What is Facial Pigmentation?
Facial pigmentation refers to dark spots, patches, and uneven skin tone that can appear on the face. It is caused by an overproduction of melanin, the pigment that gives skin its colour.
There are several types of facial pigmentation:
Melasma - Also called chloasma, this is a common form of hyperpigmentation that causes brown or greyish patches on the cheeks, nose, forehead and upper lip. It is often triggered by hormonal changes during pregnancy or with birth control pills. Melasma is more common in women and people with darker skin tones.
Age spots - Also known as liver spots or solar lentigines, these flat brown spots are caused by sun exposure and aging. They typically appear on the face, hands, shoulders and other areas frequently exposed to the sun.
Post-inflammatory hyperpigmentation - This type of pigmentation arises after an inflammatory skin condition like acne, eczema or psoriasis. It is caused by excess melanin produced while the skin heals from inflammation. It appears as dark spots or patches in the affected area.
Freckles -Clusters of concentrated melanin that give a speckled appearance. Freckles are genetic and are aggravated by sun exposure. They usually appear on the cheeks, nose and other sun-exposed areas.
Solar or actinic keratoses - Rough, scaly growths caused by sun damage. They vary in color from pink to red to brown. If untreated, they can potentially develop into skin cancer. They commonly appear on the lips, ears, bald scalp, hands, forearms or face of older adults.
The leading causes of facial pigmentation are sun exposure, hormones, inflammation, and genetics. Using proper sun protection and avoiding triggers can help prevent development of dark spots and uneven skin tone.
Common Areas Affected
The most common areas of the face affected by pigmentation include the forehead, cheeks, upper lip, nose, and chin.
- Forehead: The forehead is often exposed to the sun, making it prone to develop dark spots and melasma. The wide surface area of the forehead means pigmentation can spread easily.
- Cheeks: The cheeks contain a high concentration of melanin-producing cells. With sun exposure, the cheeks are vulnerable to freckles, age spots, and melasma.
- Upper Lip: The delicate skin of the upper lip has fewer oil glands compared to other facial areas. This can lead to pigmentation in the form of dark upper lips, melasma, or freckles.
- Nose: The nose protrudes from the face and receives a significant amount of sun exposure. The nose is susceptible to sun spots, uneven tone, and melasma. The sides of the nose and nostril area are common spots.
- Chin: With frequent motion of the mouth and exposure to the environment, the chin often develops age spots and hormonal melasma. The chin is a common area for melasma in women.
Types of Pigmentation
Pigmentation on the face can take many forms, but some of the most common types include:
Melasma
Melasma is a common skin condition that causes brown or greyish patches to appear on the face. It is much more prevalent in women, especially during pregnancy and while taking birth control pills. Melasma is sometimes referred to as the "mask of pregnancy" since it frequently emerges in pregnant women. The hormonal changes associated with pregnancy can trigger melasma. The patches often appear on the forehead, cheeks, upper lip, and chin. While melasma itself is harmless, many find it cosmetically unappealing. It can be stressful and frustrating to deal with.
Post-Inflammatory Hyperpigmentation
Post-inflammatory hyperpigmentation (PIH) refers to dark spots that are left behind after acne lesions, wounds, rashes, or other skin inflammation heals. These spots occur when the skin produces excess melanin, which is the pigment that gives skin its color. PIH spots can be tan, brown, or black in color. They are typically found on the face, neck, chest, back, arms, and legs. PIH can persist for months or even years. Getting rid of dark spots from past inflammation can be challenging.
Sun Spots (Solar Lentigines)
Sun spots, also called solar lentigines, are flat, tan or brown spots that emerge on skin after years of sun exposure. They commonly appear on the face, hands, arms, and other sun-exposed areas. Sun spots form due to increased melanin production, which is the skin's way of protecting itself from UV radiation damage from the sun. While harmless, sun spots are cosmetically bothersome to many people. They tend to multiply and grow darker over time with continued sun exposure.
Diagnosing Facial Pigmentation
Diagnosing the type and cause of facial pigmentation is best done by a dermatologist. They will examine the skin and take a full medical history to try to determine what is causing the pigmentation.
