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I have dark pigmentation on my face. What is the best treatment these days?

Dark pigmentation on the face is a common concern for patients.  Dark spots are usually one of three non-cancerous skin conditions:   sun spots, melasma or post-inflammatory hyperpigmentation (PIH). Sun spots, or solar lentigo in dermatology jargon, are flat brown spots that occur on sun-exposed surfaces (face, arms, upper back).  Basically, pigment producing cells in the skin churn out more pigment granules in response to cumulative sun exposure.  Even 5 minutes here and ten minutes there of unprotected sunlight over time can be “remembered” by the skin, triggering increased pigment production.  Melasma is chronic condition characterized by large, brown patches that usually cover the forehead and/or temple areas.  Involvement of the cheeks is also common.  Melasma is actually less common in men, who represent only 10% of the total cases (90% of cases are in women).  Cases of melasma tend to hang around for years and are a bit more resistant to treatment.  The sun’s harmful rays not only worsen melasma, but also partially cause melasma (along with genetics and hormones).  PIH is a reactive condition that results after an injury or trauma to the skin.  A common scenario is an acne bump on the face that goes away but leaves a darker reddish-brown spot in its wake.  Although sun spots, melasma and PIH are the most common culprits, skin cancer (melanoma) can also present as a brown spot.  Usually the area will change in some way, like doubling in size within 6 months or turning from brown to red to black.  According to the American Cancer Society, 39,000 men are diagnosed with melanoma every year.  In addition, Caucasian men over the age of 50 have the worst chance of surviving a melanoma than any other demographic. 

So, how do you improve the appearance of dark pigmentation?  The first step is not treating it, but rather getting it evaluated by a board-certified dermatologist to make rule out a skin cancer.  After this is done, you have a few options.  Typically, a two-pronged approach is best:  improving the spots you currently have and preventing more spots in the future.  Over-the –counter creams containing kojic acid and hydroquinone 2% can help a bit, but usually prescription-only medication, like all-


retinoic acid (Retin-A) and hydroquinone 4% are necessary to achieve noticeable improvement.  Best results are usually seen when prescription only topical creams are combined with dermatologic procedures, such as chemexfoliation or lasers.  One word of caution to patients with darker complexions:  always seek a board-certified dermatologist with expert knowledge of skin of color because of high risk of worsening the pigmentation.  In terms of preventing more spots in the future, daily use of a zinc-oxide based sunscreen is critical in blocking everyday sun exposure.  For patients who surf, bike or run, try to get a session in before 10 am or after 4 pm, when the sun’s rays are less intense.  These seemingly small tactics really add up in the long-term and help keep your skin age spot (and wrinkle) free. 

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