The sun is the primary culprit once again. Not only does it cause wrinkles, premature skin aging and skin cancer, but it’s the sun that most often leads to the ugly brown spots that mar faces, hands and other exposed skin as we age.
In a few cases, medications may cause skin discoloration, known as hyperpigmentation, and hormonal shifts can sometimes contribute, as in the case of pregnancy-induced melasma, but in most cases “the sun is a part of the recipe,” says Dr. Joseph Muccini, a dermatologist with Mid-America Skin Health and Vitality Center. And when asked about preventing the hyperpigmentation caused by sun damage, Muccini quips, “Well, one way to prevent it is to just stay in the basement!”
Of course, Muccini knows that’s not an option, so he goes on to outline more realistic strategies. Common to all, however, is a required sense of responsibility when it comes to sun protection. “Like most things, too much of a good thing is a bad thing,” he says. “You have to be careful. You need an approach to the sun that is responsible. You know it’s causing a problem, and not just pigmentation but other problems, too.”
Sunscreen is the holy grail of skin care. “If you want to do yourself a favor, stop paying attention to what you think you may have heard on television or from your friends. Just get an SPF 50 that is broad spectrum—something like the Neutrogena Helioplex product—and apply it a minimum of every two hours. If you put it on and think you’re good to go all day, you are not,” he emphasizes.
Stepping out in a wide-brimmed hat is another recommendation Muccini makes, ideally one with a three-inch brim all the way around to protect the face and neck.
Prevention is always key, but what to do about the spots already appearing? The most simple treatment is topical, says Dr. Richard Moore, medical director of The Lifestyle Center. There are both over-thecounter and prescription options that will help lighten dark spots. “It’s not going to eliminate them, and if you discontinue the use of the product it will come back,” Moore says. This is because topical products affect the more superficial skin layers and “usually that pigment is seated down in the deeper layers and works it way to the surface over time,” he says.
The most popular topical skin-lightening products contain retinols and hydroquinone, a bleaching agent that is FDA-approved but has been the subject of some controversy. It may cause skin irritation and ochronosis, a condition associated with long-term use of high-potency hydroquinone, which causes the treated area to darken instead of lighten. Animal studies that indicate hydroquinone may be a potential carcinogen were enough to ban its use in Europe, South Africa and other countries.
More immediate and effective treatments for hyperpigmentation include chemical skin peels and microdermabrasion, again affecting primarily superficial layers. Laser or intense pulsed light (IPL) treatments, such as FotoFacial, involve “energy being targeted on the skin that gets absorbed by the pigmented cells, and those pigmented cells burst and are either exfoliated off the surface of the skin or scavenged away by the body systems at work in the deeper layers of the skin,” Moore says.
The newest technology that can address hyperpigmentation is fractional resurfacing devices, such as the Matrix RF used by Moore. “They have activity against pigmentation but are designed more for anti-aging,” he says. “Some people respond better to those, and in other cases, they respond better to FotoFacial.”
Any change in pigmentation, particularly to an existing freckle or mole, should be assessed by a dermatologist to rule out precancerous changes or early skin cancer lesions that require additional evaluation and treatment.