Some of the diagnostic tests a dermatologist may perform include:
Dermoscopy - A special magnifying instrument is used to examine the skin closely to distinguish between different types of pigmentation.
Skin biopsy - Taking a small sample of skin allows the dermatologist to examine the cells under a microscope. This can confirm if pigmentation is caused by melanin or other skin pigments.
Wood's lamp exam - A special ultraviolet light can help distinguish between different forms of pigmentation based on how they reflect the light.
Patch test - Applying samples of potential irritants to see if they provoke a reaction. This can identify if allergies or contact dermatitis is the culprit.
Getting an accurate diagnosis from a dermatologist ensures proper treatment. It rules out serious skin conditions like melanoma. The dermatologist can advise on topical creams, oral medications, laser therapy or other treatments to effectively tackle the type of facial pigmentation present.
Risk Factors
Sun exposure is one of the most common causes of hyperpigmentation. UV radiation from the sun can damage skin cells and trigger excess melanin production, leading to dark spots and uneven skin tone. Using sunscreen daily can help minimize sun damage.
Hormonal changes in the body can also cause pigment issues, especially in women. Fluctuating estrogen and progesterone levels during pregnancy, taking birth control pills, or undergoing hormone replacement therapy can lead to melasma or chloasma (pregnancy mask).
Genetics play a role as well. Those with naturally darker skin tones are more prone to hyperpigmentation since their skin produces higher amounts of melanin. A family history of skin discoloration increases risks too.
Skin damage is another culprit. Injuries like acne, eczema, burns, wounds, and rashes can all cause post-inflammatory hyperpigmentation. As the skin heals, it produces excess melanin that shows up as dark marks.
Aging is also a factor. As we get older, skin cell turnover slows down and pigment-containing melanocytes can accumulate, forming age spots and liver spots. Sun damage accumulated over time contributes greatly to this.
Prevention
Protecting your skin from the sun is key to preventing and treating pigmentation. Here are some tips:
- Use sunscreen everyday. Apply a broad spectrum sunscreen with an SPF of at least 30 about 15-30 minutes before going outside. Reapply sunscreen every 2 hours when outdoors, especially after swimming or sweating.
- Wear protective clothing when out in the sun. Wide brimmed hats, tightly woven long sleeved shirts, pants, and UV blocking sunglasses can provide an extra layer of protection for your skin.
- Avoid direct sun exposure during peak hours. The sun's UV rays are strongest between 10am-2pm. Limit time outdoors during these hours as much as possible. Seek shade under trees, umbrellas or canopies when possible.
- Use caution near snow, water, sand, and concrete. These surfaces reflect sunlight and can cause sun damage even when the sun isn't directly on your skin. Wear sunscreen anytime you'll be around these surfaces for extended periods.
- Check the UV index. Pay attention to your local UV index, which measures the intensity of UV rays for the day. Limit time outside when the UV index is high (6 or above).
- The key is being diligent about sun safety year round. Following these tips can greatly reduce your risk of developing sun damage, pigmentation, premature aging, and skin cancer.
Treatment Options
Over-the-counter creams, prescription creams, laser therapy, and chemical peels can help treat facial pigmentation.
Over-the-Counter Creams
Many facial creams sold over-the-counter contain ingredients like hydroquinone, kojic acid, vitamin C, niacinamide, and retinoids that can help lighten areas of pigmentation when used consistently. Look for creams containing 2-4% hydroquinone for targeting darker pigmented patches. Using SPF daily is important when using lightening creams to avoid further sun damage.
Prescription Creams
For more stubborn pigmentation, dermatologists may prescribe creams containing higher concentrations of hydroquinone, up to 8-10%. A prescription retinoid cream containing tretinoin can also help speed up skin cell turnover to fade pigmented lesions faster.
Laser Therapy
Laser resurfacing procedures like Fraxel laser can remove pigmented lesions by targeting the top layers of damaged skin. Usually a series of treatments is required, but results are longer lasting. The most aggressive laser option is ablative laser resurfacing, which vaporizes the outer layers of skin to reveal newer skin underneath. Downtime is longer with ablative lasers.
