Pigmentation is a tricky and complicated issue. Lately, I've seen a lot of "one size fits all" approaches to treating dark spots when the truth is, the treatment is completely dependent on the cause!
Here are some ways to identify the kind of pigmentation you have and clue you into what it's actually telling you! I've also put together some general guidelines to consider when managing this issue.
What is your pigmentation telling you?
Appearance: Dark, crusty freckle looking spots that appear like tiny little islands on the skin. These are your traditional "sun spots".
Stems from: UV damage, accumulated damage throughout teen years into adulthood.
What exacerbates it: Excessive sun exposure. Photosensitizing medications, some antibiotics, and any kind of intense exfoliation (peels, lasers, retinols, hydroquinone) can also make skin more sensitive to the sun.
Treatment: Professional chemical peels (during winter), at home acids (look for glycolic, lactic, mandelic, azeleic, and kojic acid), manual exfoliation, topical vitamin C (combined with vitamin E makes a more powerful combo), niacinamide, licorice root, and physical sunscreen protection.
Try to avoid: excessive sun exposure, getting a peel/laser treatment or using retinol or hydroquinone and then going in the sun shortly after.
Your main focus: protect the skin from the sun and use topical antioxidants.
Post Inflammatory Hyperpigmentation
Appearance: purple or red undertones where acne breakouts, burns, or wounds have occurred.
Stems from: Inflammation on the deeper layers of the skin. This is a sign of damage to the tissue and surrounding blood vessels.
What exacerbates it: Using ingredients that dry the skin, picking at the skin more, lack of sleep, sun exposure, and low immunity.
Treatment: This is a sign that the body is in need of deeper healing. The body knows how to heal itself on its own, what stands in the way most of the time is inflammation. Areas where you once had a large blemish that now looks like a purple, black or red mark is called post inflammatory pigmentation and it needs more blood flow and oxygen to repair the tissue - essentially, it needs your immune system in tip top shape to assist in the repair process. This kind of condition needs internal hydration as well as topical ingredients that will nourish and HYDRATE the deeper layers to create an environment for the skin to heal from the bottom up; hyaluronic acid, seaweed, astaxanthin (antioxidant from seaweed), omega fatty acids, or any other powerful antioxidants. Best remedies encourage a combination of increasing circulation/blood flow, moving lymphatic fluid and doing gradual exfoliation. Other modalities to consider are microneedling (repairs collagen), LED light therapy (increases oxygen and nutrients to skin), facial massage, gua sha, meditation, quality sleep (to support immunity), stress reduction (to lower inflammation), drinking LOTS of water, at home acids (same as above), low inflammatory diet, dietary vitamin C as well as topical vitamin C and physical sunscreen protection.
Try to avoid: Sugar, dehydration, stress, picking at skin, excessive sun exposure, over exfoliation.
Your main focus: Boost your immunity, hydration levels and the body's natural healing response.
Appearance: Darkened skin that looks more like a continent rather than tiny islands (most commonly seen on cheeks, forehead or upper lip). This is called melasma.
Stems from: Hormones (Melanin Stimulating Hormone), Pregnancy, hormone fluctuations, birth control
What exacerbates it: heat, sun exposure, spicy food, coffee, lasers, emotional trauma, and hormone fluctuations. Melasma is a mask-like looking pigmentation condition that is coming from INSIDE the body. It is much harder to treat than the kind we develop from external forces. Many times hormones are the biggest culprit but basically anything that triggers Melanin Stimulating Hormone (MSH) within the body will cause it to present itself (sunlight can trigger MSH in a hormone sensitive person).
Treatment: Hormone balancing, stress reduction, at home acids (same as above), light peels (done very consistently), low inflammatory diet, dietary vitamin C as well as topical vitamin C, topical kojic acid, licorice root, niacinamides, and physical sun protection.
Try to avoid: Stress, taking unnecessary hormones, excessive sun exposure, getting a peel/laser treatment or using retinol or hydroquinone and then going in the sun shortly after, LED treatments (because it heats the skin), hot baths, hot weather, spicy food, or coffee (basically anything that stimulates too much heat and blood flow to the skin as melasma is fed by hormones, heat AND increased blood flow).
Your main focus: Balance hormones and eliminate triggers.
A note on Hydroquinone: HQ is often seen as the "gold standard" for treating pigmentation, but this topical bleaching cream should come with a big warning label on it and I'm often shocked that doctors either don't know or do not notify their patients of the carefulness one must take when using this ingredient on the skin. To keep things brief, HQ has been banned in some countries, mainly due to some of its properties that some claim have a cancer causing effect. The main reason why people use HQ is to lighten the skin, but overuse of this product, or improper use (like going in the sun after a nighttime application) can actually result in a severe darkening of the skin, much worse than how it started out! For this reason, I never recommend HQ to anyone, there are simply too many risks involved.
My approach to treating pigmentation is both internal and external:
External: When treating the skin topically, start low and go slow. Unless you are getting a high tech laser treatment with a doctor who specializes in pigmentation (and I even question those sometimes), you are not getting rid of the spots in one day. For most people, this is a long process that takes patience and consistency.The skin needs exfoliation and brightening ingredients used OVER TIME. The key is to gradually renew the skin cells with peels/exfoliation/sloughing off dead skin while still protecting the underlying layers with adequate hydration and nutrition. You'll want to invest in topical vitamin C, incorporate regular exfoliation into your routine (manual scrubs and/or light acids, get professional light chemical peels during the winter months), use a mineral SPF (chemical SPFs absorb UV rays while mineral SPF actually block sunlight - look for titanium dioxide or zinc oxide), and get a healthy amount of sleep (this is when the body goes through most cellular repair).
Internal: Inflammation, whether it's overt, or barely detectable, is what stands in the way of the body healing itself. Reduce the inflammation and you will reduce all kinds of hyperpigmentation. This means eating colorful fruits and vegetables (so your body receives vitamins, minerals and phytonutrients that can assist in dealing with oxidative damage), balancing your hormones (many times this can be addressed with diet and removing environmental toxins), drink lots of clean water (a hydrated inner environment is necessary for detoxification and calming inflammation), and finally, find ways to reduce daily stressors. Some of my favorite ways to purify my skin from the inside out is through deep breathing exercises, yoga, mediation, journaling and laughing.
Shell Scrub (manual exfoliant)
Hibiscus + Green Tea Peel (liquid exfoliant with glyocolic, lactic and salicylic acid, seaweed + licorice root)
Sol Veil SPF 25 (daytime seaweed + aloe based moisturizer with titanium dioxide)
Mermaid Face (hydrating mist that contains plankton enzymes which accelerate skin repair)
Omega Oil Collection (vitamin C + algae based oils)
Serum Collection (vitamin C + algae in a water based solution)
Sunny Skin Bundle (Shell Scrub, Sol Veil, Clear Glow Omega Oil, Mermaid Face)