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Hyperpigmentation 101: What Are Those Spots and How to Treat Them

We all have skin issues that we’d love to fix. While blemishes and wrinkles are the issues talked about most often, hyperpigmentation bothers many people. For some reason, this seems to be the “issue of the month” amongst my friends and family. Every time I turn around I’m being asked about how to fix a brown spot!

While I’m a physician, I’m an intensivist, and not a dermatologist.  I’ve done most of my reading for this post from a few dermatology textbooks and my favorite cosmetic dermatology textbook, by Dr. Leslie Baumann.  I’ve tried to add in some references on-line where available.

There are a lot of different kinds of hyperpigmentation. You’ll find areas of melasma, the “mask of pregnancy” on women during and after pregnancy. You’ll find sun spots on those who have forgotten their sunscreen too many times and dark post-blemish spots on teenagers. While they get there different ways, treatment for these spots is mostly the same.

  • What are these spots? 1 of 27
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    How do these hyperpigmentation areas develop? Can they be treated? What about all of those products popping up on store shelves — are they a waste of money? We'll review a little about how melanin makes its way to your skin, the 3 most common hyperpigmentation issues, and the most common over-the-counter active ingredients. I even asked a few skincare professionals for their favorite products!

  • Start with the Melanocytes 2 of 27
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    Hyperpigmentation begins in the pigment cells, aka the melanocytes. You'll find them spaced throughout the base of epidermis. What is interesting is that everyone, regardless of race or skin tone, has the same number of melanocytes. It is how these melanocytes produce melanin, and in what quantity and type, that determines your skin tone.

    Image: Wikimedia

  • Making Melanin 3 of 27
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    Within the melanocytes, there are little melanin factories called melanosomes. Through a long series of chemical reactions, the two types of melanin are produced.

     

    Once the melanosomes are filled to capacity with melanin, they are transferred out of the melanocyte and into the keratinocytes (the regular skin cells). Each melanocyte is in contact with about 36 keratinocytes, providing the melanosomes to each cell. The transfer to keratinocytes isn't very well understood at this time, and there is a lot of research into this area.

    Image: Wikimedia

  • A Little Chemical Factory 4 of 27
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    What's important to know about the melanosome and the complex reactions (which I've dramatically simplified from this chemical reaction) within it is that the beginning two reactions both take place with the help of an enzyme named tyrosinase. There are many reactions before you get to the 2 melanins produced, but at the beginning they both share a few steps, and tyrosinase is needed for the steps. Because of this, it is a great target for decreasing melanin production.

    Images: Wikimedia for L-Tyrosine, L-DOPA, and L-Dopaquinone

  • Common Types of Hyperpigmentation 5 of 27
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    Usually, melanin production and distribution is even and without issues. However, it can be increased by several factors, such as sun exposure, hormones, and inflammation. The darkness under your eyes isn't the same increase in melanin, and is really a whole other post.

  • Melasma 6 of 27
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    Also called the mask of pregnancy, this is unfortunately a disorder that can occur in any woman of childbearing age. It tends to be chronic once started. The areas of hyperpigmentation are irregularly shaped and often on the face and neck.

     

    The exact cause of melasma is not known, though there are likely hormonal connections, as it is commonly associated with pregnancy. It is also seen in those not pregnant, in those using birth control, and even in men. Melasma also tends to pop up in areas treated with heat, for example the upper lip after waxing. While it can improve when exacerbating conditions improve (such as giving birth or going off of birth control), it tends to persist and can be present for years.

    Image: Wikimedia

  • Post Inflammatory Hyperpigmentation 7 of 27
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    While this form of hyperpigmentation may occur after any inflammatory condition (a burn, infection, bad reaction to skincare, or even an eczema flare), you'll see it most often after a pimple. It tends to happen most often in those of Asian ancestry or with darker skin tones. Unfortunately, if you get it once you'll be likely to have the issue again, since you'll always be susceptible.

     

    Post-inflammatory hyperpigmentation is probably the hardest to treat, since many typical treatments (such as peels) can cause further inflammation and more hyperpigmentation. Since these spots will improve with time, the best course of action is usually sun avoidance, sunscreen, and patience.