Chemical Peels
Superficial and medium-depth chemical peels use acids like glycolic acid and trichloroacetic acid (TCA) to peel off pigmented skin layers. Repeated treatments can significantly improve the appearance of pigmentation. Healing time is usually under a week. Chemical peels with TCA can occasionally cause slight scarring in darker skin types.
Key Ingredients in OTC Creams
There are several ingredients commonly found in over-the-counter face creams that can help reduce pigmentation and even out skin tone.
- Hydroquinone: Hydroquinone is considered the gold standard for treating hyperpigmentation. It works by inhibiting tyrosinase, the enzyme involved in melanin production. This helps lighten dark spots and reduce overall pigmentation. It's available in concentrations of 2-4% in OTC creams. Higher percentages require a prescription. Hydroquinone should not be used for longer than 3 months at a time.
- Retinol: Retinol is a vitamin A derivative that increases cell turnover to help fade pigmentation faster. It also stimulates collagen production for smoother, more even toned skin. Look for creams containing 0.1-0.3% retinol for the best results on pigmentation. Start slowly and use every 2-3 nights to avoid irritation.
- Vitamin C: Vitamin C has antioxidant properties that protect skin from UV damage and free radicals which contribute to hyperpigmentation. It also inhibits melanin synthesis to brighten skin. L-ascorbic acid is the most researched form of vitamin C. Use a 5-15% vitamin C serum daily under SPF for maximum brightening.
- Niacinamide: Also known as vitamin B3, niacinamide is a powerful skin-restoring antioxidant that reduces uneven pigmentation. It's safe for all skin types and works well when combined with other brightening ingredients like vitamin C or retinol. Look for a niacinamide concentration of 4-5% in OTC pigmentation creams.
How to Use Face Cream for Pigmentation
Using a face cream consistently and correctly is important for reducing the appearance of pigmentation and discoloration on the skin. Here are some tips on how to properly use face creams for pigmentation:
Amount to Use
Apply a pea-sized amount of pigmentation cream to clean, dry skin in areas of concern 1-2 times per day. Using too much product won't make it work better or faster. Start with a small amount.
Frequency
Use your pigmentation cream once or twice a day, ideally morning and night. Consistency is key for seeing results over time.
Duration
Pigmentation takes time to fade and using cream daily over weeks and months will lead to the best outcome. Expect to use your face cream for at least 2-3 months to see initial results. Further improvements may continue with prolonged use.
Expected Results Timeline
- Initial results can take 6-8 weeks. You may notice the pigmented areas start looking a little lighter and less noticeable around this time.
- After 3 months, it's common to see a moderate reduction in the appearance of age spots, melasma, sun spots, and discoloured patches.
- Continued use over 6 months provides even better improvements in skin tone and reduction of hyperpigmentation.
- For stubborn pigmentation, using cream diligently for 9-12 months gives sufficient time to fade spots and discoloration significantly.
- Be patient and stick with your routine. Applying face cream for pigmentation daily over an extended period is necessary for the best results. Look for a gradual lightening and evening out of skin tone over time.
When to See a Dermatologist
If over-the-counter creams are not effective at fading facial pigmentation after 8-12 weeks of consistent use, it's a good idea to make an appointment with a dermatologist. A dermatologist can examine your skin more closely and determine if prescription-strength products are needed for better results.
Some signs it may be time to see a dermatologist include:
- The pigmented patches continue to darken or spread
- New pigmented areas develop rapidly
- You have a family history of skin cancer
- The pigmentation is causing significant distress or affecting your self-confidence
A dermatologist has access to prescription-only products not available over-the-counter, which are stronger and more effective for stubborn pigmentation. Some options they may prescribe include:
- Hydroquinone creams - the gold standard for inhibiting melanin production
- Retinoids - derived from vitamin A to increase cell turnover
- Chemical peels - remove outer layers of skin to reveal fresh skin underneath
- Laser treatments - precisely target pigmented areas with pulses of light
- Cryotherapy - use extreme cold to lighten pigmented lesions
Seeing a dermatologist promptly when OTC options fail can help get pigmentation under control faster. They can determine if any underlying conditions are contributing to it worsening and make sure the spots are not pre-cancerous. With their expertise and stronger treatment options, they can help minimize the appearance so your skin looks more even toned and clear.