Hyperpigmentation happens for various reasons, including sun exposure, hormone fluctuations, acne, and injuries to the skin. While it’s tough to avoid the triggers of hyperpigmentation, there are easy ways to fade dark spots, even out skin tone, and prevent the problem from coming back. Here’s what you need to know.
What is hyperpigmentation?
Hyperpigmentation is an overproduction of melanin (i.e., pigment) in certain areas of the skin. People use “hyperpigmentation” to refer to a variety of things, and while “hyperpigmentation is a general term indicating increased pigmentation,” says Dr. Krathern, "it is most typically in a more widespread distribution.”
That said, it can refer to brown spots (as they could be a hyperpigmentary disorder) or a changed darker mole. As there are many types of hyperpigmentation, you may need your dermatologist to help you diagnose your skin.
One common version of hyperpigmentation shows up as a constellation of small dark spots or larger patches of darkened skin that look like blotches, which may be a condition called melasma. melasma typically appears on the cheeks, upper lip, forehead, and jawline.
Hyperpigmentation is usually a response to sun exposure, which is why brown spots are often dubbed “sunspots.” (The medical term is “solar lentigines.”) Melanocytes, the pigment-making cells in your skin, produce melanin to protect the skin from sun damage. (For the skin nerds out there, melanocytes are already present in the epidermis at birth, but the sun speeds up their activity.)
While discoloration can be triggered by other factors, unprotected UV exposure worsens the problem. "It drives additional melanocyte activity, melanin production, and melanin distribution throughout the epidermis," says Dr. Krathen.
That’s why applying broad-spectrum SPF 30 or higher on your face and neck every day is your first (and arguably best) line of defense.
What causes hyperpigmentation and dark spots, and are certain skin tones more prone to one type?
The irony of hyperpigmentation is that it’s a skin defense mechanism. And yet it also causes complexion problems. Melanocytes produce melanin to protect your DNA from the harmful effects of UV exposure, or as a response to injury. Here's how that plays out in a few common forms of hyperpigmentation.
• Post-inflammatory hyperpigmentation (PIH): When there’s inflammation in the skin—from acne, sunburn, picking at your face, over-scrubbing, using harsh products, or an abrasion—melanocytes crank out extra melanin as an immune response. This risk is related to the Fitzpatrick scale, which organizes skin into six tonal categories. Those on the high end, who have the darkest skin, are the most prone to PIH.
The more melanin-rich your skin, the more melanocytes you have. This means more melanocytes spring into action and produce excess pigment when your skin is injured. Picking or scratching at the skin causes further trauma—and more unwanted pigment.
• Melasma: This hormone-related form of hyperpigmentation seems like a perfect storm of hormones and light. It is often set off by a rise in estrogen levels, which can occur during pregnancy or when you take birth control pills that contain estrogen. Just being female of reproductive age is a risk factor! But it's light that turbocharges it. "UV, visible, or infrared light exposure in the right context—hormones, genetics—promotes melasma," says Dr. Krathen. "It is very common to see melasma flare in the summer and abate in the winter."
If you're getting light exposure year-round—and who among us isn't, what with our collective iPhone obsession—melasma can become a chronic condition that’s difficult to control. It can take weeks or months of diligent treatment to fade a melasma patch, but just one day out in the sun without sufficient SPF protection to bring it all back. Really. A. Single. Day. So take the extra 5 minutes with your sunscreen if you don't want to undo all your hard work. (But if you do… Here’s the fastest way to cure melasma.)
Melasma is most common in Asian and Hispanic skin, and less common in Black and Cauasian skin types. But no matter what your skin type or ethnicity, becoming pregnant or taking birth control pills will make you more susceptible to melasma because of a surge in estrogen, which is why melasma is often referred to as “the mask of pregnancy.”
• Dark spots: Technically called lentigo or mecular seborrheic keratosis, a classic "dark spot" is mostly seen in fair skin, although Asian skin is also susceptible.
And if you’re wondering, as we were, whether there’s a difference between “age spots” and “sun spots,” it’s pretty much a no. “In my estimation, over 95% of ‘age spots’ are really ‘sun spots,’”explains Dr. Krathern. “In photo-protected areas, such as under the bathing suit and inner upper arms, we don’t generally see lentigines.”
Sensitive skin types are also more likely to experience pigment issues, simply because the skin is more reactive.
How can I prevent dark spots and discoloration?
Sunscreen! We’re talking year-round, rain or shine—even on a 30-degree day in November. UV exposure is a primary cause of brown spots and exacerbates both PIH and melasma. Diligent daily use of a broad-spectrum sunscreen with SPF 30 or higher is, hands down, the best prevention.
For sensitive skin that may be irritated by chemical sunscreens (remember, irritation causes inflammation, a trigger for hyperpigmentation), dermatologists recommend mineral sunscreens. They tend to be better tolerated by sensitive skin.
If you’re prone to PIH, resist the urge to pick or scratch at your skin and pop pimples. You should also consult with a dermatologist before doing medi-spa procedures such as laser therapy or chemical peels, which cause temporary inflammation in the skin and can trigger PIH, particularly in darker skin types.
How should I treat hyperpigmentation?
Tackling dark spots and discoloration requires a multi-pronged solution. You want to remove the excessive pigment while also intercepting melanin production to prevent too much from rising to the skin’s surface.
