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Dark Spots, Brown Patches, Acne Scars and Blemishes

Of all the skin disorders that affect darker brown, black, or olive skin, hyperpigmentation, especially dark spots and uneven skin tone, is the chief complaint. It can be the aftermath of inflamed skin disorder, hormones, medications, and medical conditions and many other factors, including acne and minor “skin insults” that lead to skin discoloration.

Hormones; Melasma and Chloasma

Dark patches caused by hormonal changes on the cheeks, forehead, and upper lip, can be caused by slight hormone imbalance, birth control pills and hormone devices (melasma), pregnancy (chloasma), weight gain, obesity, photo-sensitizing medications, and sun exposure. Because it’s often driven by family history, hormones, sun, and skin tone, it can be stubborn and difficult to treat. It’s often exacerbated by friction, heat sources, sun exposure, and sunscreen under-use. The various methods used to treat melasma, including exfoliants and retinoids, aggressive peels, microdermabrasion, IPL, lasers, and sonic brushes, can actually worsen it

Post-Inflammatory Hyperpigmentation

Dark spots (PIH) are the aftermath of skin disorders, injury, inflammation, and other “insults” to the skin. The causes of trauma to the skin include acne, deep ingrown hairs, picking, scratching, skin tampering, chickenpox, shingles, skin infections, insect bites, cold sores, surgical procedures, burns, severe and minor injuries, lasers, IPL, microdermabrasion and other causes discussed below.

Acne scars on darker skin tones are often just blemishes or dark spots (PIH) that eventually fade if the acne is kept under control, which halts the cause of the spots. Because they don’t always permanently damage the surface planes of the skin, these marks aren’t considered true scars. Still, they are noticeable and can be cosmetically and emotionally devastating.

Other Important Causes and Factors

Medications: Antibiotics (especially the sulfa and tetracycline families), blood pressure meds, diuretics, oral diabetic meds, hormone pills, implants, patches and IUDs, and many other meds can cause hyperpigmentation.

Sun damage and reactions: Photo-sensitivity or sun allergy, sunburn, tanning, sun freckles, seborrheic keratoses, vascular changes in the skin, photo-dermatitis (sun rash), and staining of the skin from perfumes or medications used while exposed to the sun.

Irritation: Chemicals, hard water, product overuse or misuse, skin peels, scrubbing, microdermabrasion, harsh or inappropriate treatments, cleansers, astringents, and active exfoliants.

Heat sources: Space heaters, wall heaters, car heaters, heater vents, stoves, ovens, hairdryers, curling irons, fireplaces, dry saunas, hot sun, and work-related heat exposure.

Hair removal: Shaving irritation, razor bumps, ingrown hairs, razor burn, depilatories, waxing, tweezing, threading, electrolysis, or laser hair removal.

Friction and pressure: Abrasive scrubs, friction, road rash, abrasive burns, scrubbing your skin, sonic scrubbers, wiping and rubbing the skin or eyes, poorly-fitted eyewear, seat belt shoulder straps touching the neck, tight and/or ill-fitting headgear, underwear, clothing, and footwear.

Smoking tobacco, hookah, and vaping nicotine can cause more severe acne, blackheads, dark circles, premature aging of the skin, and darkened lips and gums. Because smoking also slows healing, the scarring and discoloration from acne, inflammation, surgery, etc. are more severe than with non-smokers.

Other causes: Auto-immune diseases, kidney disease, hemochromatosis, chemotherapy, dehydration, seasonal allergies, eczema, allergic reactions, insect bites, allergic shiners (dark circles caused by allergies, inhaling scented products, smoke, etc).

Dark Scar Tissue

Scars occur when the deeper dermal layer is damaged. Most are flat, similar to dark spots, and leave only a trace of the original injury. The worse the initial damage, the worse the scar will generally be down the road. Made of fibrous tissue, scars replace normal skin after injury and/or prolonged inflammation. It’s the same protein (collagen) as the skin it replaces, but the composition is very different. And with black skin and other ethnic skin, scarring will often heal darker than the surrounding skin. Scars can also become raised (hypertrophic scars) or grow outside of the original injury site (keloids). Or, they form a sunken recess with a pitted appearance (atrophic scars), the scarring usually associated with acne. Addressing dark scars is similar to protocols used to treat dark spots, but clinic treatments may be different and additional products may be necessary.

To-Do List

Health history:  A complete health history, including family history, weight fluctuations, a list of medications, skin problems, products, and past treatments, health, healing, sun, and sensitivities, can help uncover the cause(s).

Address the cause of your skin problems and the factors that can worsen it. Only then can pigmentation problems be improved or overcome. If you smoke tobacco or vape nicotine, have acne, razor bumps, “rashy” skin, tamper with your skin, fail to follow instructions, have underlying medical problems, take sun-sensitizing medications or are overweight, all of these issues must be factored into your plan of action and the expected outcome.

