What Causes Dark Spots?

• Sun Exposure
  Melanin, the protective pigment in our skin, is triggered by the sun's UV radiation to protect our skin cells from injury, e.g. burning and free radical damage. Unfortunately, this tanning function can go wrong, and the melanocyte cells that produce the pigment can produce too much in certain overexposed areas - it may clump and create a dark mark.
   
  The solution: Reduce sun exposure. And wear sunscreen daily: To prevent further melanin stimulation, use a high-quality cream that protects against UVA and UVB every single day on your face and other affected areas, especially on areas that have excess pigmentation.  Without doing this, you’re wasting your time on other treatments.
   
  Sunscreens you can use for hyperpigmented skin:
  Bioderma Bioderma Photoderm Spot-Age SPF50 Anti-Spots Antioxidant Gel-Cream that helps reduce both dark spots and wrinkles or Photoderm Max 50+ Sun Milk SPF50, specially for use with pregnancy melasma.
  BioNike Defence B-Lucent Anti Dark Spots Protective Cream SPF 50.
  La Roche Posay Pigmentclar UV SPF30 Skin Corrector.
  Vichy Ideal Soleil 3-in-1 Tinted Anti Dark Spots Care SPF 50.
  Clinique, SPF50 Mineral Sunscreen Fluid For Face especially good for sensitive skins.
  
  Read More. 12 Important Things You May Not Know About Sunscreen (But Need To)

• Hormones
  You can usually spot hormonal pigmentation by its symmetrical appearance on the cheeks (the so-called butterfly mask), and/or forehead, upper lip, nose and chin. In women with darker complexions, a band of darker pigment often forms on one third of the face - top or bottom. This type of pigmentation is called melasma or chloasma.
  
  Hormones (from pregnancy, an unbalanced hormonal profile, or being on the contraceptive pill) trigger an overproduction of melanin.
  
  In the first stage of melasma, the excess melanin is found only in the top layer of the skin, when it's called epidermal melasma. But if it stays in the skin long term, it can descend into the dermis, where it becomes dermal melasma. Most people have a mix of both.
   
  The good news is that epidermal melasma may go away on its own after pregnancy, when hormones return to normal, and if you protect it from further triggering with sunscreen.
   
  If you have mixed or dermal melasma, you will need additional treatment. In this useful feature on his website, renowned dermatologist Dr Ian Webster advises:
   
  • Discontinue any oral contraceptive containing oestrogen.
  • The meticulous use of a high factor, broad spectrum sunscreen on a daily basis throughout the whole year. It is important to note that just one day in the sun without a proper sunscreen can result in the melasma returning to its original state.
  • Many sunscreens include a tint (iron oxide pigment) that not only helps to disguise the melasma but it also has the benefit of cutting out Visible Light. Recent studies have shown that Visible Light can trigger sun freckles as well as melasma. In addition, some of the better sunscreens also contain an antioxidant which protects the skin against pollution and ground level ozone.

• Inflammation and Irritation
  In certain skins, especially darker complexions, with any situation when there's irritation and inflammation of the skin, extra pigmentation can be produced during the healing process. This is called Post-Inflammatory Hyperpigmentation (PIH). It is traumatic for the sufferer and can take considerable time and effort to treat.
   
  PIH often occurs with acne, so people are left not only with scarring, but also patchy pigmentation and dark spots even when the skin clears. You may also get PIH if you pick at pimples and blackheads which can inflame the skin even further. It’s often difficult not to pick, but if you want to avoid dark spots – just don’t!
   
  Dr Webster advises that people with darker complexions should also avoid waxing and using depilating creams, especially on the face, as the irritation caused can create PIH. And even harsh skincare products can do the same.
   
• Ageing
  As mentioned above, oestrogen has an effect on melanin, and in healthy skin, it is kept under control. As our oestrogen levels drop when we enter the menopause phase, there is less control over the melanin production and we start seeing 'age spots' appearing on the face, chest, hands and arms in areas that have been exposed to UV rays over the years.
  
  Read More. Your Complete Guide: How to Get Rid of Acne Scars & Dark Marks

Skincare – The Best Face Products For Pigmentation And Dark Spots

• The Magic Ingredients 
  There are several natural botanical-based agents are gentle and which work to break up clumps of pigment as well as preventing the melanin-producing cells from overproducing skin pigment. These include extracts of liquorice, mulberry, raspberry and bearberry (arbutin), citrus such as grapefruit, mandarin and lemon, as well as soy, turmeric root, white birch and green tea.
  
  Also look out for ingredients such as kojic acid, glycolic acid, salicylic acid, azelaic acid in your face care products.
  
  Certain vitamins like forms of vitamin C (L-ascorbic acid and Sodium Ascorbyl Phosphate), vitamin A (retinoids, including retinol and tretinoin), niacinamide (Vitamin B3) and biotin are also proving to be effective, and the bonus is that they have a positive effect on lines and wrinkles too.
  
  You may find these with ranges that include 'brightening', 'evening' or 'lightening' products, and the more intensive treatments are available either at your medical skin-care therapist or doctor.
   
