All About Brightening

A crash course in brighter, more even skin

By Susan Sanders, MD | Aug 07, 2019


Dark and discolored spots on your skin, such as acne scars and sunspots, can make your skin look dull and blotchy. But don’t worry, while uneven skin tone is a common complaint, fortunately there are solutions that you can do at home to make your skin brighter and more radiant.


Let’s first discuss what causes those dark marks and blotches on your skin. Dark spots and blotches on the skin are called hyperpigmentation. An excess of melanin, the brown pigment that gives your skin its color, causes these spots. People with darker skin have higher amounts of melanin, and people with light skin have less melanin. Special cells in your skin called melanocytes make melanin.  Normally melanocytes spread melanin equally throughout your skin, giving you an even color. However, several factors can interfere with melanocytes’ normal activity. When this happens, melanin is not spread evenly but instead clusters in areas, giving you dark spots.


Hyperpigmentation can be caused by sun exposure, aging, injury, trauma, or certain diseases. Freckles and sunspots result from exposure to the UV radiation in sunlight. Age spots occur when your body is less able to regulate melanocytes. Post-inflammatory hyperpigmentation occurs when a wound does not heal properly and leaves a darkened area on the skin. Acne scars are a common cause of post-inflammatory hyperpigmentation, but rashes and other injuries or traumas to the skin can also cause it. Certain drugs and changes in hormone levels in your body can also cause dark spots.   Melasma, or “mask of pregnancy,” is a patchy hyperpigmentation that can be associated with pregnancy. Endocrine disorders, such as Addison’ s, Cushing’s, and celiac disease can also lead to hyperpigmentation.


If you have a darker skin tone, such as Asian, Mediterranean, or African skin, then you are more prone to developing hyperpigmentation.  The melanocytes in darker skin tones are thought to react more strongly to injury or sun damage.  However, some people with light skin tones are genetically predisposed to developing large amounts of freckles when exposed to the sun. 


Preventing and Treating Dark Spots

Always protect your skin from sun damage, as UV radiation is one of the biggest causes of dark spots and hyperpigmentation. I recommend the following to my patients:


First, always use a broad spectrum sunscreen before going outside. Even if it’s cloudy and cool, the sun’s rays can still cause harm to your skin.  Look for a sunscreen that blocks both UVA and UVB rays, such as zinc oxide, because these will provide the best protection. Also, try to stay in the shade between late morning and early afternoon, these are when the sun’s rays are the strongest. I also recommend wearing clothing that covers your arms and legs, and wide-brimmed hats and sunglasses with UVA/UVB protection. 


Use tyrosinase inhibitors. Tyrosinase inhibitors can be applied to your skin to decrease hyperpigmentation. These compounds block tyrosinase, the enzyme that stimulates melanin production in your skin. This enzyme is released when sunlight or chemicals reach your skin cells.  When tyrosinase is blocked, your skin produces less pigment and appears brighter and more even.


Hydroquinone is a synthetic tyrosinase inhibitor that is commonly prescribed by dermatologists. It’s a controversial product that has actually been banned in the European Union. Hydroquinone gradually reduces the appearance of dark spots but has several undesirable side effects, including skin irritation and increased sensitivity to sunlight. Long-term use can result in a condition called exogenous ochronosis where the skin develops patches of blue-black pigment. This condition is permanent in many cases.  If hydroquinone is stopped abruptly, your skin can develop rebound pigmentation, which means the pigmentation could come back worse than before you started using hydroquinone. If this occurs, further treatment with hydroquinone often doesn’t work.  


Alpha arbutin is a popular tyrosinase inhibitor that can be used as an alternative to hydroquinone. Though results aren’t as dramatic and immediate-it can take up to 6 months before users see significant change- it doesn’t carry the same undesirable side effects  Other natural tyrosinase inhibitors include kojic acid, licorice extract, mulberry extract, burdock root extract, and high potency vitamin C.


Alpha hydroxy acids (AHA’s) are often used in combination with tyrosinase inhibitors to remove dead skin cells on the top layers of your skin.  Melanin clumps in this layer and when you remove dead skin cells more efficiently, your skin looks more radiant. AHA’s are found in many food products, and include citric acid, glycolic acid, lactic acid, and malic acid. These are all commonly used in skin care. 


I also recommend using topical vitamin C treatments. Vitamin C is a potent antioxidant that can help protect your skin from sun damage. It is also brightens your skin by inhibiting tyrosinase. 


Peels and lasers can be an option. Chemical peels and laser resurfacing are treatments for dark spots that are performed in a dermatologist’s office. These treatments work by removing the top layers and sometimes the deeper layers, of your skin. The cost and recovery time varies for these procedures depending on how extensive they are. You should talk it over with your dermatologist to see if these procedures are right for you. 

Susan Sanders, MD

Board Certified Dermatologist

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