    Images: courtesy of Beauty 101 Blog and Slashed Beauty

  • Sun Spots 8 of 27
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    Also known by their scarier name, solar lentigos, you probably know these as sun spots or age spots. They're rarely seen under the age of 50, and really they are brought on by the sun. They're most common on sun exposed areas like the face, neck, upper chest, and the back of the hands. While more common in men, women will also have freckling in these areas that can be hard to differentiate from the sun spots.

     

    The most important thing to know about these spots is that they really signal an increased risk of melanoma and basal skin cancer. If you are under the age of 50, and have used tanning beds, there are spots that can occur and also signal an increased risk of skin cancer. If you have these spots, you'll need annual skin exams by a dermatologist.

    Image: via Geralt at Pixabay

  • Treatment of Hyperpigmentation 9 of 27
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    Treating hyperpigmenation can be agonizingly slow. It'll be months before you'll see progress. You can speed things up a bit with a visit to your dermatologist for a chemical peel, laser treatment, or prescription strength topical treatment. However, that isn't always necessary! Read on for more on the most common over-the-counter treatments (that work) for hyperpigmentation.

  • Protect Your Skin 10 of 27
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    You should always start hyperpigmentation treatment with sun avoidance and the highest SPF sunscreen you can stand. Be sure to use a full spectrum sunscreen and use it correctly! Sun exposure will make hyperpigmentation worse, so this tip only makes sense.

    Try:
    Kiehl's Super Fluid UV Defense SPF 50+ $38
    Aveeno Baby Continuous Protection Sunscreen Lotion SPF 55 $8.39
    Neutrogena Ultra Sheer Dry-Touch Sunscreen, SPF 100 $12.99

  • Tyrosinase Inhibitors 11 of 27
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    Remember that slide with the complicated looking chemical structures? The first 2 steps in making melanin involve one enzyme, tyrosinase. Tyrosinase is made only by melanocytes, so if you can shut down this enzyme you'll shut down melanin production for that area. The effects will take a while to be seen; remember that there is already melanin in the existing skin cells, and those cells will need time to turn over.

    Images: Wikimedia for L-TyrosineL-DOPA, and L-Dopaquinone

  • Hydroquinone 12 of 27
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    This is one of the easiest over-the-counter ingredients to find in the United States. While it occurs naturally in plants (so it makes an appearance in some food and beverage products, such as coffee and different grains), it was banned from use in Europe in 2000 and is highly regulated in Asia. In the US, you can buy 2% hydroquinone  over the counter and 4% with a physician's prescription. While the 4% might be more effective, it can also cause more irritation.

     

    Hydroquinone can decrease tyrosinase activity by up to 90% by preventing the tyrosinase from being created, and is toxic to melanocytes. While it can work alone, it is usually combined with other ingredients, such as a retinoid, glycolic acid, or kojic acid.

     

    You should avoid hydroquinone if you are pregnant or nursing, as safety has not been established. The main concern with hydroquinone is a disorder called ochronosis, a more permanent form of hyperpigmentation. Note that despite widespread use, only a handful of cases have been reported in North America. You can prevent ochronosis by taking a "hydroquinone holiday" every 2-3 months and using lower concentrations of the ingredient.

    Try:
    Murad Rapid Age Spot and Pigment Lightening Serum, 2% Hydroquinone, $60
    Alpha Hydrox Spot Light Targeted Skin Lightener, 2% Hydroquinone, $10.99

    Image: Wikimedia

  • Arbutin 13 of 27
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    Arbutin is a naturally occurring ingredient that is hydroquinone with a glucose (sugar) bound to the molecule. You'll find it in pear trees, wheat, and bearberry. Rather than preventing tyrosinase from being made, arbutin competes (reversibly) for the attention of the enzyme. Arbutin is available up to 3% and is mostly popular in Japan, but has been increasing in popularity in the US.

    Try:
    Chantecaille Vital Essence with Arbutin $114
    DHC Alpha-Arbutin White Cream, $49

    Image: Wikimedia

  • Kojic Acid 14 of 27
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    Kojic acid is a fungal derivative with anti-oxidant and antibacterial activities, and it's frequently used in foods as a preservative. On the skin, kojic acid will inhibit tyrosinase activity, helping fight hyperpigmentation. Studies have found that kojic acid with glycolic acid is more effective than hydroquinone 4% with glycolic acid. Note that you can have skin sensitivity to this ingredient, so be careful!