Professional products and treatments: Used correctly, most dark spots be improved dramatically with light skin peels, topical alpha hydroxy acids, and retinoids in formulations containing melanin-suppressing skin brighteners, sun avoidance, and diligent use of non-clogging, full-spectrum sunblock suited to skin type. Skin peels should be chosen for your skin condition, sensitivity, ethnicity, and lifestyle.

Sun protection: Practice “safe sun” lifestyle habits! Monitor product usage, sunscreen use or under-use, and sun exposure.

Skin Brightening Cocktails

Penetrating vehicles: To be effective, a formulation requires a skin-penetrating ingredient that acts as a “vehicle” to carry brighteners to the deeper target tissues. Fruit acids like mandelic, glycolic, and lactic acid have the smallest molecule of the alpha hydroxy acids and are suitable for day and night use if introduced gradually. Dimethyl isosorbide (gentle, penetrating vehicle) is chosen to help the stable, absorbable vitamin C ingredients penetrate into the skin. Retinoids (deep-penetrating active vitamin A derivatives) are best used as carriers at night.

Brighteners, also called lighteners and whiteners, include hydroquinone (FDA-approved skin lightening ingredient), vitamin C (stable, absorbable forms), kojic acid dipalmitate, kojic acid, alpha arbutin, azelaic acid, vitamin K, mulberry extract, bearberry (beta arbutin), licorice extract, niacinamide (vitamin B3), emblica extract, Chromobright®, Cosmo C250, Gigawhite™, mandelic acid and some citrus juice extracts. Patch-tested and used sparingly exactly as directed and in the right formulation, there is a low incidence of irritation and allergic reactions.

It is important to discuss past skin brightener and fade cream usage (especially hydroquinone and steroid-containing skin bleaches) and subsequent reactions, amount of daily sun exposure, sunscreen usage (or lack of it), and the need for sun avoidance. Passive sun exposure, like riding in a car, waiting for the bus, working in the sun, gardening and outdoor sports pose the greatest risk. Many people mistakenly feel that they don’t need sun protection for brief intermittent sun exposure, or because they have a darker skin tone.

Tips for Success

Clear your acne: Use active products and make lifestyle changes to clear acne and prevent new acne, scarring, and dark blemishes.

Lose weight! Dark pigmentation is easier to address when you lose weight. Fat cells alter the body’s hormone levels and can contribute to increasing the darkening and sun sensitivity.

Address the reason for the discoloration (outline above) and make the necessary lifestyle changes.

Protect From The Sun

Protect your skin by practicing “safe sun“. Use a micronized zinc oxide and/or titanium dioxide sunscreen, apply a generous amount, and massage gently until it disappears. Apply extra to problem areas. Don’t forget your neck, chest, arms, feet, and hands. Avoid the sun whenever humanly possible. Stay in the shade when possible and cover-up. Purchase a lightweight “booney hat” with a wide brim. Use extreme caution around bodies of water, sand, and snow, which can bounce the sun up into your face.

Reapply sunscreen hourly, and after swimming, sweating, and when driving, walking, golfing, running, swimming, skiing, gardening, doing outdoor work, and playing sports.

Get your car windows tinted to the legal limit. Keep that sunroof closed too!

Protect your eye area. Wear large 100% UV protective sunglasses that cover the entire eye area. Prescription eyeglasses that “transitions” when you go outside may not darken enough in cars and buses and are usually way too small to do the job. Don’t be fooled by overcast skies because the glare-producing, skin-darkening UVA rays can penetrate clouds and windshields.

Don’t use scented products on any sun-exposed body parts, even with sunscreen.

Product Use or Over-Use

Follow directions. Always apply your active brightening products (a) exactly as directed, (b) in small amounts, massaged all the way into the skin, and (c) in the total absence of irritation. Avoid the entire mouth area and smile lines every other day if you’re dry, sensitive, or if you are directed to do so. Avoid sensitive areas for a few days if they become darkened, too dry or irritated.

Don’t scrub your skin if you start to peel or flake. Don’t use sonic brushes, washcloths, towels, buffing pads, spa gloves or abrasive scrubs. Ask for help if constant flaking is an ongoing issue.

Don’t try to rush things! If your skin gets irritated, you may be overusing your active skin brighteners by applying them too thick or too often.

Never attempt to ‘dot’ brightener or exfoliants onto the dark spots only.

Never apply a thicker coat of your skin brightener or exfoliant to dark areas. This will cause light “halos” around the dark spots and patches, and cause irritation and rebound darkening of those areas.

Follow-up evaluations allow us to monitor your progress, product use, sun practices, health and lifestyle. We often adjust your treatment plan and product potency to boost the results.

Get refills before you run out or you may have to start over. Check if there is a more effective product or new treatment to jump-start your efforts.

Get professional treatments every two to four weeks in the absence of irritation or sunburn. Exfoliation and brightening procedures boost your home care efforts.

Note: Individual results may vary and require compliance to corrective home care products, diligent sun protection, professional treatments, and important lifestyle changes, all of which must be monitored and maintained on a long-term basis.

©2020 Kathryn Khadija Leverette and clinicallyclear.com.

The material on this website is provided for educational purposes only and is not to be used for medical advice, diagnosis or treatment.