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Skin Care

Pigmentation and Dark Spots Explained: Everything You Need to Know

14 Jul, 2020
By Daniela Massenz
We unpack the causes of hyperpigmentation and give you solutions on how to get rid of those dark spots on your face.
You outgrow your teen acne at last, but before you can celebrate, you have to deal with the fall-out - patches of dark spots on your skin where you had pimples.
Though very common, acne isn't the only culprit (see below), but whatever the cause, dark spots - properly named hyperpigmentation - affect women of all skin tones and ages, particularly women with darker complexions, and it's one of SA women's biggest skin concerns.
Other than slapping on total camouflage make-up, there are several treatment options available to help remove dark marks from your face. But first, you need to understand these lessons:
Lesson 1: There are no quick fixes.
Lesson 2: Do your homework (like reading up on the causes, treatments and future prevention here).
Lesson 3: Don't be too aggressive in your treatment as you could cause even more pigmentation.
Lesson 4: Only use trusted treatments from reputable skin-care brands, skin-care therapists and dermatologists.
Lesson 5: Follow instructions to the letter, and complete the course of treatment, unless something goes horribly wrong. And always use sun protection.

What Causes Dark Spots?

Hyperpigmentation comes in various types, with various causes. Blame the usual suspects – UV exposure from the sun, hormones, ageing, damage to the skin, stress and acne scarring (especially on darker skin). Sadly, improper cleansing and harsh treatment products can make the problem worse. And the darker your skin, the more prone to excess pigmentation you will be, because of the amount of pigment (melanin) in your skin.
  • 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, when 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 and Face Creams For Dark Spots

  • The medical solution
    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.
WARNING: If you are pregnant or breastfeeding, please confirm whether your chosen product is safe for use. Products containing any vitamin-A derivatives like retinol may not be used. Ask for alternative products that are safe for use during pregnancy.

Specialist Treatments for Dark Spots

The rule of thumb when treating hyperpigmentation is to avoid irritation or inflammation, which can cause even more pigmentation. So opt for gentle, exfoliating treatments at a reputable skin-care salon, such as:
  • 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) and SkinCeuticals Micropeel.
  • 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-Switch 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.

    Fraxel is also a popular laser choice for treating pigmentation, but be prepared for a little downtime.

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