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Skin pigmentation is a topic that is slightly nuanced. Few would object to a smattering of freckles across the nose or a single Marilyn Monroe-esque beauty mark that has been there for most of our lives. But it’s when uneven dark spots and patches of skin pigmentation start cropping up willy-nilly on our face (and hands, and body) that many of us start asking whether there’s not a way we can get rid of the things.
While the vast majority of skin pigmentation is actually harmless, there’s a reason why it bothers us.
"Our brains are programmed to perceive an even ‘canvas’ of skin as more pleasing to look at than one with marks,” says dermatologist Dr Sam Bunting. The theory is that our caveman instincts associate discolourations and textural imperfections with declining health and advancing age and therefore strength, and because of that, says Bunting, “studies have shown that we think an uneven skin tone is as ageing as lines or wrinkles."
It can affect any skin tone and skin type and make a dent in our confidence. Author and TV personality Kate Ferdinand took to Instagram to share her experience, writing: "I always feel so insecure about it and it really does get me down, I try to cover it at all costs." Her followers were quick to share their experiences, writing: "I’m so going through this right now" and "I have this and I really worry what people will think.
Why do brown spots and skin pigmentation or, to give it its correct medical term, hyperpigmentation - i.e. melanin that’s gone into overdrive –come from?
What causes skin pigmentation?
Hyperpigmentation is when the skin distributes melanin unevenly, creating areas that are darker than others. There are a number of causes.
The sun - even on cloudy days
UV rays cause the skin to tan as a defence mechanism: it’s trying to protect your skin cells’ DNA from getting nuked, because that way lies permanent damage and a small issue called skin cancer. The more you expose your skin to the sun, the more damage your cells sustain and the less efficient they get at protecting, repairing and renewing themselves. One very visible sign of this is dark blotches instead of a smooth, all-over tan: “this is sun damage, and it’s the most common cause of hyperpigmentation,” says Dr Amiee Vyas. “It can lie in wait under the surface of the skin from a young age [sun damage is cumulative, forms from the first day you step out into the sun unprotected, and is caused by UVA rays that are present even on cloudy days and in winter months] and comes to the surface as you get older, sometimes gradually, sometimes all at once.”
So the more you’ve tanned in your teens and twenties, the more you should brace for blotches when you hit your thirties and forties.
Inflammation – whenever your skin has been ‘injured’
Any kind of injury to the skin such as bites, ingrown hairs, eczema and aggressive skincare can leave a dark mark behind, thanks to a surge of melanin in the area (inflammation stimulates melanocytes, the cells that create melanin), that can last for weeks, months or even longer. “This is known as post-inflammatory hyperpigmentation (PIH),” says Dr Vyas, “and the most common ‘injury’ is acne. PIH is most common or visible in darker skin tones and those that tan very easily.” Dr Bunting adds that the colour will vary depending on your complexion: "In very fair skin, PIH tends to be more red-toned whereas in darker skin types the spots tend towards brown."
Hormonal changes such as pregnancy and the Pill
Hormonal pigmentation is known as melasma and is commonly seen during times of hormonal upheaval such as menopause, puberty, when you start the pill, during pregnancy or when breastfeeding. It manifests in much larger darkened areas than regular brown spots, often in a ‘butterfly shape’ over the forehead and nose, or on the top lip. It can disappear as suddenly as it has appeared but can also be very tenacious.
Illness and medication
“Sometimes illness may cause pigmentation, and some drugs can induce it as well,” says Dr Vyas. Non-steroidal anti-inflammatory drugs (such as ibuprofen), antimalarials and psychotropic drugs (such as Prozac) are some of them. “HRT (a hormone-based treatment) can also cause pigment lesions, particularly in those with darker skin tones; think 3 on the Fitzpatrick scale (olive) or higher,” says oculoplastic surgeon Dr Maryam Zamani.
The wrong skincare and treatments
Skincare as well as professional and clinical skincare treatments, if not chosen and administered carefully, can cause inflammation that can lead to post-inflammatory hyperpigmentation. It’s why it’s advisable to always choose a very experienced therapist or doctor if you’re going to have your brown marks or melasma treated professionally. Energy or heat-based devices in particular, such as radiofrequency devices or lasers, can make hyperpigmentation and, particularly, melasma worse. Many lasers are not advisable for the treatment of pigmentation in darker skin tones, and these are particularly prone to PIH.
