In the News:

Delete Dark Spots and Brighten Your Skin Tone

Of all the skin disorders that affect darker skin, black skin and other brown-skinned people of color, hyperpigmentation, especially dark spots, is the chief complaint. It can be the aftermath of skin problems, hormones, medications and medical conditions and many other factors, including acne and minor “skin insults” that lead to skin discoloration.

Hormonal Hyperpigmentation

Hormonal hyperpigmentation (dark patches) on the cheeks, forehead and upper lip, can be caused by slight hormone imbalance, birth control pills and hormone devices (melasma), pregnancy (chloasma), weight gain, obesity, photo-sensitizing medications and sun exposure. It can be very stubborn and difficult to treat because it’s driven by family history, hormone changes, skin tone, sun exposure, product overuse and sunscreen underuse. It’s aggravated by friction, heat sources and sun exposure, and often worsened by the various methods used to treat it, like microdermabrasion, IPL, lasers, sonic brushes, and potent combinations of retinoids, steroids and hydroquinone.

Post-Inflammatory Hyperpigmentation

Caused by skin disorders, injury and inflammation, post-inflammatory hyperpigmentation is sometimes called PIH (dark spots). The causes of trauma to the skin include acne, deep ingrowns, picking, scratching, skin tampering, chicken pox, shingles, skin infections, cold sores, surgical procedures, burns, severe injuries, lasers, IPL, microdermabrasion and other causes discussed below.

Acne scars on darker skins are often dark spots (PIH) that eventually fade if the acne is kept under control, which halts the cause of the spots. Because they don’t always permanently damage the surface planes of the skin, many PIH marks aren’t considered true scars. Still, they can be both cosmetically and emotionally devastating.

Medications: Antibiotics (sulfa and tetracycline families), blood pressure meds, diuretics, oral diabetic meds, hormone pills and devices, and many others can cause hyperpigmentation.

Sun: Photo-sensitivity or sun allergy, sunburn, tanning, sun freckles, seborrheic keratoses, vascular changes in the skin, photo-dermatitis (sun rash), and staining of the skin from perfumes or medications used while exposed to the sun.

Irritation: Chemicals, hard water, product overuse or misuse, skin peels, scrubbing, microdermabrasion, harsh or inappropriate treatments, cleansers, astringents and/or active exfoliants.

Heat sources: Space heaters, stoves, ovens, hair dryers, fireplaces, dry saunas, hot sun, and work-related heat exposure.

Hair removal: Shaving irritation, razor bumps, ingrown hairs, shaving irritation, razor burn, depilatories, waxing, tweezing, threading, electrolysis, or laser hair removal.

Friction and pressure: Abrasive scrubs, friction, road rash, abrasive burns, scrubbing your skin, sonic scrubbers, wiping and rubbing the skin or eyes,  poorly-fitted eyewear, seat belt shoulder straps, tight and/or ill-fitting headgear, underwear, clothing and footwear.

Smoking causes severe dark circles, darkened lips and gums, and encourages dark spots and scarring from acne, surgery, etc. because it shows down the healing process.

Other causes: Auto-immune diseases, kidney disease, hemochromatosis, chemotherapy, dehydration, seasonal allergies, eczema, allergic reactions, insect bites, allergic shiners (dark circles caused by allergies, inhaling scented products, smoke, etc).

Dark Scar Tissue

Scars occur when the deeper dermal layer is damaged. Most are flat, similar to dark spots, and leave only a trace of the original injury. The worse the initial damage, the worse the scar will generally be down the road. Made of fibrous tissue, scars replace normal skin after injury and/or prolonged inflammation. It’s the same protein (collagen) as the skin it replaces, but the composition is very different, and with black skin and other ethnic skin, scarring will often heal darker than the surrounding skin. Scars can also become raised (hypertrophic), grow outside of the original injury site (keloid), or form a sunken recess with a pitted appearance (atrophic), the scarring usually associated with acne. Addressing dark scars is similar to protocols used to treat dark spots, but clinic treatment will be different and additional products may be necessary.

To Do List

(1) Take a complete health history (weight, list of medications, skin problems and products, health, healing, sun, sensitivities), (2) address lifestyle issues that can cause or worsen the problem, (3) add melanin-suppression to existing skin care regimen, (4) get professional skin peels chosen for your skin condition, sensitivity, ethnicity and lifestyle, (5) practice “safe sun” lifestyle habits, and (6) monitor product usage, sunscreen use and/or under-use, and sun exposure.

