How To Treat Dark Spots (Hyperpigmentation) on Your Skin

Hyperpigmentation refers to the excessive darkening of certain skin areas, such as the face, elbows, bikini line and underarms. Although it is more prevalent in those with dark skin, it affects people of any race and age.¹ Melasma, for example, is a type of hyperpigmentation that affects roughly six million American women.²

Even if it's not an urgent concern, hyperpigmentation can be unpleasant. People experience it differently, so understanding it is crucial to uncovering the most effective treatment suitable for each individual.

Types of Hyperpigmentation

Hyperpigmentation has multiple forms, depending on its cause. There are three main types, and it's possible to have one or all of them:

• Melasma
• Post-inflammatory hyperpigmentation (PIH)
• Sun spots

Melasma

Melasma is hormonally induced pigmentation triggered by stress, sun exposure, thyroid disease and some medications. Researchers don't fully know what causes it, but they found that melanocytes — the cells that produce the pigment melanin — tend to be more active in individuals with melasma.³

Some factors can also elevate the risk of melasma, such as:³

• Age. It occurs in women between 20 and 40 years old, due to fluctuating hormones.
• Skin color. It's likely to develop in people with medium or dark skin color.
• Genetics. If it runs in the family, the risk is higher.

Melasma can last for years but disappears if you address the root cause. Hence, it's important to visit your dermatologist, as they can diagnose the underlying causes of the skin problem, whether it's due to stress, hormonal changes or medications.³

Post-inflammatory hyperpigmentation (PIH)

PIH are dark spots from skin trauma or inflammation, such as acne, wounds and bug bites. Once the trauma has healed or the inflammation has gone down, the skin turns brown, gray or black. The damage to the epidermis and dermis caused by inflamed skin encourages melanin production, leading to pigmentation.⁴

It's often temporary and slowly disappears but can become permanent after a major injury. PIH hyperpigmentation is more common in people with darker skin and affects both men and women.⁴

Sun spots

When exposed to the sun, the skin produces extra melanin to provide a barrier against damage from UV rays. In some, this translates to tanned skin. However, people who spend a lot of time outdoors can develop sun spots. While they are often harmless, they can turn into white and red patches and potentially melanoma — a form of skin cancer.⁵

Treatment Options for Hyperpigmentation (Dark Spots)

The methods to treat skin discoloration vary from over-the-counter products to chemical peels to lasers. A dermatologist can create a treatment plan suited to the type of skin condition you have. Some treatments may include:

1. Topical treatments

Hydroquinone, retinoids and corticosteroids are creams or liquids you can apply to dark spots. These products have lightening agents to restore the natural color of your skin.⁶

Another option is facials, which are a noninvasive treatment that uses serums and vitamins to cleanse, exfoliate and rejuvenate the skin.

2. Chemical peels

Your doctor may also apply a chemical peel to help treat hyperpigmentation. Chemical peels have varying strengths, and skin discoloration deep in the dermis will require a more concentrated solution. Healing time can last up to seven days for a mild peel and up to 21 days for a deep one.⁷

3. Laser therapy

Targeted light beams work by breaking down melanin pigments beneath the skin. Fractional and CO2 lasers are especially effective in simultaneously treating multiple skin problems, such as age spots, melasma and freckles. A numbing cream will be applied to the affected area to reduce the discomfort during treatment. You may experience redness and itchiness, but this disappears after a few days.⁸

4. Intense pulsed light (IPL) therapy

IPL uses broad-spectrum light therapy to remedy various pigmentation issues. It's similar to lasers and heats the pigmented cells to disintegrate them. After a session, the treated area may turn pink or red, which lasts about four to eight hours. While it's generally safe, pregnant women and those on blood thinners should avoid this kind of treatment.⁹

5. Microneedling

Microneedling is a less invasive treatment that can improve skin texture and pigmentation. It uses needles that pierce the top layer of the skin to create tiny wounds that stimulate collagen and elastin. Apart from discoloration, it also treats acne scars, wrinkles and uneven skin tone. Afterward, the treated area may appear swollen and red for up to five days.¹⁰

Average Cost to Treat Hyperpigmentation

The cost of treating melasma, age spots and other skin imperfections depends on the type of procedure.

• Topical treatments: Beauty care products with lightening agents you can get at the nearest pharmacy are the most accessible. The costs range from around $5 to $25, depending on the brand and type of skin-lightening products. For instance, an ounce of kojic acid costs $24.89, while an ounce of salicylic acid costs $15.¹¹
• Chemical peels: The average cost of a chemical peel is $644, but prices may rise as the strength of the peel increases.¹²
• Laser therapy: Laser treatments deliver excellent results but have higher average costs — $2,509 for ablative and $1,445 for non-ablative treatments.¹⁴ This is just part of the total price tag, however; related expenses like those added by the surgical facility, as well as anesthesia and prescription medication can increase the overall cost.¹³
• Intense pulsed light (IPL): According to the American Society of Plastic Surgeons, the average cost in 2020 was $412.¹⁴