How to prevent pigmentation
There are a few skincare basics to consider to stop you from getting hyperpigmentation in the first place
“Healthy, optimally functioning skin is essential for preventing the formation of dark spots, uneven patches and dullness, as it will empower skin to do its own preventative and repair work,” says Dr Vyas. She recommends regular, effective exfoliation while cleansing so that further skincare ingredients and moisture don’t just remain on the surface, but can work on a deeper level to actually tackle your pigmentation issues.
Choose an exfoliating acid, she says, that doesn’t irritate your skin, or you may actually set off pigmentation. “Glycolic acid is very effective and stimulates deep down into the skin, but if it ‘bites’, you’re better off with the gentler and deeply hydrating lactic acid. For very sensitive skins and those who need to ease themselves in carefully so as not to risk PIH, including those with darker skin tones, try malic acid or polyhydroxy acids,” says Dr Vyas. We rate Dermalogica Daily Milkfoliant, £59.
“For strong, self-reliant skin that can cope effectively with strong, problem-solving actives, choose bland (unscented and frills-free) cleansers [see our picks of cleansers for sensitive skin]and moisturisers with deep-hydrating ingredients such as hyaluronic acid alongside ceramides to seal in the moisture and reinforce the skin’s protective barrier,” says Dr Vyas. We love Glossier After Baume, £25
“Daily high-SPF UV protection throughout the year is simply non-negotiable if you want to prevent, treat or diminish hyperpigmentation,” says Dr Vyas. And that doesn’t just go for sun-damaged induced brown spots and discolouration. “Any UV exposure will worsen the effects of inflammatory hyperpigmentation and make the marks worse. So even if your pigmentation is due mainly due to trauma or acne, a broad-spectrum SPF50 sunscreen is essential,” says Dr Bunting. The same goes for melasma: the cause is hormonal, but any dose of UV light will entrench it further and make it look worse. So finding the best everyday SPF is key.
Why does pigmentation come back?
If you manage to successfully lessen your brown marks with potent skincare or expensive professional treatments and follow your achievement by stepping out into the sun, the pigmentation will come back in a flash – likely worse than ever before. “Skin has a memory,” says Dr Zamani. So if you reintroduce it to the trigger that set off the pigmentation, it will send in the troops at speed. “It takes many, many skin cycles (one cycle is two months) of suppressing and preventing melanin formation to wipe this memory from skin’s ‘brain’; you’re looking at least a year.”
Why sunscreen is THE non-negotiable pigmentation treatment
Even then, Dr Zamani says, “certain types of pigmentation can recur despite your best efforts. Pigmentation is a bit like grey hair: once you’ve got it, it’s not really going to go away.” That’s just the reality of it, and the reason why a high-quality SPF is the most important pigmentation- buster about. Luckily, countless good ones are available at every price point these days, but to name just one, Dr Vyas’s all-time favourite is Neostrata Sheer Physical Protection SPF50, £30, which comes with a universal tint but there are many other best tinted spfs out there.
How to treat and minimise pigmentation with skincare
Pigmentation is a complex issue that reaches deep into the skin and requires intensive treatment. Brown marks are among the most difficult-to-treat skin complaints with creams and serums. For very dramatic results, you may need to look into professional procedures such as chemical peels, laser resurfacing or some carefully selected heat-based treatments such as IPL or Morpheus 8.
It is important to choose a very experienced specialist who can diagnose the causes of your pigmentation issues properly, as these will dictate your treatment. Melasma, for example, requires quite a different approach than other types of pigmentation, while there’s no point treating pigmented acne marks without dealing with the acne first.
While you can’t ‘cure’ or ‘remove’ your brown spots with skincare, a regime with powerful, proven actives can lighten pigment flecks, spots and patches, and achieve an overall brighter and more even complexion.
Is there a ‘best skincare ingredient’ for hyperpigmentation?