“The go-to approach for dermatologists to reduce hyperpigmentation, especially when treating melasma, is a prescription-strength topical formula that combines hydroquinone, tretinoin, and a steroid,” says Michael Krathen, M.D., a board-certified dermatologist in Natick, Massachusetts, and Chief Medical Advisor for Cottonball. “Hydroquinone works to decrease melanin production, tretinoin enhances pigment removal by increasing skin cell turnover, and a steroid reduces inflammation.”
While each of these ingredients plays an important role in fighting hyperpigmentation, numerous studies have shown that they work better together as a team. “Research shows that a triple combination of hydroquinone, tretinoin, and an anti-inflammatory corticosteroid like fluocinolone is more effective [at treating discoloration] than using hydroquinone alone, while being just as safe,” says Dr. Krathen.
Cottonball CX.1 Advanced Dark Spot Treatment is a personalized prescription treatment designed to resolve hyperpigmentation with this proven trifecta of ingredients, plus kojic acid to help prevent and break up excess melanin at the surface level of skin. And because hydroquinone can cause redness and dryness, our formula also contains the anti-inflammatory niacinamide and moisturizer hyaluronic acid.
The game-changing formula targets different steps in the overproduction of melanin “by reducing its formation, increasing skin cell turnover, and removing excess pigment from the skin,” says Dr. Krathen. (Take this short quiz to find out if CX.1 is right for you.)
Here’s how the ingredients in Cottonball CX.1 Advanced Dark Spot Treatment work:
Hydroquinone (HQ) is a clinically proven, gold-standard treatment for hyperpigmentation. It suppresses overactive melanocytes and slows down the pigment-making process by inhibiting tyrosinase, an enzyme needed for the production of melanin. Hydroquinone is available by prescription only, and CX.1 Advanced Dark Spot Treatment is customized to deliver between 4% and 8% hydroquinone, depending on your individual skin needs.
Tretinoin is a synthetic form of vitamin A and another derm-favorite prescription ingredient for treating and preventing hyperpigmentation, along with wrinkles and acne. It regulates your skin’s cell turnover rate so that skin sheds the dark, overpigmented cells and allows fresh, even-toned cells to rise to the surface. Tretinoin is available in CX.1 Advanced Dark Spot Treatment in a concentration of 0.01% to 0.05%, depending on your individual skin needs.
Fluocinolone is a prescription topical corticosteroid that reduces inflammation. It helps prevent the skin reaction that triggers post-inflammatory hyperpigmentation.
Kojic acid is found naturally in several types of mushrooms and is also a byproduct of fermentation in certain foods like rice or soybeans. The ingredient blocks and inactivates tyrosinase when the skin wants to produce new melanin in response to inflammation from sun exposure or injury. But it doesn't interrupt the normal pigmentation process. This allows kojic acid to effectively fade dark spots and discoloration without over-lightening the skin, while also preventing new hyperpigmentation from occurring.
Niacinamide is a vitamin B3 derivative that has numerous skin benefits, including acting as a brightening agent by blocking excess pigment from rising to the skin's surface. The ingredient also has anti-inflammatory properties that help prevent pigment “spill,” as Dr. Krathen calls it. “The melanin in skin cells can spill over into the dermis—the upper layer of skin—during periods of inflammation,” he explains, “potentially making surface discoloration worse.”
What is the best way to use a hydroquinone cream?
Cottonball CX.1 Advanced Dark Spot Treatment should be applied at night on the areas of your face where you have spots or discoloration, notes Dr. Krathen. It’s best to ease into the treatment by using it for 2 to 3 nights for the first few weeks, gradually increasing to nightly use as tolerated. The cream is intended to be applied for 8 consecutive weeks; never use a product with hydroquinone for more than 12 consecutive weeks. If needed, you can resume the treatment after 12 consecutive weeks of no use.
Once you’ve completed the treatment, we recommend transitioning to Cottonball VX.4 Daily Skin-Brightening Formula, “a hydroquinone-free formula with a lower dose of tretinoin to maintain even-toned skin and prevent new discoloration and dark spots from forming,” says Dr. Krathen.
Is hydroquinone safe to use on darker skin?
Yes, Cottonball CX.1 Advanced Dark Spot Treatment is safe for all skin tones and types, including darker skin, and the formula is customized for each person’s specific skin needs. However, hydroquinone and tretinoin are not recommended for use if you’re pregnant or breastfeeding, so discuss with your doctor when it’s safe to resume using these ingredients. (Get all your hydroquinone questions answered.)
How long does it take for dark spots and discoloration to fade?
With a prescription-strength formula like CX.1 Advanced Dark Spot Treatment, you may begin to see improvement in discoloration in 4 to 6 weeks, though it can take up to 3 months to see optimal results, notes Dr. Krathen. (Over-the-counter spot faders typically take 6 months or longer for noticeable changes.)
An important note: If you have even moderate hyperpigmentation, it’s a good idea to see a dermatologist before beginning a prescription treatment to screen any dark spots for skin cancer.
To find out if Cottonball CX.1 Advanced Dark Spot Treatment or VX.4 Daily Skin-Brightening Formula is right for you, take this short quiz.
Don’t hide it. Fade it. Our dark spot Rx is clinically proven.
