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Dark Spots Treatments Overview

What is hyperpigmentation?

Hyperpigmentation is characterized as darkening of the skin (dark spots) due to increased melanin- the natural substance that give skin its color. These discolorations develop when the skin produces excess melanin in response to damage from the sun, aging, acne, melasma, prescription medications and hormone imbalances.

It is prevalent and can be difficult to treat. It affects women and men equally, in all ethnic groups. It is largely a condition of middle age, but can also be found in younger patients. It is not dangerous but the impact can result in depression and anxiety.

There are 3 main types of hyperpigmentation, each of which result in excess or hyper- pigmentation:

  1. Melasma
  2. Post- Inflammatory hyperpigmentation due to an injury to the skin like acne, eczema or psoriasis which causes increased pigment production that results in dark spots.
  3. Sun damage- the leading cause of dark spots (i.e. liver spots or solar lentigines), and can worsen melasma.





Melasma is a common skin problem that primarily affects women. It appears as gray-brown patches on the face, cheeks, bridge of nose, forehead, chin, and above the upper lip. It can appear on other parts of the body that receives significant sun exposure, such as the forearms and neck. Only 10% of men develop melasma. People of color are more likely to develop melasma. People who have a blood relative who had melasma are more likely to get melasma.



Melasma is triggered by:

  • Sun Exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes- the skin cells that provide your skin with color. Skin exposed only for a short time, can trigger a return of melasma after it has faded. Sun exposure is the reason that melasma gets worse in summer.
  • A change in hormones: Pregnant women often get melasma. Birth control pills and hormone replacement medicine can also trigger melasma. It is so common in pregnancy that you may hear it referred to as the “mask of pregnancy”.
  • Cosmetics: Skin care products that irritate the skin may worsen melasma.



Generally, there are no symptoms other than the appearance of those brownish-gray patches.



A dermatologist can diagnose melasma simply by looking at your skin. She may also want to look at how deeply melasma has penetrated the skin and may use a device called a Wood’s light for this purpose. To rule out another skin condition, your dermatologist may do a biopsy, where she removes a small piece of skin. This is an office procedure that is quick and safe.



First and foremost, consistent sun protection can prevent melasma. Melasma can fade by itself, especially when the triggering event is removed. Yet some people have melasma for a lifetime.

1 – Hydroquinone is commonly the first treatment. It works by lightening the skin, and can be found in a topical such as a cream, lotion, gel or liquid. Lower strengths of hydroquinone are available over the counter. When that is not enough, your dermatologist will prescribe a higher dose of hydroquinone treatment.

2 – Tretinoin and corticosteroids enhance skin lightening. You may receive a prescription for these medicines in addition to hydroquinone. Other topical medicines that may be prescribed are azelaic acid or kojic acid to help lighten melasma.

Melasma is among the most common skin conditions and can be difficult to treat. It may take a few months of treatment to see an improvement. Even after your Melasma clears, you may need maintenance therapy to prevent it from returning.





It appears as dark brown patches that have poorly defined borders and little surface change. PIH affects people of color more frequently and more severely.



The most common causes of PIH include:

  • Inflammatory skin conditions. Any inflammatory skin condition can cause hyperpigmentation – e.g. eczema, psoriasis, lichen planus, acne, systemic lupus erythematosus, chronic dermatitis and cutaneous T-cell lymphoma.
  • Trauma
  • Allergic reactions
  • Phototoxicity– over exposure to UV light and a adverse reaction to drugs that make you sensitive to the sun.
    Iatrogenic– In dark-skinned patients, hyperpigmentation can be a complication of treatment with a fully ablative laser device. The risk can be reduced by the use of fractional CO2
  • Drugs
  • Exposure to chemicals such as silver, gold and arsenic.
  • Idiopathic. Occasionally no cause can be identified.

In response to any of these triggers there is a release of inflammatory chemicals in the epidermis. These chemicals stimulate the overproduction of melanin at the site of the inflammation resulting in hyperpigmentation.

Treatment – Diagnosis and management of the underlying inflammatory condition is important. First-line therapy typically consists of topical skin- lightening agents and sunscreen.

Hydroquinone is the foundation of treatment. It may be used alone or combined with other agents like retinoids, antioxidants, glycolic acid, sunscreens and corticosteroids to improve efficacy.

Topical therapy is typically effective for epidermal post- inflammatory hyperpigmentation. However, certain procedures, like chemical peels and laser therapy, may be employed where topical therapy is insufficient. It is also important to use caution with all of the above treatments to prevent irritation and worsening of post- inflammatory condition.


Dark spots, liver spots, age spots



Liver spots (i.e. Solar Lentigines) are colored lesions that appear on sun- exposed skin of the face, hands, forearms, chest, back and shins. They erupt after acute or chronic UV exposure. Liver spots or age spots are found on 90% of light- skinned people over the age of 60. White and Asian people are most likely to develop solar lentigines.

They are an unwelcome side effect of living in beautiful Southern California, and being constantly exposed to the glorious, yet dangerous rays of the sun. Many of our patients complain that they have unwanted dark spots and discolorations on their face, chest and hands.



A Board-Certified Dermatologist can assure that these dark spots are not something more serious. Our team of board-certified, dermatologists, led by Dr. Neda Mehr, an expert in Melanoma and Skin Cancers, are skilled diagnosticians.



After diagnosis you will be prescribed a personalized skin care regimen to brighten your skin.

Prescription and non-prescription skin brighteners work on superficial dark spots, reducing their appearance. The importance of consistent and careful sun protection so the spots do not reappear, cannot be emphasized enough. Ablative treatments may be necessary to remove dark spots. They include TCA chemical peels, cyrotherapy, laser therapy or topical treatments.

At Pure Dermatology & Cosmetic Center we use natural, specialized, botanical regimens and office procedures like microdermabrasion, chemical peels, microneedling, PRP, IPL and fractional lasers to keep dark spots away. We have the latest FDA approved laser for the treatment of melasma (a butterfly pattern of hyperpigmentation that appears with exposure to the sun).

Dr. Nada Mehr is an expert in cosmetic dermatology & surgical dermatology and performs all Injectables, including Botox, Fillers (including Juvederm and Voluma), Kybella and more. Call Pure Dermatology & Cosmetic Center in Newport Beach, California at 949-706-1469 to schedule a consultation today.


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