Causes of Hyperpigmentation

Melanocytes are cells that produce melanin, with the primary function of giving your hair, eyes and skin their color.¹⁵ If these cells are damaged — for instance, due to excessive sun exposure — they respond by overproducing pigments to protect you.¹⁶ Their secondary role is to balance out the free radicals and antioxidants in the body by absorbing UV rays.¹⁶ If they can't even it out, it leads to hyperpigmentation.¹⁵

The internal and external forces that contribute to hyperpigmentation include:

• Melanin overproduction. The basic function of melanocytes is to make melanin. If the cells' health and growth are compromised, they can overproduce the pigment.¹⁶
• Hormonal changes. Imbalances and fluctuations of estrogen can catalyze excessive melanin production. Hyperpigmentation likely occurs during pregnancy and the menstrual cycle as the amount of female hormones rises and falls.¹⁸
• Sun exposure. Melanin has light-absorbing capabilities and acts as a natural sunscreen. When under the sun, the cells create more melanin as a defense mechanism to protect your skin.¹⁶
• Inflammatory conditions. Acne, eczema or psoriasis can lead to PIH. Red, brown, black or pink spots can appear in place of a wound or acne. The larger and deeper the area of damage, the darker the hyperpigmentation.⁴
• Certain medications. Some drugs can provoke melanocytes to generate melanin as a side effect. Examples are antimalarials, nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics.¹⁹

Signs of Hyperpigmentation

Spotting signs of hyperpigmentation is important in understanding how and what to treat. Here are some of the signs to look for:

• Dark patches or spots on the skin. Melasma often appears as black, gray or brown patches on the cheeks, chin, forehead and nose.² PIH also appear as dark patches and spots on the skin.⁴ Women find these more troublesome as they sometimes cover the face.
• Uneven skin tone or discoloration. Sun spots typically develop in exposed skin, such as the neck, back, shoulders and hands.⁵ It may turn into sunburn, which quickly heals with proper care. However, severe sun damage can result in blisters and scaly skin.

How to Diagnose Hyperpigmentation

Hyperpigmentation is classified into two types: generalized and localized.²¹

• Generalized hyperpigmentation is due to underlying conditions, such as thyroid disease and Addison's disease, genetic disorders and medication side effects.²¹
• Localized hyperpigmentation stems from external or natural causes, such as sun exposure, acne and fluctuating hormones during pregnancy.²¹

These imperfections affect people's self-esteem, confidence and quality of life. Hence, many find means to treat it. A dermatologist can help identify the type and root cause of skin discoloration and devise a personalized treatment plan.

A diagnosis includes two parts:¹⁷

1. Visual examination and history assessment. Your doctor will visually inspect your skin condition and ask medical questions, including your family history and any prescription medicines you're taking. This information will help unveil the root cause of the problem.
2. Use of special diagnostic tools. If a physical examination doesn't suffice, the doctor may suggest a skin biopsy and use a Wood's lamp to determine the extent of hyperpigmentation. These tools can reveal whether it's epidermal or dermal.

Tips to Prevent Hyperpigmentation

Sun damage ranks first as the cause of hyperpigmentation, and proper care and protection can help prevent skin damage. If you already have age spots, being extra diligent with your beauty care routine can save your skin. Here are some other ways to help prevent hyperpigmentation:

• Sunscreen usage. Indoors or outdoors, preventative skin care is vital for avoiding problems such as skin cancer.²² Apply sunscreen with SPF 30 or higher.²⁰ Reapply more frequently if you spend more time out in the sun.²⁰
• Protective clothing. The clothes you wear can block UV rays. Choose long sleeves and wear hats when going out. Pick dark-colored clothing made of polyester or rayon for tops and bottoms, as they provide optimal protection.²³
• Gentle skin care. Exfoliating your face or body more aggressively can dry the skin and remove the natural oils that coat a protective layer against sun damage. Avoid harsh chemicals in your personal care products and choose brands that suit your skin type.
• Treat any underlying conditions. Ask your doctor to put you in a program to treat illnesses and hormonal imbalances associated with hyperpigmentation.²¹

Hyperpigmentation Is Preventable and Treatable

Hyperpigmentation can be localized — caused by an external factor — or generalized due to certain health conditions. A dermatologist will diagnose your skin problems through a physical evaluation and various tools. It's essential to seek professional advice since the cause of melasma or age spots can differ. Personalized treatment ensures the method will work and generate results.

CareCredit Credit Card Financing for Dermatology

The CareCredit credit card makes it easy to pay for dermatology visits, over-the-counter treatments and prescription medications at locations within the CareCredit network.* Start enhancing your skin today and find a dermatologist near you that accepts CareCredit. Continue your wellness journey by downloading the CareCredit Mobile App to manage your account, find a provider on the go and easily access the Well U blog for more great articles, podcasts and videos.

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Author Bio

Mia Barnes is a freelance writer and researcher with experience covering health, well-being and financial wellness. She is also the Founder and Editor-in-Chief of Body+Mind Magazine. Her work has appeared in publications such as Science of People, SMSNA, Employee Benefit News and Austin Fit Magazine.