Lighten Up: The Guide to Freckles, Age Spots & Skin Discoloration
Posted On Apr 29, 2019
No person on Earth has as many spots on their skin as I do. I am covered in freckles, and a few years back, large brown dots—there’s no other way to describe them—appeared on my hands and legs. There’s a patch of brown pigmentation on my left cheek. Strangers have informed me that I have dirt on my nose. I don’t. I have two freckles that are larger and darker than the rest.
My lineage, on both sides of my family, is fair-skinned, blue-eyed Irish. I also happen to be cursed with the freckle gene gone wild. My parents would boost my morale by assuring me, insisting, “Freckles are a sign of beauty.” My dermatologist now says I have hyperpigmentation.
Forgive me, ancestors, but I long to give these dark spots the boot. The worldwide market for skin lighteners is expected to hit $10 billion by 2015. That’s quite a number of people who have declared war on their pigment. A 2006 study published in the journal Evolution and Human Behavior found that women with uneven skin tone were perceived as older and less attractive than those with more even pigmentation. Hmmmph.
You can’t blame people for wanting an even complexion. According to Zoe Diana Draelos, MD, a consulting professor of dermatology at Duke University School of Medicine and founder of Dermatology Consulting Services in High Point, North Carolina, it’s “hardwired into us.”
An Inside Look at Pigment
Melanin is the pigment that gives our skin, hair, and eyes their color. Some people’s melanocytes—or pigment-producing cells—do what they’re supposed to. Other genetically susceptible individuals experience an overproduction of melanin churned out by their melanocytes, due to sun exposure, hormones, injury, or even medication. The result is hyperpigmentation—freckles, blotchy areas, or age spots.
Sun exposure is a common reason for fired-up melanocytes. Sun damages skin, then melanocytes produce more melanin to protect against further damage. While many individuals enjoy a nice, golden-brown tan, others get sunburned. Still others (like me) end up with uneven patches of color.
The age spots (otherwise known as liver spots) on my hands and legs can also be traced to sun exposure. Dermatologists call these “solar lentigines.” They make their presence known as one gets older, on sun-exposed spots such as the face, hands, and arms. Solar lentigines occur when melanocytes cluster together. “Cells normally shed when they reach the top layer of skin,” says David Bank, MD, director of the Center for Dermatology, Cosmetic & Laser Surgery in Mount Kisco, New York. Over time, pockets of these cells may get “a little sticky,” he says. They feel no thicker than surrounding areas, however, “they stack up on top of each other and thicken slightly, looking a little darker. Under the microscope, you see extra layers of skin piled on top of each other.” Solar lentigines, which range in color from tan to black, may be large in some cases. Other times they may resemble an ink spot. Though benign, some resemble skin cancer. (Be sure to have your dermatologist check such spots out.)
Meanwhile, hormones and sun exposure cause a condition called melasma—brown or grayish-brown patches that appear on the cheek, forehead, nose, chin, and upper lip, according to the American Academy of Dermatology. “It’s a lacy-brown discoloration,” says Dr. Draelos. Melasma can appear during pregnancy (it has been called the “mask of pregnancy”) or when a woman takes birth control or undergoes hormone replacement therapy (HRT).
Estrogen is the hormonal culprit here. When the skin of a genetically susceptible woman is exposed to ultraviolet (UV) light, “estrogen hormones turn pigment cells into super responders,” says Dr. Bank. Instead of producing normal amounts of melanin, they produce larger amounts. Experts don’t know why, but estrogen produces hypersensitive pockets of color. “You get islands of increased pigment darkness against relatively normal skin,” Dr. Bank says. Meanwhile, sun exposure causes melasma to darken.
Melasma is most common in individuals with darker skin—those of Hispanic, African, Asian, or Indian descent. While it will often disappear once a woman gives birth or stops taking birth control pills or HRT, in certain circumstances it can hang around for life.
