Before and after photo of a woman's face.

Think nothing is worse than a wrinkle? Cosmetic clinicians like me would beg to differ. Often, my patients find hyperpigmentation (also called dark spots or sunspots) to also be a big barrier to their healthiest-looking skin . And, while wrinkles have a quick cosmetic fix in the form of injections or temporary line fillers, hyperpigmentation and dark spots are more stubborn and require diligence and patience.  When treating hyperpigmentation, I tell my patients to think “more marathon, less sprint”.

What causes this pesky skin condition?  It’s all about the skin cells.   Your skin contains melanocyte cells that produce melanin and give our skin and hair its color. When excess melanin is produced, hyperpigmentation spots or patches that are darker than the surrounding skin appear. 

Regardless of skin tone, hyperpigmentation can be triggered by:

  • An inflammatory process like acne or eczema
  • Cumulative exposure to UV or an intense burn
  • Starting a new medication/prescription
  • Hormonal shifts

Medium-depth skin peels are a safe and effective treatment option for hyperpigmentation in patients of color. I typically prescribe peels with less than 15% TCA (trichloroacetic acid), like the VI Peel. It’s important to note the percentage of TCA in the peels you use, because a concentration too high can potentially cause an inflammatory response, leading to post-inflammatory hyperpigmentation. VI peels® are great because they are painless and the level of TCA is high enough to be effective without being inflammatory.  Remember that skin peels shouldn’t be synonymous with pain: You can treat hyperpigmentation successfully with a medium-depth peel that doesn’t cause intense discomfort.

Microneedling is another option that combined with skin peels will give a great result.  The microneedle is a device with tiny needles that punctures the surface of the skin with just enough pressure to trigger the skin’s healing response. This healing response then stimulates collagen production that ultimately helps with common skin aging concerns like texture, and elasticity. While microneedling is typically more focused on treatment of textural issues like acne scarring, rough texture, and elasticity, it can also help to break up excess pigment in your skin. It’s best to combine microneedling with something that can help lift unwanted pigment, like the VI Peel.

Hydroquinone is a prescription-only topical medication that  I often use in my practice to manage hyperpigmentation and to even out the skin tone.  There are also many non-prescription options available that are great adjunct treatments.  These ingredients include TXA (tranexamic acid), azelaic acid, kojic acid, niacinamide, and other alpha hydroxy acids like lactic acid and mandelic acid. These are all helpful, especially when used in combination, for relieving uneven skin tone. 

At BeautoxEtc, we have several product lines that combine prescription and non-prescription ingredients to effectively lighten hyperpigmentation and dark spots in all skin tones.  Vitality Institute’s new VI Derm Dark Spot Lifting Serum with 5% Tranexamic Acid(TXA) is a product that delivers dark-spot fading results that are comparable to a prescription-grade product, and it includes four of the proven skin brighteners I mentioned above: tranexamic acid, kojic acid, lactic acid, and niacinamide.  ZO Skin Health® skin brightening line contains retinol, ascorbic acid and glycolic acid.  Together, these ingredients create a powerful combination therapy that corrects existing discoloration and prevents future pigmentation safely, without triggering inflammation.  

It’s also important to remember that prolonged sun exposure makes hyperpigmentation worse and can disrupt and even worsen your treatment cycle. Always use an SPF of 30 or higher, even on cloudy days.

Lastly, it’s also important to remember that everyone’s skin responds differently to different types of treatments based on their DNA, past skin history, environment, and so much more. Make sure to speak with your healthcare professional to set up a treatment path that’s right for your skin that’s completely unique to you. 

Mary Dealy

Mary Dealy, is a board certified Nurse Practitioner with over 25 years of clinical expertise from some of Massachusetts most prestigious hospitals. She launched BeautoxEtc, a cosmetic dermatology practice located in Medfield, Massachusetts.

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