time because they can cause skin inflammation, itching and an allergic reaction in some patients.

To reduce the appearance of spots, Dr. Zedlitz says acids should be your friend: “The best way to treat dark spots at home is with a topical alphahydroxy acid (AHA) product that you apply on the entire area of skin.”

Brighteners to Look for:
2-Percent Hydroquinone
Azelaic Acid
Glycolic Acid
Kojic Acid
Tranexamic Acid (TXA)
Retinoids (Retinol, Tretinoin, Adapalene, or Tazarotene)
Vitamin C
Arbutin
Niacinamide
Cysteamine
Licorice Root Extract

When A-list clients visit celebrity facialist Georgia Louise for dark spot correction, she recommends starting first with lower actives to help lighten. “It will take more time versus using stronger actives,” she says. “I do this to be as gentle as possible to the skin. First and foremost, I suggest using a product with vitamin C. Then spot-treat every other night with retinol.”

Step 3: In-Office Treatments

If the pigment is deep down in the dermis, an in-office procedure can help lift it out of the skin.

Chemical Peels
Low-strength glycolic acid and salicylic acid peels can help reduce the look of dark spots. “Not in the same strength I would normally use for other skin concerns,” says Dr. Bucay. “For hyperpigmentation, I go low in concentration, and I go slow.”

Microneedling
According to Dr. Longwill, microneedling can help with the absorption of brightening ingredients in topicals, as well as remove specific layers of skin containing the melanin.

Light and Energy Devices
Intense pulsed light (IPL) and BroadBand Light (BBL) therapy “selectively heat up the pigment, but leave the surrounding tissue alone and unharmed,” explains Dr. Zedlitz. “They then lift that heated, ‘damaged’ area to the surface of the skin, where it is removed by the body’s natural exfoliation process.”

Laser-Resurfacing Treatments
For more severe cases, a laser treatment may be recommended. “In those cases, I might use PicoSure, Fraxel or Nd:YAG,” adds Dr. Bucay. “You should only go to a board-certified dermatologist or plastic surgeon because when you introduce a heat device, you can make matters worse. It’s important to have a qualified expert choosing the proper settings for your particular case.”

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