Know the Dark Spots on your Skin

We all want crystal clear skin, which is only possible in photographs taken on a beauty app or filter. Yes there are some people who are genetically blessed but it is very common to have some dark spots on the skin. Know how to prevent it and seek medical help as it starts developing. Please do not go for self-medication as it can have adverse effect on skin. 

Dark spots in our skin are medically known as hyperpigmentation.Hyperpigmentation refers to patches of skin that become darker than the surrounding areas of skin. It occurs when the skin produces excess melanin, the pigment that gives skin its colour. It can affect people of all skin types.

Hyperpigmentation is more common in darker skin owing to their high content of melanin. From a simple acne mark to cut mark, any scar in skin can present as hyperpigmentation.

There are many types of hyperpigmentation owing to their style of presentation/occurence

Age spot/liver spot: This is a brown tan on the areas exposed to the sun. It is most commonly seen on face, hands and other exposed areas. It is also mostly seen in older adults who have been exposed to too much sun.

Melasma: It occurs as a large patch of darkened skin around the cheeks, forehead, nose and upper lips. It is usually associated with hormonal changes like pregnancy, contraceptive pills, menopause etc and fades. However, if it does not fade, a doctor may recommend the following:

• Avoiding sun exposure

• Using a broad-spectrum sunscreen.

• Using another medication for other types of hyperpigmentation, such as hydroquinone.

• Using camouflage makeup until the melasma fades

Freckles: This is pinpoint hyper pigmented spots in fair skin patients belonging to a higher altitude. This condition can be treated with light devices like Laser and IPL.

Post inflammatory hyperpigmentation: It can happen anywhere in the body post injury, acne, scars etc. The best way to prevent post acne hyperpigmentation is by not pricking the acne .

Reactions to drug use: Certain medications, such as antimalarial drugs and tricyclic antidepressants, can cause hyperpigmentation. In these cases, patches of skin may turn grey.

Genetics: Some kinds of hyperpigmentation, such as freckles, are hereditary; so if you have a family history of uneven skin tone or pigmentation, you may experience it as well.

Lack of vitamins: An insufficiency of vitamins like B12 and Folic Acid can cause spots and pigmentation. It is important to ensure you are getting enough of these vitamins, both topically and orally.

Among some serious diseases associated with skin symptoms is the Addison's disease that affects the adrenal glands. It can cause hyperpigmentation in certain areas of the body, including the folds of the skin, lips, elbows and knees, knuckles, toes and the inside of the cheek.

Hemochromatosis is an inherited condition that causes the body to contain too much iron. It can cause hyperpigmentation, making the skin appear darker or tanned. Hyperpigmentation can occur when iron levels are much higher than usual.

Treatment options:

Hyperpigmentation is often harmless and may require no treatment at all. However, some people may prefer to remove it. For those who do, various treatment methods and home remedies may help.

Topical applications:

Skin lightening ointments: These need to be prescribed by a doctor. Some of the commonly used ingredients are hydroquinone, liquorice, kojic acid, glycolic acid, niacinamide, etc.

Exfoliation:

Physical exfoliation like scrubs and chemical exfoliation like AHA and BHA containing cleansers work well. Treat existing hyperpigmentation by first sloughing off dead, dulling skin cells at the surface. This clears the path for the ingredients in your serums and moisturisers to better penetrate the skin. The in-clinic procedures like MDA or chemical peels are also a good option.

Role of other medications:

Of late, Tranexamic acid has found to have a significant role in treating hyperpigmentation specially Melasma and PIHs. Also, certain other drugs like glutathione, superoxide dismutase have been found to have antioxidant property and hence prevent hyper-melanogenesis.

In clinic procedures

Some cosmetic procedures can also lighten areas of skin to reduce the appearance of hyperpigmentation.

Cosmetic procedures for hyperpigmentation include:

• Laser therapy: Works mostly in freckles and PIH

• Intense pulsed light: Works in diffused pigmentation also.

• Exfoliators like Microdermabrasion and Dermabrasion works well in some.

• Chemical exfoliation by chemical peels: Glycolic acids and lactic acids are superficial peels which help in maintaining melasma and other hyperpigmentation. Deeper peels like yellow peels give better results for deeper pigmentation.

Prevention

It is not always possible to prevent hyperpigmentation or stop it from becoming more prominent, but there are some ways to reduce the risk. These include:

• Protecting the skin from the sun by using a sunscreen of SPF 30or higher and wearing clothes that protect the skin

• One should avoid picking at the skin after an injury or when there are spots, scabs, or acne

• Seeking professional advice before using creams to lighten dark patches, as this can cause reactions

Steroid Dermatitis

The availability and use of drugs without prescription and the inadvertent use of steroid creams to whiten or smoothen the skin by people has led to this condition. Many people suffer from steroid dependence as the skin becomes hypersensitive to sun, itching and acne on stopping the application. They have skin thinning which cannot be reversed. Many a times, the creams are given for very short duration to give immediate relief from the existing condition under precaution but patients often misuse or overuse this.

Summary: We all want crystal clear skin, which is only possible in photographs taken on a beauty app or filter. Yes there are some people who are genetically blessed but it is very common to have some dark spots on the skin. Know how to prevent it and seek medical help as it starts developing. Please do not go for self-medication as it can have adverse effect on skin.

By Dr Reema Das Mallik

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