When we are young freckles seem cute but with lots of sun exposure & normal aging they start to coalesce and we don’t consider them cute in our society. Hyperpigmentation is darkening of normal skin color. This can look like macules (small flat spots) or patches (larger flat spots). There are different reasons for these so it’s a good idea to get checked at a dermatology office to be sure of the diagnosis. Any spot that stands out and is different that the others, like an ugly duckling, should definitely be checked by a professional. The most common causes of hyperpigmentation are spots from the sun, hormones, or from previous inflamed areas. No treatment will work for any hyperpigmentation without proper sunblock. This means putting on a physical sunblock and reapplying every 2 hours. A wide brim hat and umbrella is also a good idea. Now lets talk treatments!
- Bleaching creams: Hydroquinone 4% is a common bleaching cream that can be prescribed or sold in dermatology office. Usually it’s formulated with other ingredients like kojic acid or retinol. It should be used at night on spots for no more than 2 months. It works for lots of folks but hyperpigmentation can really be a battle especially when its from hormones (melasma). So I like to tell my patients not to give up and fight the battle with all these weapons we have. For those that can’t tolerate hydroquinone or want a more natural alternative, luckily there are other options available. Burts Bees Dark Spot Corrector is a good one which has an active ingredient Bakuchiol. Bakuchiol is from a plant & is natural alternative to retinol and this is also a great product to use in between stronger treatments. Azelaic Acid 15% can also be prescribed which can improve pigment and is gentle.
- IPL: Intense Pulsed Laser treatments can do wonders for certain types of hyperpigmentation. For the “liver spots” that happen on fair skin it can be a very quick and a satisfying treatment. Sometimes they disappear in one treatment. For melasma & post inflammatory hyperpigmentation it can be a bit more resistant. But combined with the right products we can usually head in the right direction. With darker skin types extra care must be taken when using the IPL, such as lower settings & a test spot to be safe. Typically IPL treatments take 3 to 5 treatments 3 weeks apart.
- Peels: A peel is when a chemical solution is applied to the skin and washed off after a certain amount of time, depending on what solution is used. I use a combo of acids including TCA (trichloroacetic acid) and Vitamin C. This causes the outer layers of skin to shed revealing clearer glowing skin. Since the outer compact dead stratum corneum (outer layer of skin) is gone, this also allows your products to penetrate and work much better. That’s why its important to combine some of these treatments for stubborn hyperpigmentation. It’s usually recommended to do a series of 3 peels one month apart.
Shanah Gavia, PA-C 