Darker-skinned women are also at higher risk for post-inflammatory hyperpigmentation (PIH), which is characterized by light brown or dark brown areas on skin. “Following inflammation, skin pigment deepens,” says Valerie D. Callender, MD, associate professor of dermatology at Howard University College of Medicine in Washington, D.C. The most common cause of PIH in women of color is acne, says Dr. Callender. But darker areas can also appear after as a result of inflammatory conditions such as eczema or psoriasis, or after an injury such as a burn has healed. PIH can also be caused by medications, such as tetracycline or anti-cancer drugs.
Tackling the Problem
The goal of over-the-counter and prescription skin lightening products is to lighten or eradicate bothersome spots and patches of uneven color. A more even skin tone is achieved by inhibiting the production of an enzyme called tyrosinase. This enzyme regulates melanin production, keeping the melanin from entering cells (called keratinocytes) in upper layers of the skin.
Your top layer of skin turns over about every 28 days, explains Zakia Rahman, MD, a clinical assistant professor of dermatology at Stanford University who specializes in laser and aesthetic surgery at the Stanford Hospital and Clinics. The pigmented cells slough off. Over-the-counter and prescription lighteners can help fade whatever pigment remains. “The hope is that new skin cells won’t have the pigment,” says Dr. Rahman. Alas, some dark areas such as age spots or melasma may be so entrenched that cell turnover doesn’t make much difference.
Even if topical lighteners get rid of pigment, slight sun exposure can cause dark spots to return or deepen. That’s why freckles may fade during the winter but return with a vengeance during the summer when a person spends more time outdoors.
Different lighteners have different active ingredients; some may have more than one. Choosing the right lightener can be a matter of trial and error and preference. If your skin is sensitive, try a product containing more natural ingredients. If your pigment issue is mild, you might be fine with an over-the-counter formulation. If you have more severe discoloration, you may need a prescription product. Your dermatologist may also have you use more than one lightening product simultaneously. “You get a team effect,” says Dr. Bank.
When topicals don’t do the job, your physician may recommend laser therapy to vaporize pigment cells in deeper layers of skin. Dr. Rahman may prime a patient’s skin with a topical prior to performing laser surgery. Treating an underlying problem is also crucial. If acne sparked your pigment issue, your dermatologist will tackle that as well. “I get patients on a good acne regimen to prevent new break-outs,” says Dr. Callender. That could consist of prescription medication or oral antibiotics.
One essential ingredient that can’t be formulated: patience. Dark spots don’t lighten overnight. “Getting rid of pigment is a very slow process,” says Dr. Draelos. It can take at least three months to notice an improvement—longer to lighten super dark spots. Even then, you aren’t necessarily going to end up with unblemished skin. “You can lighten dark spots, but it’s very difficult to get rid of them,” says Dr. Draelos.
Skin lightening is only part of the equation. Reclaiming an even complexion requires “a two-pronged attack,” says Dr. Bank. “You need an active fading agent to get rid of excess pigment, and sunblock to prevent new pigment from being put down and replacing the old pigment.”
This requires vigilance. Dr. Draelos has her patients wear a sunscreen with an SPF of at least 30 whenever they venture outdoors. “If you go one day without sunscreen, all the pigment lightening that occurs may be undone,” says Dr. Draelos. “You treat the pigmentation for months to lighten it and it darkens within an hour.”
A Glossary of Lighteners
A wide range of active ingredients can help lighten skin. Here, a rundown of some of the most common components.
Hydroquinone “This is the workhorse pigment-lightening ingredient in the marketplace today,” says Dr. Draelos. Two percent hydroquinone is “minimally effective. If you want to see a good result, use 4 percent.”
Retinoids After hydroquinone, retinoids are dermatologists’ top lightener. Derived from vitamin A, retinoids inhibit the transfer of pigment from melanocytes to keratinocytes, cells in the top layer of skin. OTC retinoids are known as retinol. Their prescription cousin is retinoic acid.