Address the cause of the skin problem, and the factors that can worsen it. Only then can pigmentation problems be improved or overcome. If you have acne, razor bumps, “rashy” skin, tamper with your skin, fail to follow instructions, have underlying medical problems, take sun-sensitizing medications or are overweight, these issues must be factored in to your plan of action.

Professional products and treatments: Most dark spots be improved dramatically with light skin peels, topical alpha hydroxy acids and retinoids in formulations containing melanin-suppressing skin brighteners, sun avoidance and diligent use of non-clogging, full-spectrum sunblock suited to skin type.

Active skin brightening “cocktails” can contain AHAs like mandelic, glycolic, lactic acid (fruit acid exfoliators that act as “vehicles” to deeper tissues), dimethyl isosorbide (gentle, penetrating vehicle), retinoids (deep-penetrating active vitamin A derivatives), hydroquinone (FDA-approved skin lightening ingredient), vitamin C (stable, absorbable forms), and the following melanin-suppressing brighteners: kojic acid dipalmitate, alpha arbutin, azelaic acid, vitamin K, mulberry extract, bearberry (beta arbutin), licorice extract, niacinamide (vitamin B3), emblica extract, Chromobright®, Cosmo C250, Gigawhite™, mandelic acid and some citrus juice extracts. Patch-tested and used sparingly exactly as directed and in the right formulation, there is a low incidence of irritation or allergic reaction.

It is important to discuss past skin brightener and fade cream usage (especially hydroquinone) and subsequent reactions, amount of daily sun exposure, sunblock usage (or lack of it) and the need for sun avoidance. Passive sun exposure, like riding in a car, waiting for the bus, working in the sun, gardening and outdoor sports poses the greatest risk. Many people mistakenly feel that they don’t need sun protection for brief intermittent sun exposure, or because they have a darker skin tone.

Tips for Success                             

Clear your acne: Use active products and make lifestyle changes to clear acne and prevent new acne, scarring and dark blemishes.

Lose weight! Dark pigmentation is easier to address when you lose weight. Fat cells alter the body’s hormone levels and can increase darkening and sun sensitivity.

Address the reason for the discoloration (outline above) and make the necessary lifestyle changes.

Protect your skin by practicing “safe sun“. Use a micronized zinc oxide and/or titanium dioxide sunscreen, apply a generous amount, and massage gently until it disappears. Apply extra to problem areas. Don’t forget your neck, chest, arms, feet and hands. Avoid the sun whenever humanly possible. Stay in the shade when possible and cover up. Purchase a “booney hat” from Costco.

Reapply sunscreen hourly, and after swimming, sweating, and when driving, walking, golfing, running, swimming, skiing, gardening, doing outdoor work and football practice.

Get your car windows tinted to the legal limit. Keep that sunroof closed too.

Protect your eye area. Wear large 100% UV protective sunglasses the cover the entire eye area. Prescription eyeglasses that “transitions” when you go outside may not darken enough in cars and buses and are usually way too small to do the job. Don’t be fooled by overcast skies because the glare-producing, skin-darkening UVA rays penetrate clouds and windshields.

Don’t try to rush things! If your skin gets irritated, you may be overusing your active skin brighteners by applying them too thick or too often.

Get professional treatments every two to four weeks in the absence of irritation or sunburn. Exfoliation and brightening procedures boost your home care efforts.

Follow-up evaluations allow us to monitor your progress, product use, sun practices, health and lifestyle. We often adjust your treatment plan and product potency to boost the results.

Get refills before you run out or you may have to start over. Check if there is a more effective product or new treatment to jump-start your efforts.

Don’t use scented products on any sun-exposed body parts, even with sunscreen.

Product Use or Over-Use

Don’t scrub your skin if you start to peel or flake. Don’t use sonic brushes, washcloths, buffing pads or abrasive scrubs. Ask for help if constant flaking is an ongoing issue.

Follow directions. Always apply your active brightening products (a) exactly as directed, (b) in small amounts, massaged all the way into the skin, and (c) in the total absence of irritation. Avoid the entire mouth area and smile lines every other day if you’re dry, sensitive, or if you are directed to do so. Avoid sensitive areas for a few days if they become darkened, too dry or irritated.

Never attempt to ‘dot’ lighteners onto the dark spots only. Never apply a thicker coat of your skin lightener to dark areas. This will cause light “halos” around the dark spots and patches, and cause irritation and rebound darkening of those areas.

Note: Individual results may vary and require compliance to corrective home care products, diligent sun protection, professional treatments, and important lifestyle changes, all of which must be monitored and maintained on a longterm basis.

©2016 Kathryn Khadija Leverette and katleverette.com. Reprinted with permission.

The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.