Hyperpigmentation's Many Faces: How to Identify and Treat Dark Spots

Jenna, a mother of two, experienced melasma for the first time eight years ago when she was pregnant with her oldest son. “I was pregnant throughout the summer and pretty good with wearing sunscreen, though some days it was just whatever SPF was in my moisturizer,” Jenna remembers. But then, she began to see some changes on her face.

“I started to notice darkening on my forehead; at first it looked splotchy, like a tan that was peeling. The body is so strange, generally, in pregnancy, that I didn’t think much of it until after I gave birth, and it still hadn’t gone away.”

What Jenna was dealing with was melasma, also known as the “mask of pregnancy.” This issue is part of the broader umbrella of hyperpigmentation, a skin condition characterized by dark spots or patches on the skin that occurs when something triggers the cells in your skin to begin overproducing the pigment melanin. Freckles are a type of hyperpigmentation, as are sunspots, age spots, the discoloration left after a breakout fades, and the mask of pregnancy.

The Different Types of Hyperpigmentation:

While freckles may be just a fact of life for some of us, there are three main types of hyperpigmentation that can be more distressing and problematic, each with its own characteristics and triggers.

Post-inflammatory hyperpigmentation

If you’ve ever noticed a dark spot left behind after a pimple cleared up, yep, that’s hyperpigmentation. “Some dark spots are post-inflammatory hyperpigmentation [PIH] — that is, pigment that is left in the skin after an inflammatory process resolves,” NYC-based dermatologist Dr. Hadley King says. “We commonly see this after acne, particularly acne that gets picked. But sometimes acne by itself is inflammatory enough to cause discoloration, even if it's not picked.”

It’s always a good idea to try to keep your hands off your pimples (they’re tempting, we know) but even if you do all the right things, you may still experience a dark spot when the breakout fades. This is the result of cells overproducing melanin during the healing process. The lingering dark spot that remains is not just confined to acne; any inflammatory skin reaction, including eczema, contact dermatitis, or even bug bites can result in PIH.

While PIH can affect anyone, it is an issue that is particularly of concern to people with darker skin tones. Skin color is determined by how much melanin is in the skin, with darker tones having a higher concentration of melanin and being more susceptible to the effects of increased pigmentation levels during the normal acne healing process.

“In darker skin tones there is more ‘pigment potential’,” Dr. King explains. “This means that more pigment can get triggered, and then more pigment must be faded to get rid of the spots.” A 2014 study found that over two thirds of Black women who have acne experience lingering discoloration from PIH.  

Sun Spots

A day spent in the sun can lead to a type of hyperpigmentation known as sun spots that are small, flat brown spots that are a bit bigger than freckles. They may fade eventually, but this is also a type of hyperpigmentation.

“Dark spots can be entirely caused by sun exposure,” Dr. King says. “Sun spots, or lentigines, are small pigmented spots on the skin with a clearly defined edge, surrounded by normal-appearing skin. They occur in sun-exposed areas of the body.  They are caused by sun exposure, plus a susceptible genetic background.”

Dr. King notes that lighter skin tones are more vulnerable to sun spots, and that they’re most common in white people over the age of 60, occurring in as much as 90% of that demographic.

Melasma

Whereas the first two types of hyperpigmentation normally appear as spots, melasma generally shows up as a patch of darker skin. While it can be influenced by a genetic predisposition and sun exposure, the main trigger for melasma is hormonal changes, which is why this type is commonly associated with pregnancy when hormones are all over the place.  

While Jenna’s melasma did eventually clear with the help of a melasma cream she used after giving birth, she says it still comes back sometimes in the summer, especially when she’s not careful with SPF. “I need to use serious SPF now,” she says. “No more SPF 15 in my moisturizer. I need the zinc paste that makes me look like a lifeguard.”

How to Treat Hyperpigmentation for All Skin Tones

Regardless of what caused your hyperpigmentation in the first place, there are a few steps you can take to prevent new dark spots and treat the ones you may already have.

Wear Sunscreen…always!

To put it simply, if you’re experiencing hyperpigmentation (and even if you’re not) you want to be the person sitting in the shade wearing a healthy dose of sunscreen and a wide-brimmed hat. Your skin will thank you.

“Try to be compulsive with sunscreen,” dermatologist Dr. Angela Lamb says. “That's really important, particularly for melasma.” She adds that a metal-based blocker (like zinc or titanium) is the best sunscreen option for anyone dealing with hyperpigmentation. This advice applies to people of all skin tones, but the good news is that there are an increasing number of mineral sunscreen options on the shelves that won’t give you that ghostly white pallor and are specifically formulated for darker skin.

Avoid medications that disrupt hormone levels

Because melasma is often associated with the​​ female hormones estrogen and progesterone, Dr. King says that if you are prone to melasma, it might be beneficial to avoid medications that increase estrogen levels (birth control pills, for example) if possible.

Treat inflammation when it occurs

Since you are no longer allowed to pick at your acne, turn to more healthy measures to target your blemishes. Cortisone can be particularly helpful for treating the inflammation associated with PIH.

“Use a cortisone injection and other acne medications to treat acne, or use a cortisone cream to treat eczema or contact dermatitis. [This will} decrease the inflammation and thereby decrease the risk of post inflammatory hyperpigmentation,” Dr. King says.

Look for certain skincare ingredients

Skin-lightening products (both over the counter and prescription) containing hydroquinone have been a go-to treatment for hormone-driven hyperpigmentation for years. This ingredient works to lighten skin by interfering with melanin production.

But it also has some downsides. Questions remain about its safety, it is critical to religiously apply SPF while using or sun exposure will make it ineffective, it is not safe for use during pregnancy, and it can only be used for up to three months at a time.

But the good news is hydroquinone isn’t the only option for reversing melasma. Dr. Lamb notes that vitamin C, glycolic acid, and kojic acid are some other known ingredients with lightening and brightening properties that can work for all skin tones. As a bonus, glycolic acid also helps to control acne.

Noticing spots of skin discoloration can be distressing, but rest assured that, beyond treating and preventing hyperpigmentation, this skin condition is very common and normal. If you do begin to see a flare-up whether in the wake of a breakout or during pregnancy, know that you are not alone in your skin experience.