  From Dis-Chem, we recommend the following face products for dark spots:
  BioNike Defence B-Lucent - use the anti-dark spots treatment for small dark spots and marks), and the skin evening concentrate for melasma or larger dark patches.
  Neutrogena Bright Boost includes a gel cream for daily use and an illuminating serum for a more powerful boost of active ingredients at night. Includes potent resurfacing ingredients, like Neoglucosamine and naturally derived Turmeric Extract, to boost the skin’s natural renewal process.
  Eucerin Even Pigment Perfector Double Booster Serum and Spot Corrector for targeted treatment. It has been clinically and dermatologically proven to reduce dark spots and prevent their re-appearance with regular use.
  Dermactin Equatone’s deep penetrating dark spot serum with a natural skin brightener, liquorice root extract, to help fade dark marks, blemishes and discolorations, and maintain the skin’s elasticity.
  La Roche Posay Pure Niacinamide 10 is a highly-concentrated multi-tasking serum with niacinamide that helps brighten and even skin tone. It reduces dark marks and uneven skin tone while offering hydration and repair benefits. Suitable for sensitive skin with hyperpigmentation.
  Bioderma Pigmentbio C-Concentrate is a brightening pigmentation corrector with a highly concentrated cocktail of ingredients including Vitamin C, glycolic acid, salicylic acid, niacinamide, azelaic acid and liquorice extract. Designed to help fade pigmentation over a short period of time. Not for continuous use.
  La Roche Posay Pigmentclar with SPF30 is a lightweight day moisturiser containing complementary ingredients for treating and preventing mild pigmentation and evening out skin tone.
  Nip And Fab Glycolic Fix Pads with glycolic acid, are a good exfoliator option to help fade dark marks and spots.
  Demelan Even Tone Cream with three potent ingredients including glycolic acid, alpha arbutin, and dipalmitate of kojic acid to help even out hyperpigmented skin tone.
  
  From dermatologists, medispas and dermastore online, we recommend:
  SkinCeuticals C E Ferulic is a revolutionary cult favourite day time antioxidant serum with Vitamins C and E as well as ferulic acid to lighten and brighten the skin. Recommended for surface pigmentation.
  Lamelle Brighter Concentrate is a powerful corrective serum with unique peptide ingredients and a derivative of arbutin to help reduce the appearance of dark spots.
  SkinCeuticals Phloretin CF is an extremely popular day time antioxidant serum with Phloretin, Vitamin C and ferulic acid which help reduce and prevent dark marks. In recent studies it has shown a 20% improvement in a more even skin tone.
  SkinMedica Lytera is a highly rated advanced pigment correcting serum, formulated to address stubborn skin discoloration, regardless of skin type or genetic makeup. Rave reviews.
  Neostrata Enlighten is an antioxidant-enriched moisturiser with an exfoliator and powerful brighteners to improve overall skin tone. For both the prevention and correction of dark marks.
  Lamelle Luminesce Brightening Defense 30 - a broad-spectrum sunscreen enhanced with skin brightening peptides with antioxidant benefits to help prevent hyperpigmentation. Use together with the Luminesce Brighter Day Cream and Evening Glow.
  
  Read More. Product Reviews: BioNike Defence B-Lucent and Vitamin C Treatment for Dark Spots, Marks and Hyperpigmentation 

• The Medical Solution – Dermatologist Treatments For Dark Spots
  If you have mixed or dermal pigmentation and nothing is helping, see your dermatologist for a prescription cream with hydroquinone. Hydroquinone is a dirty word in SA because of past history, where unregulated creams containing toxic levels of this ingredient (not to mention other ingredients like mercury), were sold and caused many women severe physical skin damage, not to mention emotional damage. It’s since been banned in SA, other than under prescription via your dermatologist. 
  
  It is still the preferred clinical solution for doctors, when used under strictly regulated doses and with aftercare. Hydroquinone may have some side effects, such as sensitivity to sunlight and irritation, so you have to be extra vigilant about following doctor’s orders, especially about staying out of the sun! 
  
  Hydroquinone is only used as a short-course treatment, and then other treatments, such as the medical skincare treatments above, are prescribed.

Best Specialist Treatments For Dark Spots On Face

• Microdermabrasion 
  This is a gentle exfoliating treatment using fine microcrystals 'sandblasted' on your skin to remove the skin's top layer. As long as it's done very gently, it’s a great option for buffing away old skin to reveal new (and less pigmented) layers underneath.

• Superficial Peels
  Mild chemical peels can correct or improve a wide range of skin conditions: evening out skin tone and pigmentation, helping decrease fine lines and wrinkles, as well as controlling oily skin and reducing breakouts.
  
  The benefit of superficial peels is that they are quick and there's no downtime (with redness and peeling), so they are called 'lunch-time' peels. Ingredients such as glycolic acid, salicylic acid and lactic acid are used. A series of four to six gentle superficial peels can have the same result as a medium-depth peel, without any risk of inflammation and skin damage.
  
  Ones we like: NeoStrata ProSystem Free-Glycolic Peel, Lamelle Beta Peel (excellent for acne), Skin Renewal Yellow Peel – all available at Skin Renewal Clinics – and Mesoestetic Brightening Peel Booster.

• Lasers
  These can be used effectively on hyperpigmentation, targeting the dark pigment in the skin’s second layer (similar to a tattoo). Dermatologists often use lasers such as the Q-Switched Laser, which is used to remove tattoos, because it uses low energy and heat, meaning it won't make pigmentation or inflammation worse. And the longer wavelength it uses makes it safe for all skin tones too.
  
  There are other types of gentler laser treatments especially good for dark skins which are more sensitive and prone to damage from burning and scarring.
  
  Fraxel is also a popular laser choice for treating pigmentation, but be prepared for a little downtime.