A dusting of freckles across the nose is one thing. A blotch that causes people to ask if you’ve been hit in the head (true story) is a whole other ball game. So what’s a lady with hyperpigmentation to do?
According to Dr. Neal Schultz, NYC dermatologist, host of DermTV.com and creator of BeautyRx by Dr. Schultz, “The most relevant age-related skin discoloration is age spots — also known as liver or sun spots. While they’re caused by repeated and prolonged sun exposure, they take many years to form — typically showing up around the mid- to late-40s.” He explains the process: The skin’s melanocytes, cells that form the natural pigment in skin known as melanin, make extra melanin whenever the skin is injured. “That’s why insect bites, pimples, curling iron burns, etc. eventually turn brown — even temporarily,” he says. Unprotected or inadequately protected skin that is exposed to UV rays incurs damage, pushing the melanocytes into overdrive to produce more melanin — and an age spot, or 20, forms.
If sun damage has already been done — a likely experience for any woman over 45 — is prevention still an option? “You can slow (but not stop) existing hyperpigmentation’s development or emergence,” Dr. Schultz says. And the first solution, over-the-counter (OTC) creams, is key to this deceleration.
Solution #1: Over-the-Counter Care
The easiest way to counter hyperpigmentation? OTC creams. Though they can’t reverse damage, they can help visually improve age spots (usually within two to eight weeks), aid in slowing their formation, and, in the case of sunscreen, prevent further damage. Dr. Schultz recommends three OTC product categories.
Sunscreen. “Diligent sunscreen applied 365 days a year to all sun-exposed areas is extremely important because the sun can cause age spots to form faster than we can remove them,” Dr. Schultz says. He recommends choosing an SPF 30 or higher with either titanium dioxide or zinc oxide. And, he notes, no matter if you choose an over-the-counter, prescription, or in-office treatment, never skip sunscreen! Try: Image Skincare Prevention+ Daily Hydrating Moisturizer SPF 30+.
Chemical exfoliation. Daily use of a gentle chemical exfoliant (either lactic or glycolic acids) to sun-exposed skin helps remove dead cells, which, according to Dr. Schultz, “have too much brown melanin pigment in them.” Try: BeautyRX by Dr. Schultz Essential 8% Exfoliating Serum.
Topical bleach. “Using a topical bleach twice a day on any visible spots, regardless of how faint, will slow down melanocytes’ formation of new excess brown melanin pigment,” Dr. Schultz says. Hydroquinone, which he feels has received an undeserved bad rep, remains the most effective OTC ingredient for lightening hyperpigmentation. Also keep an eye out for vitamin C (formulated as an ester), kojic acid, licorice extract, arbutin (a natural alternative to hydroquinone), soy, and niacinamide, which all work to decrease hyperpigmentation. Try: La Roche-Posay Mela-D Pigment Control.
Solution #2: Prescription Topical Treatments
If you find OTC creams are netting indiscernable results, a prescription cream would be your next best bet. Again, hydroquinone is a star ingredient. It is found in higher strengths (like 5%) in prescription varieties than its OTC counterpart (which is, at most, 2%). Dr. Schultz points to Kligman’s Formula and TriLuma Cream as popular hydroquinone choices. Azelaic acid, a prescription ingredient used to treat acne and rosacea in such creams as Azelex and Finacea, has been found to effectively reduce the formation of new excess melanin as well.
“With any of these prescription treatments, it can take weeks to months to see improvement,” he says.
Solution #3: In-Office Therapies
Dr. Schultz makes no bones about it: In-office treatments are the most efficacious way to tackle existing hyperpigmentation. What you need to consider: the procedure’s recovery time and the number of treatments needed. Make sure your dermatologist walks you through what to expect during and after a treatment and how much follow-up is necessary. Once you’ve determined your parameters, these are the treatments worth trying.
Intense pulsed light (IPL) therapy. The non-invasive and non-ablative treatment uses high-intensity pulses of filtered visible light to improve the appearance of age spots. It requires multiple treatments (three to five) and has virtually no downtime.
Chemical peels. A “controlled injury” to the skin causes the body to go into wound-healing mode and regenerate healthy new tissue while dead skin sloughs off. Depending on the chemical used (trichloroacetic acid, glycolic acid, salicylic acid), chemical peels have variable downtimes and may require multiple treatments.
Laser removal. Dr. Schultz believes this is the best option because it can “completely eliminate age spots.” For the treatment, a technician uses a wand-like laser instrument to remove the top layers of skin. “Different lasers have different recovery periods and number of treatments, but they all work,” he says. For example, the Yag and Alexandrite lasers each require a single treatment, but they also cause the treated areas to turn black and blue for one week on the face and two weeks on the body. Eventually, the dark spots wash away, leaving skin slightly pinked, but that fades over the course of a few weeks. Another laser, the Fraxel Thulium, diffuses brown pigmentation and is better equipped for larger numbers of brown spots, according to Dr. Schultz. It often requires two to three treatments, repeated at three- to four-week intervals, with virtually no downtime.