    Try:
    PCA SKIN pHaze 13 Pigment Gel, $40.50
    SkinCeuticals Phyto+, $80

    Image: Wikimedia

  • Licorice Root 15 of 27
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    Licorice root may win the prize for the brightening ingredient most likely to be added to a product. It seems to be popping up everywhere, and with good reason! This extract is useful against dermatitis, eczema, and skin irritation. It even has demonstrated anti-cancer properties and is recognized by the National Cancer Institute. When used to fight hyperpigmentation, it will inhibit tyrosinase activity. One study even found that it was superior to hydroquinone for lightening. In Europe, this ingredient is frequently added to products to soothe irritation.

    Try:
    Kiehl's Photo-Age High-Potency Spot Treatment $50
    DermaDoctor KP Duty Intensive Priming Serum, $44

    Image: Wikimedia

  • Melanosome Transfer Inhibitors 16 of 27
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    The melanosomes are made in the melanocytes, but need to make their way into the skin cells. While the exact mechanism of this transfer hasn't been worked out, there are a lot of theories. And we know that we have a few ingredients that help to stop this transfer!  

  • Niacinamide 17 of 27
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    This form of Vitamin B3, also known as nicotinamide, can inhibit melanosome transfer by up to 63%. It also is a potent anti-oxidant and anti-inflammatory. It can cause flushing, though this is usually temporary.

    Try:
    Olay Total Effects 7-in-1 Tone Correcting Spot Treatment, $20.09
    StriVectin-SD Intensive Concentrate for Stretch Marks & Wrinkles, $139

    Image: Wikimedia

  • Soy 18 of 27
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    In China, it is well known that women working with soybeans and tofu have beautiful skin. It turns out that soy prevents a receptor (PAR-2) involved in the transfer of melanosomes. Soy has been proven to both treat hyperpigmentation and prevent sunlight-induced skin darkening.

    Try:
    Aveeno Positively Radiant Daily Moisturizer Broad Spectrum SPF 30, $14.99

    Image: United Soybean Board

  • Antioxidants 19 of 27
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    Antioxidants seem to be in every new skincare product, though with good reason. They help fight damage from free radicals (learn more about how antioxidants work in skincare), resulting in anti-aging, anti-cancer and anti-inflammatory effects. They also help to decrease the increase in pigmentation seen after sun exposure by neutralizing free radicals before they cause damage. While that increase in pigmentation is usually seem as tanning, in hyperpigmented areas, the results can be exaggerated and result in much darker hyperpigmentation. In addition, it appears that antioxidants may affect overall melanin production.

    Image: 15 Minute Beauty

  • Vitamin C 20 of 27
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    Vitamin C is also known as ascorbic acid, and in skincare it can help to reverse parts of melanin production and prevent further production of melanin. It has also been found to increase collagen production, making it a great ingredient to include in your anti-aging skincare routine.

     

    The main issue with Vitamin C is that it is very difficult to keep stable in skincare formulations. To help deal with this issue, many brands have come up with unique formulations to prevent degradation.

    Try:
    FutureDerm Vitamin CE Caffeic Silk Serum $89
    Kiehl's Clearly Corrective Dark Spot Solution $49.50

    Image: Wikimedia

  • Vitamin E 21 of 27
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    There's quite a bit of evidence in the Japanese medical literature supporting the use of Vitamin E to fight hyperpigmentation, especially when taken orally and combined with Vitamin C! In fact, a derivative of Vitamin E (α-tocopheryl ferulate) has been found to be more effective than arbutin and kojic acid.

    Try:
    Dermae Vitamin E 12,000 IU Crème $13.75
    The Body Shop Vitamin E Skincare Starter Kit $25

    Image: Wikimedia

  • AHA and BHA 22 of 27
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    The exact mechanism of action isn't really fully understood for alpha and beta hydroxy acids in skincare, but we do know that they affect both the epidermis and the dermis. In the epidermis, they help to break bonds between skin cells, resulting in exfoliation. This, in turn, increases cell turnover. In hyperpigmentation, this means that the cells with increased amounts of melanin are shed more quickly in favor of those with lower amounts of melanin. The end result is a faster resolution of the hyperpigmentation.