There are many ingredients to treat pigmentation and despite the popularity of single ingredient-led skincare, there’s no stand-alone performer (although as mentioned SPF should be on your non-negotiable list).
You need a combination approach. “Pigmentation forms through a number of different pathways and can only successfully be treated with a complex of ingredients that address all of these,” says Dr Bunting.
Some ingredients prevent pigmentation cells being generated, others break up the pigmentation that’s already there by exfoliating it away, yet others prevent pigment cells migrating to the skin’s surface. The more pigment pathways you interrupt, the better the result, says Dr Bunting.
Whatever type of pigmentation you have, you need a blend of these actives.
Preventing hyperpigmentation: skincare ingredients to know
Tyrosinase inhibitors to stop melanin production
Some active ingredients work by interrupting an enzyme called tyrosinase, which stimulates the production of melanin (brown pigment) in the skin. They are known as tyrosinase inhibitors and they basically put the brakes on brown patches forming in the first place. They should be part of any successful pigment or melasma-suppressing skincare, whether your hyperpigmentation is already visible or you want to try and prevent the dark patches lurking under the skin surface from making an appearance.
- Hydroquinone is probably the best-proven tyrosinase inhibitor, but it makes the skin more prone to sun damage while you are using it and may be carcinogenic if used incorrectly, so is only available on prescription in the UK.
- Arbutin (also often listed and mulberry or bearberry extract), kojic acid, licorice root, hexylresorcinol, azelaic acid and tranexamic acid are viable alternatives is cosmetic skincare.
- Cysteamine, which is currently only available under the brand name Cyspera, is a new tyrosinase inhibitor that skin doctors such as Dr Sophie Shotter are excited about. It also inhibits peroxidase, which is another enzyme in the melanin production pathway, so it’s doubly effective and, says Shotter, clinical studies show it’s at least as effective as gold-standard hydroquinone, but without the latter’s drawbacks.
- L-ascorbic acid (vitamin C) and retinol (vitamin A) also appear to have tyrosinase-inhibiting properties, alongside helping to break up the existing pigment.
Acids, enzymes and retinoids: ingredients that break up hyperpigmentation
Other ingredients (again, you’ll need them for treating any type of pigmentation), help get rid of existing brown spots, either by sloughing them away (using exfoliating acids - AHAs such as glycolic and lactic acid, or exfoliating enzymes such as bromelain and papain) or pushing out pigmented cells and replacing them with bright new ones (retinoids).
Niacinamide, peptides, antioxidants and other pigment busters
Vitamin C and certain peptides help fade pigmentation by regulating melanin production, niacinamide blocks the transfer of melanin cells to the skin surface, and some powerful antioxidants such as green tea and glucosamine help protect from free radical damage and inflammation and have tyrosinase-inhibiting properties.
What the experts use to treat hyperpigmentation
“I love the combination of a retinoid, vitamin C, niacinamide and azelaic acid,” says Dr Bunting, who uses it in her own Dr Sam’s skincare range. In her medical practice, she likes to “rotate through different tyrosinase inhibitors over the course of the year.
“Hydroquinone is often used when a patient wants their skin to be at its best, for a wedding for example. And then we’ll use something like arbutin for the colder months when there is less chance of UV damage.” She combines this with antioxidants, exfoliants, and broad-spectrum sunscreens.
Paula Begoun, the woman behind evidence-based skincare brand Paula’s Choice, favours two brightening ingredient combos (safe for all skin tones). “Niacinamide plus glucosamine is backed by impressive research showing its ability to alleviate the appearance of uneven skin tone and redness,” she says. Meanwhile, “tranexamic acid plus niacinamide is a research-supported combination for targeting stubborn, patchy discolourations.”
Skincare the experts use for melasma
Melasma is a particularly hardy, deep-rooted form of pigmentation that is very hard to treat with skincare alone, but some products can make a dent in it if used consistently. Dermatologist Dr Emma Craythorne quotes clinical studies that show roughly 50 per cent improvement in melasma patches when a concentration of four per cent niacinamide (a level widely available in cosmetics) is used. Niacinamide is also a calming anti-inflammatory, which is important for melasma as it’s associated with inflammation as well as hormonal fluctuations.
