How Do You Get Rid of Dark Spots?
With less time outside, cold weather months are a wonderful time to work on some of those unsightly brown spots that just seem to crop up. A little souvenir of summer’s past. Those freckles scattered across your nose or cheeks can be sweet looking when you’re six-years-old, but as most of us march toward, and through, middle age they become less cute as they increase in size, darken in color, and seem to be accompanied by fine lines and broken blood vessels that can age us unduly. How do we get rid of this evidence of our fun in the sun? The good news is you can improve the appearance of sunspots with products and treatments. Heads up, in this article I’m only addressing brown spots caused by sun exposure (solar lentigines).
Let’s start with the active ingredients that help reduce pigment. First things first: to lighten dark spots is to slow down a complex biological process of producing, transporting, and transferring melanin in an area. This is a slow, gradual process that relies on using products consistently over many weeks, if not months. The idea is that the skin is saturated with ingredients that actively suppress the enzymes, like tyrosinase, that aid in melanin formation and then inhibit the movement of pigment in cells and to neighboring cells.
Here are some of the most effective ingredients for hyperpigmentations:
Niacinamide: In studies, this form of vitamin B3 has been shown to decrease the transport of melanosomes to neighboring unpigmented cells. If the color can’t be transported then it can’t spread and become more visible.
Hydroquinone (HQ): HQ is one of the most effective for reducing pigmentation because it inhibits the production of melanin by decreasing tyrosinase, the enzyme responsible for the first step in making melanin. Some offices believe that it should be used for three months then a different pigment product used for three months, cycling back and forth. This is a personal preference.
Kojic Acid: This is derived from fermented mushrooms or rice and is a tyrosinase inhibitor. It’s quite popular in Asia both as a supplement and a topical. Kojic has a high incidence of causing allergic dermatitis so concentrations are typically kept low. It’s not nearly as effective as hydroquinone but it works well in tandem with it.
Tretinoin (retinoids): “Retinoic acids are the most important agents in this context and act by disrupting pigment transfer, by inhibiting the dispersion of pigment granules in keratinocytes, by accelerating epidermal turnover” (Brenner 2008). You can make it even more effective if you combine it with other pigment inhibiting products like hydroquinone.
Azelaic Acid: Azelaic acid flys below the radar with its myriad of benefits not only for pigment but also for acne and rosacea. In regard to hyperpigmentation, it interferes with the production of abnormal pigment cells and is also a weak tyrosinase inhibitor.
Vitamin C: Yet another great tyrosinase inhibitor that’s also a powerful antioxidant to help protect against UV damage and plays an important role in collagen synthesis. This is a multifaceted ingredient that covers a lot of bases. Obagi even has a vitamin C serum that combines it with hydroquinone!
Now it’s time for some of the best in-office treatments that can help improve brown spots.
(1) IPL is amazing for both brown and red spots. This energy treatment is not a laser because it has more than one wavelength that’s flashed into the skin. The light energy turns into heat and damages the targeted brown and red in the skin. The body then “cleans out” the damaged cells through the lymphatic system. You’ll see improvement after one treatment but for the best clearance multiple treatments are required with yearly maintenance visits. This treatment is best for those people with pale to light golden skin tones. Avoid this if you have a tan or are dark complected as the machine can’t discern between a brown spot and brown skin tone.
(2) Chemical peels are another in-office treatment that can help slough off skin resulting in a clearer, more even skin tone. I recommend a medium depth peel like the VI Peel with the hydroquinone add-on. There’s usually several days of visible skin peeling but it’s a small price to pay for the smooth, clear skin you’ll have once it’s healed. Two peels one month apart is the recommended course of treatment.
(3) CO2 laser facial rejuvenation is the third treatment that drastically improves brown spots but also smooths the overall skin texture and increases collagen. This procedure is the most invasive and intense out of this list by far. During a fractional CO2 treatment, a predetermined percentage of skin is vaporized leaving healthy islands of tissue in between the injured skin. During the healing process your skin regenerates healthy, plump unpigmented cells to replace the damaged ones. CO2 laser resurfacing is an amazing treatment to improve skin quality as a whole but pre-planning is a must due to pretreatment and downtime.
There are a lot of options to help correct brown spots but a varied approach using products and treatments will yield the best outcome. We’d love to have a consultation with you if visible sun damage is a concern of yours, in order to guide down the best path for you. Whatever you choose, stay consistent!
References
Baliña, L M, and K Graupe. “The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream.” International journal of dermatology vol. 30,12 (1991): 893-5. doi:10.1111/j.1365-4362.1991.tb04362.x
Battaini, G et al. “Inhibition of the catecholase activity of biomimetic dinuclear copper complexes by kojic acid.” Journal of biological inorganic chemistry : JBIC : a publication of the Society of Biological Inorganic Chemistry vol. 5,2 (2000): 262-8. doi:10.1007/s007750050370
Brenner, Michaela, and Vincent J Hearing. “Modifying skin pigmentation - approaches through intrinsic biochemistry and exogenous agents.” Drug discovery today. Disease mechanisms vol. 5,2 (2008): e189-e199. doi:10.1016/j.ddmec.2008.02.001
Hakozaki, T., et al. “The Effect of Niacinamide on Reducing Cutaneous Pigmentation and Suppression of Melanosome Transfer.” The British Journal of Dermatology, vol. 147, no. 1, 1 July 2002, pp. 20–31, www.ncbi.nlm.nih.gov/pubmed/12100180, 10.1046/j.1365-2133.2002.04834.x.
Sanadi, Rizwan M, and Revati S Deshmukh. “The effect of Vitamin C on melanin pigmentation - A systematic review.” Journal of oral and maxillofacial pathology : JOMFP vol. 24,2 (2020): 374-382. doi:10.4103/jomfp.JOMFP_207_20