How a Dark Spot Forms

Question:  All I had was a simple pimple – why did it leave such a dark spot and how can I get rid of it as quick as possible?

Answer:  Of course the answer’s not that simple! Everyone’s propensity to form a dark spot in response to anything that causes skin redness and swelling,  (medically called post-inflammatory hyperpigmentation) varies depending on skin type, ethnicity and racial group as well as the severity of the inflammation and its duration. That’s because the amount melanin (light-absorbing pigment) and type of melanosomes (pigmented skin cells)  have a significant impact on the formation of a dark spot in your skin.

To avoid dark spots from forming at all costs, it’s a good idea to first know what skin type you have. Your Fitzpatrick Skin Scale type depends on genetic disposition and your skin’s reaction to sunlight and tanning. Dark spot intensity and duration is linked to skin hue and more pronounced in skin of color, especially phototypes IV-VI. Click the link above to take the quiz and find out if you’re more at risk for developing dark spots, then read on.

What causes dark spots?

• Any skin disease, infection or injury-producing inflammation
• Acne
• Insect bites
• Razor bumps (pseudofolliculitis barbae or PFB)
• Allergic or contact irritation (dermatitis)
• Surgical or cosmetic procedures

Treat recurring conditions immediately!

The darkness, or intensity, of the spot, area or scar left behind depends on the duration of the inflammatory process underneath the skin and whether or not is has a chance to reach deeper tissues and cause damage. In response to a skin eruption or inflammation, melanin is over-produced at the site causing the skin-darkening. The longer the period of inflammation, the darker the postinflammatory hyperpigmentation response so action should be taken to avoid or intervene on any known causes of inflammation such as acne and PFB and treatment should be instituted as quickly as possible to stop the inflammation from damaging skin’s deeper tissues and causing the dark spot response. Skin conditions with a recurring nature such as acne or PFB intensify the hue of dark spots as do skin diseases that disrupt skin’s basal layer such as lichen planus, psoriasis eruptions and lupus)

Stay out of the sun!

In addition to any post-inflammatory response, UVA and UVB exposure also stimulate increased melanin production so limit sun exposure by walking on the shady side of street, wearing a hat, sunglasses and use sunscreen daily  on exposed, inflamed, irritated or healing areas. Sun exposure frequently darkens hyperpigmentation and chronic sun exposure may result in a longer resolution period of any dark spots.

Don’t let scabs form!

For any skin eruption (acne, insect bite), injury or surgery where the skin is open (no matter what the cause) never let a dry scab form and never pick at, squeeze or further exacerbate the inflammation! Acne surgery can be performed by medical professionals to  help acne heal faster to avoid skin damage and spots. Keep the area covered with antibiotic ointment until there is no crust at all and new skin is formed. And keep that area out of the sun the whole time it is healing and protected with sunscreen at all times until skin has returned to normal.

Rx for already-formed dark spots

Hydroquinone 4%:  This melanin-inhibitor is the most widley-used  active ingredient to fade dark spots. It is available at 4% strength by prescription only and at weaker concentrations (which you can try first) over-the-counter. Depending on the age and darkness of a dark spot, therapy may be required for 20 weeks, although you may see results much sooner than that.  If only used on one spot, sometimes a light ring of lighter skin surrounds the area like a halo, and this halo effect disappears when the hydroquinone is discontinued.  Do not use hydroquinone if it is a known allergen and watch out for any irritation or further discoloration (called exogenous ochronosis) in which case hydroquinone should be discontinued.

Azelaic acid:  An alternate, but slightly weaker ingredient for treatment if you’re allergic to hydroquinone. Similarly, kojic acid and glycolic acid are two more ingredients for hydroquinone-intolerant patients.

Combinations: We have even found that combinations, depending on your skin type and condition, including hydroquinone , and/or a corticosteroid, retinoid and Combinations are more effective than 4% hydroquinone alone. These can be prescribed if necessary by a dermatologic practitioner.

Chemical peels: Chemical peeling agents have been found effective in removing dark spots, but be mindful to start with the lowest concentration and then move upward because you want to avoid any additional postinflammatory hyperpigmentation caused by chemical peeling agents

Follow my advice and you will see spots fade and fewer spots form!