     

    It's great to add an AHA or BHA to your hyperpigmentation treatment, but be careful! You'll increase sun sensitivity, so be sure you're using a good sunscreen. In addition, if you are treating postinflammatory hyperpigmentation, additional irritation can actually increase your pigmentation even more. So use a low level of AHA or BHA (perhaps a lotion with a small amount) rather than a more intense peel.

    Try:
    Alpha Hydrox AHA Enhanced Lotion $10.69
    Freeze 24/7 Skin Smoothie $75

  • Retinoids 23 of 27
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    You probably are most familiar with retinoids for their anti-aging properties. This is the most proven over-the-counter topical ingredient for fighting aging and the only one found to reverse the signs of aging! Retinoids are Vitamin A derivatives that penetrate fairly easily into the skin, and while there are effects on hyperpigmentation, the mechanism is not understood.

     

    Retinoids should be avoided in pregnancy due to links to birth defects. They're also known to be irritating. I recommend using a retinoid cream or serum that is separate from your regular night cream. The retinoid can be added in as your skin tolerates it; start every third night and work your way up to every other night or every night. Retinoids will also make your skin more sensitive to the sun, so that sunscreen is even more important!

    Try:
    RoC Deep Wrinkle Night Cream $18.39
    Neutrogena Rapid Wrinkle Repair Serum $20.99

  • Where to Start? 24 of 27
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    Now that you know a bit more about the more popular ingredients to treat hyperpigmenation (and there are hundreds more), where should you start? It is definitely overwhelming to start treating your hyperpigmentation with so many ingredients out there.

     

    As a general rule, here's what is recommended:

    1. Protect your skin from the sun! You need to prevent more hyperpigmentation, so start with the most obvious source — the sun.

    2. Exfoliate. It can take months to see a difference in your hyperpigmentation treatment, but you can speed that up a bit by getting rid of some of the cells with too much melanin. You can use a scrub, peel, AHA or BHA, or even just a cheap washcloth. Don't overdo it; you'll want fresh looking skin that isn't irritated or scrubbed raw.

    3. Treat! It's up to you to decide what route you'll take to help treat your hyperpigmentation. But in general, most skincare experts recommend using a few ingredients, paying attention to your skin to make sure you can tolerate them, and then being patient.

     

    I asked a few amazing skincare experts for their favorite products to treat hyperpigmentation. Read on to see their picks!

    Image: Stux on Pixabay

  • The Esthetician 25 of 27
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    "I prefer treating with mild exfoliants and light peels in the treatment room and home care consisting of enzymatic cleansers, Vitamin C based serums and brighteners such as Kojic Acid, Licorice, Arbutin as an alternative to the chemical skin lightener Hydroquinone," says Regina Ventimiglia, an esthetician in the Philadelphia area who you can find at Skincare Absorbed and Twitter.

     

    Regina recommends using an exfoliating cleanser, treatment product, moisturizer, and then sun protection (daytime) or repair treatment (nighttime).

    Try:
    Mario Badescu Enzyme Cleansing Gel $12
    Mario Badescu Vitamin C Serum $45
    Dermalogica MultiVitamin Power Serum $65
    Dermalogica Super Sensitive Shield $48

  • The Skin Trainer 26 of 27
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    Dermae is a Southern California skincare company, and Kate Tart is their esthetician in charge of training for their product line.

     

    Kate says, "I have faithfully been using the Microdermabrasion Scrub in combination with the Evenly Radiant Brightening Serum, and I have seen beautiful results. My freckles are visibly fading, and my skin is definitely more refined and soft. I couldn't be happier with my results, and I always suggest the pair when I'm conducting my skincare trainings."

    Try:
    Dermae Microdermabrasion Scrub $32.50
    Dermae Evenly Radiant Brightening Serum $29.95

  • The Medical Esthetician 27 of 27
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    Christine Gayski is a medical esthetician at Mercy Medical Center in Baltimore, where she works very closely with dermatologists and their patients.

     

    "A skin lightener that I have found to work well and has extensive science and research behind it is SkinMedica's Lytera, an all plant-based skin lightener." says Christine. "I also love SkinCeuticals Phyto+ gel."

    Try:
    SkinMedica Lytera Skin Brightening Complex $125
    SkinCeuticals Phyto+ $80

Read more from Christine on Babble and her blog, 15 Minute Beauty. You can also follow her on Facebook, Twitter and Pinterest.

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