Dr Craythorne also loves azelaic acid, which is an anti-inflammatory agent and tyrosinase inhibitor. “It’s shown in randomised trials to be more effective than 2% hydroquinone,” she says. But to get the strength used in the trials (20 per cent) you’d need a prescription. The highest level you can get in cosmetics is 10 per cent, which can still be effective over a longer period of time (think four to six months). Azelaic is a gentle chemical exfoliant as well, safe for treating acne and post-inflammatory pigmentation in all skin tones.
Cysteamine is the new kid on the block for melasma. “It’s a great option and so much less aggressive than other topical melasma treatments,” says Dr Shotter. It’s not perfect, though: “Melasma is particularly stubborn - it’s not JUST pigment, but also has a vascular component and is often hormonally driven,” says Dr Shotter. “I like to combine a topical such as cysteamine with oral tranexamic acid, which has excellent evidence for working synergistically, and professional peels.”
The best skincare products for treating hyperpigmentation
A carefully balanced blend of azelaic acid, niacinamide, vitamin C and retinol-mimicking bakuchiol in white lotion-like serum that you apply all over under your SPF, designed to gently but resolutely even out your skin tone, calm breakouts and prevent marks forming.
This clear serum that can be used all over or on individual patches is formulated with 1.8% tranexamic acid, 5% niacinamide and 5% gently exfoliating sulfonic acid for a synergistic brightening effect. According to Dr Craythorne, there is some clinical proof that a concentration of 2-3% tranexamic acid in a topical preparation can safely reduce pigmentation in all skin tones.
This is a silky serum that has a resorcinol derivative to prevent the formation of melanin, patented by Nivea, alongside vitamin C. Together, they’re said to fade brown spots in four weeks. Whether it’s really effective against melasma (as the marketing implies) remains to be seen – usually, you need something a little more clinical-grade for that.
This purse-friendly all-over serum is designed to be a gentle alternative to hydroquinone-based products for treating melasma and hyperpigmentation. With niacinamide in the line-up, too, and the brand being known for is no-bull, effective formulas, it’s a great choice at a great price.
Best three-way discolouration slayer: Medik8 Oxy-R Peptides, £55 for 2x 10ml
This silky serum featuring two peptides that interrupt melanin pathways was created to target all three types of pigmentation with a three-pronged attack. It also uniquely uses oxyresveratrol to block tyrosinase – apparently it’s 33 times more effective than kojic acid, but notoriously unstable. Medik8 has created a preservation system by storing it in the lid; click it straight into the bottle of serum right before use for box-fresh ultra-potency.
A seven-day intensive twice-daily regime of ampoules to minimise hyperpigmentation, melasma and age spots with alpha arbutin, tranexamic acid, vitamin C and antioxidant vitamins. It’s very flash and should help brighten within the week. There’s enough in each ampule to treat face, neck and decolletage.
Azelaic and salicylic acids, both skin-calming and effective against acne spots and brown spots, are assisted by licorice extract and further skin-soothing agents to make this a weapon against melasma to boot, at a reasonable price. Can be used twice daily, all over, under moisturiser or SPF.
Vitamin C may already be in your daily routine, but if you suffer from hyperpigmentation, consider substituting this for your daily vitamin C serum. 15 Per cent l-ascorbic acid (active vitamin C), lactic acid, mulberry and licorice extracts are in here to chip away at pigmented patches in their multiple ways. Smells a bit ‘meaty’ but don’t let that put you off; that’s the natural scent of vitamin C.
A fresh, grown-up serum that instantly plumps and deep-delivers a cocktail of reliable skin tone evener-outers that won’t irritate – think hexylresorcinol, niacinamide and licorice extract. Can be used at any time, applied all over under other serums, moisturisers or SPF.
A three-product system based on clinically-backed cysteamine, which includes a neutraliser to deal with the stinky whiff the active gives off (who says beauty is glamour?!). There’s also isobionic amide, a gentle pigment buster that, says Dr Shotter, works synergistically with cysteamine, alongside AHAs to resurface the skin. You need to use it every night for 16 weeks to see your pigmentation fade, then use it twice weekly for maintenance.