Is blotchy, discolored skin becoming a problem for your self-esteem? You are NOT alone! Sure, it’s not a club that anyone enjoys being a part of, but it might help to know that up to 40% of the population complains of hyperpigmentation. Sun-spots, liver spots, patches of dark skin called melasma - they’re all included in the umbrella of hyperpigmentation.
When your skin cells produce unequal amounts of melanin, some cells will be lighter and some will be darker. That will make your skin tone look blotchy and can even cause dark spots. This is called hyperpigmentation.
Sun damage is one major cause of uneven skin tone. However, there are other reasons for hyperpigmentation. For example, melasma is a specific example of hyperpigmentation. Melasma looks like whole patches of brown or darker skin.
Melasma can be caused by UV damage, but there are also genetic, hormonal, and medication-induced causes for melasma, too. So, to determine the proper treatment for your hyperpigmentation, a dermatologist will want to understand the root cause of it.
To help you start the journey into identifying the reason for your uneven skin tone, we’ve put together a detailed, scientifically-backed list of causes for hyperpigmentation and/or melasma. After you’ve got an idea of the cause, we’ll cover the range of treatments available to you to treat your hyperpigmentation.
Then you can start a discussion with a dermatologist for guidance and a personalized treatment plan, whether that includes over-the-counter treatment, prescriptions, or in-office procedures.
Of course, there’s a quick way to analyze your own skin and determine the right ingredients for your type of skin and your personal skincare concerns. Take the Y’OUR Skin Analysis Quiz. It’ll take about 3 minutes to complete. We’ll then recommend a personalized skincare ritual that just works for you
In some cases, hyperpigmentation is inherited genetically. For example, about 50% of people with melasma have traced the same condition in family members. So, you can start your search for the root cause of your hyperpigmentation by finding out whether you have family members who also have similar symptoms.
Certain hormones have been linked with melasma.
And if we’re going there, let’s just go all the way - it seems that women in general have melasma more often than men.
So, if you’re a woman with melasma, you may not have to look very far to find the root cause. Bummer, isn’t it? Don’t worry, though, there’s some good news. Most gals’ melasma fades on its own after pregnancy or after changing hormone treatment.
But what if hormones are a permanent part of your life? Deep breath: there are some great treatment options to keep melasma from keeping you down.
There has been a demonstrated link between people with melasma and people with thyroid conditions. Researchers are still actively working to understand it, though. It’s sort of a “Which came first, the chicken or the egg?” situation.
So, if you have a thyroid condition and have started to develop dark spots, it could be melasma.
If you have been trying out new makeup and cosmetics recently, an ingredient in one might be the culprit for recently developed hyperpigmentation. There is some indication that certain ingredients in cosmetics can cause melasma. Cetrimide, gallate mix, and thiomersal are some of the named ingredients that have been linked to contact melasma.
There are some medications that make your skin more sensitive to UV light than normal. These types of medications are called phototoxic drugs. Examples include:
So, if you’ve been using any of these medications and have recently developed dark patches on your face and neck (or anywhere that’s exposed to sun), you can blame the phototoxic drugs for hyperpigmentation. In many of these cases, skin discoloration lessened or disappeared completely after ending the medication.
Another type of medication known to cause hyperpigmentation is the category of anti-seizure medications. Some of these listed include:
For many people on antiepileptics, medication is a permanent part of life. The good news is that there are many treatments that could manage your hyperpigmentation on a permanent level, too.
If none of the other boxes check for you, then it’s most likely that your hyperpigmentation is due to daily sun exposure. It’s well-known that over-exposure to sunlight can cause hyperpigmentation of the skin.
If you really want to understand how the process takes place, the scientists explain it best: “UV radiation can cause lipids peroxidation in cellular membranes, resulting in free radicals which could stimulate melanocytes to produce excess melanin.”
Um, sure. What they said.
The bottom line is that if you don’t wear daily sunscreen on your face and neck or take other precautions against sun damage, your dark spots could easily be UV damage. And not all sunscreens block UV-A rays that cause radiation. That’s why you want to look for “full-spectrum” SPF to ensure that you’re getting total coverage from any sun damage to your skin.
Take our three-minute Skin Analysis Quiz to identify your unique skin needs. You’ll get a custom skincare routine with the right ingredients for your skin.
Alright, now let’s get down to the heavy lifting: how do you get rid of your dark spots to get that smooth complexion you’re dying for?
Step one: make an appointment with a dermatologist! Have we made that point clear yet? Great.
