Get Even, Glowing Skin
Also known as liver spots, these brown splotches are the result of chronic sun damage. "Melanocytes, or the pigment-making cells in our skin, react to chronic UV exposure by producing more melanin," explains Naissan Wesley, MD, a dermatologist at Skin Care and Laser Physicians of Beverly Hills. For reasons even scientists don't fully understand, the melanin then clusters, leaving lasting brown spots.
- Retinoids: Found in prescription creams such as Retin-A and Renova, these vitamin A derivatives do a good job of dispersing pigment and speeding cell turnover, says Dr. Wesley. You can also combine retinoids with other pigment fighters, such as the kojic acid found in La Roche-Posay Mela-D Pigment Control Concentrated Dark-Spot Correcting Serum, $59. "The retinoid helps the lightener penetrate more effectively," explains Dr. Wesley, cautioning that the combo may irritate skin. You can expect to start seeing results in six to eight weeks.
- Lasers: Lasers are the big guns of spot removal. Many doctors prefer the KTP version because it targets melanin, says Eric Schweiger, MD, a dermatologist in New York City. The number of treatments you'll need depends on how dark the spots are. (Prices start at around $450 per treatment.) Though you will end up with a light scab, it should peel after about seven days. If your sun damage is spread over a large area, consider Intense Pulsed Light. This treatment emits multiple wavelengths that target various shades of red and brown but may take between four and six treatments (at around $400 each) for the full fading effect.
- Sun protection: To prevent new spots from forming, protect your skin with a sunscreen that contains a physical barrier such as zinc oxide -- preferably micronized zinc, says Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology. She recommends Elta MD UV Clear SPF 46, $29; the super-fine formula goes on smoothly without the telltale chalkiness. And remember that protection is nonnegotiable year-round, indoors and out: "Sunlight comes through window glass and clouds. It bounces off concrete, water, sand, and snow," cautions Dr. Jacob.
While the exact cause of these brownish patches is unknown, sun exposure, along with hormonal changes (think pregnancy), can often stimulate the overproduction of pigment, says Dr. Wesley. And while the condition can affect anyone, it's most common among women of Hispanic, Asian, African, or Middle Eastern descent.
- Skin lighteners: Prescription-strength hydroquinone is the most potent option. "Despite the concerns you may have heard over the years, most dermatologists still consider it safe because harmful side effects are rare," says Dr. Wesley. "The most common potential side effects are redness and irritation." The ingredient doesn't actually bleach skin but inhibits tyrosinase, an enzyme involved in producing pigment. A newer option is the Lumixyl Brightening System (typically, $270), a four-part doctor-dispensed topical regimen that -- if used twice daily -- may fade melasma in as little as eight weeks. Botanical agents from kojic acid to licorice extract can also inhibit melanin production, says Dr. Wesley. Look for them in over-the-counter skin-lightening products such as Kiehl's Photo-Age Corrector High-Potency Spot Treatment, $49.
- Sun protection: Even if melasma is effectively treated, it can return with sun exposure," Dr. Wesley warns. To keep skin splotch-free, slather on a broad-spectrum sunscreen with an SPF of at least 30. (Try Roc Multi Correxion 4-Zone Daily Moisturizer SPF 30, $22.)
Though a pimple can scar on its own, squeezing and prodding it make matters worse by dilating vessels and activating melanocytes. The result? Post-inflammatory hyperpigmentation. "People with darker skin are more at risk because their melanocytes are more reactive," says Dr. Wesley. But if you're fair, the discoloration stands out and lasts longer.
- Blemish creams: These creams turbo-boost the clear-up process so you're less likely to pick. Dr. Jacob suggests washing your face twice a day with a cleanser spiked with glycolic or salicylic acid to exfoliate and unclog pores (try Neutrogena Oil-Free Acne Wash Pink Grapefruit Cream Cleanser, $8), then applying a topical benzoyl peroxide to kill bacteria (try Clearasil DailyClear Vanishing Acne Treatment Cream, $6.50). And while blemishes are healing, avoid the sun; it's like rocket fuel for your pigment-producing cells.
- Skin lighteners: While most of these spots will fade naturally, the process can take up to two years. To nudge it along, try the same over-the-counter skin lighteners that are used to treat melasma, says Dr. Wesley. A good new option: Philosophy Miracle Worker Dark Spot Corrector, $62. But be careful to limit application to the spots themselves; otherwise you may lighten the surrounding areas.
- Lasers: The same KTP laser used to treat sunspots can also help fade the discoloration that blemishes leave behind (and the same prices and treatment protocols apply). Other kinds of light therapy, such as Intense Pulsed Light, may help, too -- though they can deepen pigment in dark skin.
Cruelly, you lose fat where you want it -- and gain it where you don't -- as you age. Starting in your 30s, the skin under your eyes thins, making blood vessels more visible for some. (If your circles are more brown than blue, blame genetics; excess undereye pigment is often inherited.) Allergies may also be a contributing factor: Rubbing your eyes can traumatize red blood cells that then create a staining effect -- or trigger melanin production that results in post-inflammatory hyperpigmentation, says Dr. Wesley.
- Eye creams: A daily dose of eye cream can temporarily plump skin, obscuring vessels. Consider one that contains vessel-constricting vitamin K or caffeine (try Jason Pure Natural Vitamin K Plus Creme, $23) or fading kojic acid or Eyeseryl (try Kinerase Under Eye Rescue, $78).
- Injectables: Restylane, which causes less swelling than other fillers and provides instant results, can help fill in circles (for about six months, generally), says Dr. Schweiger. Avoid herbal remedies, aspirin, and alcohol for five days prior to treatment, and to be extra safe, don't simply seek an injection specialist; ask the doctor for before-and-after pics of other patients. Not that anyone's going to show you bad photos, of course. But the fact that there's a body of work should be somewhat reassuring.
Originally published in Ladies' Home Journal, September 2011.