How to treat and prevent uneven pigmentation

Not all dark spots are the same. There are different types of hyperpigmentation (dark spots) and each one is treated differently. Many people will have multiple types of hyperpigmentation in one area requiring multiple types of treatment. If dark spots are treated incorrectly they could worsen, making it even more important that you see your dermatologist to get the correct treatments, before grabbing the newest dark spot corrector at your favorite department store.

The 4 types of hyperpigmentation

  1. Melasma

    • One of the most difficult types of hyperpigmentation to treat. It presents itself as large and patchy spots and is mostly cause by hormonal changes. This is why melanoma is seen on women during pregnancy in the second and third trimesters and while taking birth control pills for one to four months. There are two types of melasma: epidermal and dermal. Epidermal is on the surface of the skin and seen as light discoloration, whereas dermal is deeper in the skin and seen to the naked eye as dark brown or grey patches. 

    • In-office treatments 

      • Lasers and chemical peels for epidermal melasma only

  2. Post-inflammatory hyperpigmentation (PIH)

    • PIH is most seen as a result of cystic acne or extreme inflammation. It is seen on the skin as red, pink or brown spots and can surface anywhere from a couple of days to a fe weeks post-trauma. Ways to avoid PIH are to not pick your breakouts, keep your skin out of the sun, and to use anti-inflammatory products on your skin that contain green tea extract or bisabolol. The most important way to avoid post-inflammatory hyperpigmentation is to find out the underlying cause of it and treat that as well. If your cystic acne is causing the PIH, it is smart to start treating your breakouts as well. 

    • In-office treatments

      • Chemical peels 

  3. Age and sunspots

    • These spots, usually found on the face, chest, and hands, are spots of different shades of brown cause by the sun. They can turn up as you age due to a sunburn you had as a kid or a sunburn you got a year ago. It might take hours to days for sunspots to appear, although it is likely some pigment has been building up for years. 

    • In-office treatments

      • Intense pulsed light (IPL), chemical peels, and for heavy sun damage lasers can be used

  4. Freckles

    • Most freckles pop up during childhood before puberty and fade as you age. However, exposure to the sun will darken them if not protected. Freckles are most visible on light skin, but all skin tones can develop them. 

    • In-office treatments

      • Lasers 

Pigment Preventers

Blocking tyrosinase (an enzyme responsible for melanin production) is crucial to impeding discoloration of the skin. There are a few inhibitors out there that you can use to do the blocking.

  1. Hydroquinone 

    • The heavy hitter of tyrosinase inhibitors. This is the best option for blocking pigment, but can only be used for a few months at a time. If used too long it will create a dark blue-black pigment that is almost impossible to erase. It is the fastest working ingredient known to lighten dark patches. 

  2. Azelaic acid

    • This is a great alternative to hydroquinone and can be used when you need to take a break from it. Azelaic acid is a natural anti-inflammatory agent and has the ability to lighten skin. 

  3. Licorice extract

    • Licorice contains a natural tyrosinase inhibitor: glabridin. This is a gentle substitute for harsh chemical-based products. 

  4. Vitamin C

    • Vitamin C is rich in antioxidants, therefore naturally increases the skins antioxidants and vitamin E. Both of these aid in producing pheomelanin (a type of melanin), which slows down the production of tyrosinase. 

  5. Kojic acid

    • Kojic acid comes from mushrooms and rice, making it a naturally derived lightning agent. It is a good option for those with sensitive skin!



Fading discolorations on the skin does not happen overnight. On average it takes three months for you to see a change. Exfoliating will speed up the process and help to even out the skin’s complexion. However you should use each exfoliator with caution, over exfoliating can lead to inflammation eventually causing PIH. Here are some useful ingredients to look for in your exfoliators:

  1. Glycolic Acid

    • This is the smallest of the alphahydroxy acids (ADAs), meaning it penetrates the skin deep and fast. 

  2. Salicylic acid

    • A product mostly used for acne-acne-prone skin, salicylic acid breaks up discolorations and dead skin without causing irritation.

  3. Fruit enzymes

    • Papaya, pineapple, pomegranate and grapefruit are all acid-rich fruits that gently dissolve dead skin cells. 

  4. Retinol

    • Retinol and retinoids (the prescription version) lift away discolored skin cells by stimulating cell turnover. They are often paired with a low-dose steroid and short-term use of hydroquinone when treating discoloration. 


It is important to know what you are putting on your skin and the best ways to treat your dark spots. Coming in to see Dr. Legacy is your best bet at a bright and clear complexion! 

Tabin, Elise M. “The Guide: Hyperpigmentation”. New Beauty, Summer-Fall 2018: 100-106. Print.