Now, you can arm yourself for your first appointment by having a broad understanding of the various treatments of sun damage and melasma:
The most effective treatment of melasma is to reduce the visibility of the dark patches by lightening the skin. Topical creams and ointments that lighten the skin are also known as “hypopigmenting agents” (“hypopigmentation” being the opposite of “hyperpigmentation”).
There are a variety of types of topical medications that lighten the skin, and which works best for your skin will depend on your sensitivity to irritation, your skin type, and genetics. It’s very important that you follow a dermatologist’s guidance to any medication, including over-the-counter skin treatments.
Hydroquinone is one of the most used and most effective topical skin-lightening agents approved by the Food and Drug Administration for the treatment of melasma.
It is important to note that there are some risks with long-term use of hydroquinone. In rare instances, using this medication over years has actually caused the skin of some people to develop bluish-black patches, called ochronosis. This condition seems to occur with people of darker skin tones in general.
Also, there is some indication that hydroquinone has carcinogenic properties. In recent scientific studies, it has been shown that long-term use of hydroquinone could increase the chance of developing cancer. Therefore, this might not be a safe option. That’s why it’s so important to use the right ingredients for your skin.
Trentinol and Azelaic Acid are two more types of topical ointment to treat hyperpigmentation. These types of medications work by speeding up the skin cell turnover process, revealing healthy young skin underneath.
Triple Combination Creams: The most-recommended use of topical medication to treat hyperpigmentation is a combination of three ingredients. Typically, this would include a lightening agent along with a retinoid agent (like trentinoin) and a chemical exfoliant: fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%.
If you find that you’re sensitive to one of these three ingredients, your next best option is to try a blend of just the two ingredients hydroquinone plus glycolic acid
For those with extremely sensitive skin, individual ingredients can be used one at a time in order to determine which ingredient is most effective at treating your melasma without irritating the skin: 4% hydroquinone, 0.1% retinoic acid, or 20% azelaic acid.
We can’t stress enough how important it is to find the right ingredients for your skin type. You can find out exactly what types of ingredients will work best for your skin type by taking our short Skin Analysis Quiz.
A “peel” or “chemical peel” is a process of using topical medications (chemicals) to actually kill the topmost layer of your skin.
Did you say KILL the skin?
Yes, it may seem counterintuitive at first to harm your skin in order to heal it, but it’s sort of the same way that reptiles shed their dead skin all in one go. Then they emerge with more elastic, smooth skin. Rather than letting our skin cells die off little by little each day, chemical peel forces all of the superficial skin cells to flake off at once. The result reveals the re-generated, healthier skin hiding underneath the damage.
As the outer layer is shed, new skin grows back smoother, with fewer blemishes and dark spots.
The process is typically quick and painless, but your skin will be red and highly irritated for a time after the chemical peel is applied.
Depending on your dermatologist’s preparation of different types of ingredients, a chemical peel can range from superficial to deep. Superficial peels might only take a few days for your skin to heal, letting you resume normal daily life quickly.
Deep chemical peels may leave your face extremely raw and red for more than a week, so people will typically have to stay home to recover for a longer period. Some of the redness may even linger for months.
Some people will find their melasma responds beautifully to one or two peels, while others will need to occasionally re-treat or use topical medications to keep the melasma in remission.
People with light complexions seem to respond best to chemical peels for melasma. Dark complexions show higher risk (about 4%) of developing even more dark spots (post-inflammatory hyperpigmentation) with chemical peels.
Laser treatment is usually not the first line of treatment for melasma; however, it has been effective in many cases. In this type of treatment, a laser is used across the skin in multiple sessions over the course of a month. Results are usually seen up to several months later.
There is a higher risk with laser treatment than skin-lightening medications or chemical peels. Inflammation and prolonged irritation of the skin are two concerns. Another is the risk of developing further dark spots and hyperpigmentation after using lasers.
There are actually many different types of laser options for treating skin conditions like melasma. Studies using laser treatment for melasma have been relatively inconclusive thus far, so dermatologists are still divided as to whether laser treatment is a confident choice of melasma treatment.
Finding out the root cause of your skin’s discoloration will help your dermatologist recommend the proper course of treatment. Whether you need regularly scheduled chemical peels for genetic melasma or occasional topical treatment for sun spots, we hope you find a lasting solution! Because when you feel confident behind an even complexion, we’ll all be able to enjoy your inner glow and radiant beauty!
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Shalini Vemula, Mayra B.C. Maymone, Eric A. Secemsky, Raphael Widjajahakim, Nicole M. Patzelt, Dana Saade, Neelam A. Vashi. Assessing the Safety of Superficial Chemical Peels in Darker Skin: A Retrospective Study. Journal of the American Academy of Dermatology, 2018.