Elizabeth K. Hale, MD is a Board Certified Dermatologist and a Clinical Associate Professor of Dermatology at the New York University School of Medicine, where she received the Surgical Attending of the Year Award. She is also the Vice President of the Skin Cancer Foundation. As a widely respected dermatologist, Dr. Hale is frequently sought out and extensively quoted by national broadcast, print and online publications.
We’ve heard a lot of buzz lately about hyperpigmentation. While marketers may be behind some of this chatter (Really? Another thing we should worry about?), hyperpigmentation is a real problem for many people. To get an unbiased expert perspective on what it is and how it can be prevented and treated, we spoke to Elizabeth K. Hale, M.D., a leading expert in the field of dermatology. Liz has a particular passion for sun protection and all the benefits it offers – including the prevention of hyperpigmentation.
Ayla: What is hyperpigmentation, and why do people talk about it so much these days?
DR. HALE: Hyperpigmentation includes:
• Sun spots (solar lentigines)
• Post-inflammatory hyperpigmentation (e.g., the spot left behind after a pimple clears up)
A lot of people talk about hyperpigmentation because it covers a number of specific conditions and affects many individuals. Also, since everyone wants a clear, even-textured, even-toned complexion – and hyperpigmentation is a fairly noticeable obstacle – it’s become something that people are paying more attention to.
Ayla: Let's start with freckling and sunspots. Can you tell us more about them?
DR. HALE: Uneven pigmentation in the form of sunspots and freckling – covering discrete areas of the skin – can be a sign of sun damage or aging of the skin.
• Freckling is a normal and common variant in skin tone that can occur with increased sun exposure and become more pronounced with age.
• Sun spots (solar lentigines) are the product of chronic sun exposure; you see these appear more in people between the ages of 30 and 50.
Ayla: How can freckling and sunspots be prevented?
DR. HALE: The key to avoiding both freckling and sun spots is prevention – always use a broad-spectrum sunscreen.
Note from Ayla: Our current favorites are
- MDSolarSciences Mineral Creme SPF 30 for its lightweight, all-skin-types-suitable texture and no-pores, never-white finish
- Ursa Major Force Field SPF 17 for its suitability for even the most sensitive, acne-prone skin
- Luzern La Defense SPF 30 for its long list of age-fighting ingredients
- Suntegrity BB Cream SPF 30 for its ability to replace foundation
And if you'd rather use a moisturizer + sunscreen in one go, consider Naturopathica Lavender Protective Moisturizer SPF 17 if your skin tends to be combination/balanced or Josh Rosebrook Nutrient Day Cream, which also comes in a tinted version, if your skin tends to run on the balanced to dry side.
Ayla: How can they be treated?
DR. HALE: AHA treatments and retinol treatments can lighten epidermal hyperpigmentation by exfoliating the top layers of the skin (whereas BHA treatments target acne and the sebaceous glands). Only use these at night, and use a good, broad-spectrum sunscreen during the day.
Note from Ayla: We suggest Luzern Labs Serum Absolut Au Vin, Kristina Holey + Marie Veronique Intensive Repair Serum, and Marie Veronique Gentle Retinol Night Serum.
Alternatively, sun spots can effectively be removed in one session with a Q-switched laser.
Also, Kojic acid and azelaic acid are good natural alternatives to hydroquinone, a frequently-prescribed bleaching agent that can sometimes cause paradoxical darkening if it’s used over a long period of time.
Vitamin C is a good option, too – it doesn’t directly decrease pigmentation, but it can increase radiance. So it’s a good adjunct treatment for the daytime.
If you visit a dermatologist, peels and lasers are the types of treatments you can ask about.
Ayla: Tell us more about melasma.
DR. HALE: Melasma, in contrast, covers less well-defined areas of the skin – it looks patchy and covers broader areas.
It’s partially caused by sun exposure, but there’s a hormonal component to it, too. With women from age 20-50, there’s an interplay of hormonal fluctuations and sun exposure that can trigger melasma. It’s very common in pregnant women (sometimes it’s called “the mask of pregnancy”), especially on the upper cheeks and upper lip.
Ayla: How can melasma be prevented?
DR. HALE: In all cases where melasma is concerned, sun protection is very important – always use a broad-spectrum sunscreen. Sometimes oral contraceptives can trigger it, too – in that case, I recommend switching to a low-estrogen birth control pill.
Ayla: How can it be treated?
DR. HALE: The same types of treatments for sunspots and freckling will be helpful where melasma is concerned.
Ayla: What about post-inflammatory hyperpigmentation?
DR. HALE: Post-inflammatory hyperpigmentation occurs after minor injury to the skin – after the skin heals, a dark spot is left in its place.
These dark spots can be left behind, for instance, after an acne cyst clears up on certain skin tones (people with darker skin tones are more susceptible to this). They’re the result of a sequential process: your pimple is red & inflamed because your body is trying to attack the buildup of sebum with white blood cells. Then, those white blood cells begin to deposit melanin. The more trauma you induce (by squeezing it, for example), the more it gets inflamed.
Ayla: How can post-inflammatory hyperpigmentation be prevented?
DR. HALE: The key to prevention in this case is about treating the acne condition effectively – and avoiding the manipulation of acne (popping pimples, etc.) as much as possible. Once this type of hyperpigmentation occurs, it’s much harder to get rid of.
Note from Ayla: Medik8 betaGel not only treats acne effectively, but also prevents post-inflammatory hyperpigmentation with azelaic acid.
Ayla: How can it be treated?
DR. HALE: Look for products with anti-inflammatory ingredients (green tea, oat extract, chamomile), or see your dermatologist to ask about a topical steroid that might help.
Note from Ayla: We suggest The Organic Pharmacy Anti-Oxidant Gel, which is packed with anti-inflammatory ingredients. Kahina Brightening Serum and S5 Illuminate Serum are specifically designed to boost skin's luminosity while preventing post-inflammatory hyperpigmentation.
About Dr. Hale: Liz is a Board Certified Dermatologist and a Clinical Associate Professor of Dermatology at the New York University Langone Medical Center, where she received the Surgical Attending of the Year Award in 2008. She specializes in Mohs micrographic surgery, cosmetic dermatology, and laser surgery. Dr. Hale has extensive experience in the field of skin cancer and is a vice president of The Skin Cancer Foundation. A widely respected dermatologist, Dr. Hale has received an astounding number of awards and honors. Learn more about her impressive background — and her brand new, state-of-the-art dermatology, laser and skin surgery practice on the Upper East Side of Manhattan — here.
Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.