Sun Spots Age Spots Hyperpigmentation

Hyperpigmentation refers to a condition where patches of skin become darker than the surrounding areas. This occurs when excess melanin, the pigment responsible for skin color, is produced. Hyperpigmentation can affect both small and large areas of the skin and may appear in various shades, from light brown to deep black, depending on the individual’s skin tone. It results in response to sun exposure, hormonal changes, skin inflammation or injury, and aging.

Several types of pigmentation disorders can cause uneven skin tone:

1. Sun Spots/Age Spots: These are flat, brown, gray, or black spots that appear on sun-exposed areas of the skin. Commonly found on the face, neck, chest, hands, shoulders, and arms, they develop due to prolonged exposure to ultraviolet (UV) rays from the sun or tanning beds. Although these spots are typically harmless, they can be a cosmetic concern for many individuals. They are more common in individuals over 40 but can develop in younger people who spend a lot of time in the sun without protection. Sometimes it is difficult to distinguish between sun spots and pigmented spots that may be concerning for skin cancer.  Patients with numerous sun spots are at a higher risk of developing skin cancer and annual skin checks are beneficial.
2. Melasma: Melasma is characterized by brown or grayish patches that commonly appears on the face, particularly on the cheeks, forehead, nose, and upper lip. Hormonal changes, such as those experienced during pregnancy, are often responsible for melasma, leading to its nickname, “the mask of pregnancy.” Melasma is divided into epidermal (superficial), dermal (deep) and epidermal and dermal (mixed) types. A Wood’s lamp or black light can be used to distinguish epidermal type from dermal and mixed types of pigmentation.  Sun exposure and some medications can exacerbate melasma, making it more noticeable.  Occasionally, melasma can develop on the upper extremities, neck and back.
3. Post-Inflammatory Hyperpigmentation (PIH): This type of hyperpigmentation occurs after an inflammatory skin condition, such as acne, eczema, or a skin injury of any type. It can also result from drug reactions, exposure to chemicals such as gold, silver and arsenic, and allergic reactions. In response to any of these triggers there is a release of inflammatory chemicals in the epidermis. These chemicals stimulate the overproduction of melanin at the site of the inflammation.  As the skin heals, it may leave behind a darker patch in the affected area. Post-Inflammatory Hyperpigmentation can be more pronounced in individuals with darker skin tones.

At the Palo Alto Dermatology Institute, accurately diagnosing the cause of skin discoloration is a crucial first step in developing an effective treatment plan. Understanding the underlying reason for dark spots or patches allows our dermatologists to recommend the most appropriate and personalized approach. Diagnosing skin discoloration involves a combination of clinical assessment, patient history, and, when necessary, specialized tests.

During the initial consultation, a board-certified dermatologist will conduct a thorough examination of the affected areas. They will evaluate the size, shape, color, and distribution of the discoloration. They may use a Wood’s lamp (also called a black light) to help distinguish between epidermal (superficial) and dermal (deep) pigmentation. This examination helps differentiate between various types of hyperpigmentation, such as sun spots, melasma, and post-inflammatory hyperpigmentation (PIH).

They will also review your patient history to understand the possible causes of your skin discoloration including sun exposure, hormonal changes, skin conditions and injuries, medications and skin care products, and your family history, since genetics play a role in skin pigmentation disorders.

At the Palo Alto Dermatology Institute, our board-certified dermatologists offer a range of effective treatments to address sun spots, age spots, and hyperpigmentation. Treatment plans are tailored to the individual’s skin type, severity of the pigmentation, and desired outcomes. Some of the available options include:

1. Topical Treatments: Prescription creams containing hydroquinone bleaching agent, retinoids, or other skin-lightening agents can be effective in reducing the appearance of dark spots. These treatments work by slowing down melanin production and promoting the turnover of skin cells to reveal a more even skin tone.  These prescription creams are typically combined with a medicated skin care regimen.  Topical treatments are useful for all types of pigmentation.
2. Chemical Peels: A chemical peel involves applying a solution to the skin that causes it to exfoliate and peel off, revealing smoother, less pigmented skin underneath. Chemical peels can vary in strength, from superficial to deep, depending on the needs of the patient and the severity of the pigmentation.  Chemical peels are a mainstay treatment for photodamage and sun induced pigmentation.  For melasma patients, chemical peels are most effective for epidermal pigmentation, however very light peels may be helpful in dermal and mixed melasma as part of a comprehensive treatment plan.
3. Laser Treatments: Laser therapy is a popular and effective method for treating various forms of hyperpigmentation. Lasers can target pigmented areas, breaking down the excess melanin while leaving the surrounding skin unharmed. Different types of laser treatments are available, and our dermatologists can recommend the most appropriate one based on the patient’s condition and skin type.  Laser treatments are another treatment option for all types of pigmentation.
4. Microneedling: This minimally invasive procedure uses tiny needles to create controlled micro-injuries in the skin, stimulating collagen production and helping to reduce the appearance of hyperpigmentation. Microneedling can also enhance the absorption of topical treatments, making them more effective.  Microneedling may be beneficial for some types of pigmentation.
5. Cryotherapy: This treatment uses extreme cold to freeze and remove sun spots. It is a quick and straightforward procedure that can effectively lighten small, localized spots such as sun spots including freckles and keratoses.
6. Sun Protection: Preventing further pigmentation is crucial. Using a broad-spectrum sunscreen with a high SPF daily, even on cloudy days, helps protect the skin from harmful UV rays. Our dermatologists can recommend specific sunscreens suitable for different skin types to ensure effective protection.