Updated: Aug 29, 2022
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The key to managing hyperpigmentation or dark spots is to understand that not all discoloration is the same. So many patients have told me that they tried a ‘spot corrector’ or a ‘bleaching cream’ without understanding that not every “spot” is the same and not every product is referring to the type of “spot” that you may be trying to treat. In other words, different spots have different causes and different treatments that may be needed.
What are the most common types of spots?
In my experience, there is a wide range of spots that people are looking to treat. These can range from freckles to acne scars to traumatic scars to keratoses to moles to shingles scars to light spots and on and on. Each of these types of spots may have some factors in common but not all. The main thing these spots have in common is that there is some disruption in the surface of our skin that makes it appear uneven.
Do you know which “spot” you have?
Freckles (Lentigo or Lentigines)
Traumatic scars (e.g., burn scars, shingle scars, cuts, or scrapes)
Actinic keratoses (Precancerous spots)
Light spots (Idiopathic guttate hypomelanosis)
Seborrhea (includes petaloid seborrheic dermatitis)
Lupus, Discoid Lupus
Which of these diagnoses are spot correctors really meant to manage?
The most common sources of hyperpigmentation are post-inflammatory hyperpigmentation, melasma, and actinic damage.
Think of post-inflammatory pigmentation (PIP) as secondary or reactive discoloration of the skin.
Trauma, inflammation, or irritation occurs in the skin and resolves with discoloration as part of the healing process. Triggers can also include acne and cysts. This type of pigmentation may resolve gradually over time. Hydroquinone-based bleaching creams alone or combined with tretinoin can help accelerate resolution. These should be used in consultation with a dermatologist as hydroquinone is not ‘smart’- it will bleach anything and can make normal skin even lighter. Ideally, hydroquinone is used as a spot treatment- only on the spots. Tretinoin can be used uniformly all over. The use of azelaic acid or kojic acid can be of benefit to even out skin tone. Pigmentation generally takes about 6-8 weeks to resolve.
Melasma is discoloration in the skin as a result of hormones interacting with light exposure. I say ‘light’ broadly as it has been shown to be linked to UV rays as well as other spectrums of visible light and blue light such as from computer screens. Although bleaching creams can help, it is essential to incorporate zinc and/or titanium-based sunscreens on a routine basis as any light exposure could repigment the skin.
Actinic damage is damage to the skin with chronic UV exposure over time. Many times the UV exposure was years or decades prior to the changes in skin pigmentation. This is challenging as it is the result of both pigmentations as well as a change to the quality of skin where thinning makes it more noticeable. Vitamin C serums as well as retinol can play a role in improving and preventing further discoloration of the skin.
What types of ingredients are found in spot correctors?
Spot correctors tend to include a range of potential ingredients. For example, if you type in “spot treatment” on Sephora’s website, products can contain any one or more of over a dozen ingredients.
Some of these ingredients have similar mechanisms of action or outcomes, others may not, while others may actually cause some trouble to your skin if you use it the wrong way.
How do these ingredients work and which kinds of spots do they treat?
Understanding how each ingredient works can help drive decision-making on which product is best for you. Also, recognize that some ingredients actively treat the skin while others are more preventative to avoid pigmentation. Products will often use vague marketing language that makes distinguishing between these claims difficult.
When looking at how these ingredients work, remember that lightening the skin is usually broken down by three possible routes:
Decreasing pigment production. This can occur by blocking Tyrosinase, an enzyme responsible for melanin production.
Accelerating skin turnover. By increasing the rate of exfoliation, the goal is to accelerate how quickly the excess pigment present in the skin can be removed.
Blocking the transfer of pigment from melanocytes to keratinocytes. By reducing how much melanin is transferred, the hope is that less melanin will spread through the skin cells.
Mechanism of Action
Retinol itself is inactive. It can be converted by your skin into active Retinoic Acid which can:
Plasmin inhibitor - inhibits the release of inflammatory mediators that trigger pigment production. Interferes with the ability of melanocytes to transfer melanin to keratinocytes.
Phyto- Retinol (Bakuchiol)
Similar to retinol above
Inhibit melanin synthesis Can cause oxidative damage to melanocytes, risking permanent loss of these pigment producing cells Prescription only.
Licorice root extract (glabiridin)