Azelaic Acid Derived from a yeast that lives on skin, prescription azelaic acid is used to treat rosacea and acne. However, it may be used off label to lighten melasma and post-inflammatory hyperpigmentation. Ten percent strength azelaic acid is available over-the-counter. The prescription form is generally 15 to 20 percent strength.
Kojic Acid Derived from a fungus, kojic acid works like hydroquinone, inhibiting pigment production. Kojic acid has been widely used in Asia to treat melasma and bleach skin.
Glabridin The main ingredient in licorice extract, it inhibits pigment production and also acts as an anti-inflammatory.
Arbutin A derivative of hydroquinone that is less potent, arbutin inhibits pigment production, though it may also cause hyperpigmentation. It has been typically used to treat PIH.
Niacinamide A form of vitamin B3, this reduces the transfer of pigment to keratinocytes in a cell culture by 35 to 68 percent, according to a 2002 study in the British Journal of Dermatology.
Vitamin C This potent antioxidant interferes with the production of melanin. Because it’s unstable, however, it’s hard to deliver the right dosage of vitamin C into skin. Often it’s combined with other pigment-lightening ingredients. Because it’s an anti-inflammatory, it may prevent PIH. It may cause redness, dry skin, and stinging.
Choosing a Lightener
The skin lightener you use will depend upon preference, price, and your pigment issue. If you have mild discoloration, start with an over-the-counter formulation. If you don’t get results, try a physician- or spa-dispensed product. If your problem is severe, you may need a prescription lightener. While a physician-dispensed or prescription product may cost more, you’ll get better, faster results than you would with an over-the-counter lightener.
Rapid Tone Repair, the new line from Neutrogena, promises results in as little as one week. Products feature “Accelerated Retinol SA” technology to diminish the appearance of age spots, vitamin C to even skin tone, hyaluronic acid to rejuvenate skin, and glucose complex to boost skin’s cell turnover ($21 each, neutrogena.com).
L’Oréal Paris Youth Code Dark Spot Correcting & Illuminating Collection features a Serum Corrector to reduce the appearance of pigment by 78 percent, antioxidants to brighten and protect skin, and chestnut seed extract to boost natural exfoliation. It also features a day cream containing vitamin B3 and SPF 30 to shield skin from further sun damage ($25 each, ulta.com).
Circadia White Veil Brightener gently diminishes age spots and sunspots. Circadia’s brightener can be used as a moisturizer under sunscreen. It contains K3 Vita C (a stabilized form of vitamin C), which has a lightening effect. Alpha-Arbutin, SepiWhite MSH, B-white, and Chromobright work together to inhibit the production of pigment cell enzyme, tyrosinase ($65, circadia.com).
MD Complete Anti-Aging Dark Spot Remover promises to visibly fade dark spots, even skin, and brighten complexion with consistent use. Containing hydroquinone; vitamins B, C, and E; allantoin; and berry extracts, this formula lightens, promotes collagen production, soothes the skin, and evens everything out—all without parabens ($40, target.com).
Spas and Docs
SkinMedica Lytera Skin Brightening Complex has niacinamide, licorice root extract, and other potent ingredients to diminish the appearance of dark spots ($125, skinmedica.com).
SkinCeuticals Advanced Pigment Corrector is considered as effective as a RX hydroquinone and 0.025 percent tretinoin. It contains salicylic acid to exfoliate skin and prime it for spot-reducing ingredients, melanin-taming hydroxyphenoxy propionic and ellagic acids, and yeast extract to help skin resist spots ($90, skinceuticals.com).
Epionce MelanoLyte Pigment Perfecting Serum is the latest entry in the MelanoLyte Skin Brightening System. It’s a gentle, botanics-based serum that brightens skin and fights inflammation ($99, epionce.com).
Obagi Nu-Derm System Products have ingredients such as hydroquinone that improve hyperpigmentation, age spots, and uneven skin tone while smooththing fine lines and wrinkles ($440, obagi.com).