Quick Facts about Dark Skin Spots
- Sun exposure is a major risk factor for hyperpigmentation at all ages.
- Women of dark skin color are more prone to hyperpigmentation.
- Dark skin spots that occur as a result of acne are called post-inflammatory hyperpigmentation.
Dark skin spots - or hyperpigmentation - are related to the increased or uncontrolled production of melanin, the most abundant skin pigment. Hormones regulate the activity of melanocytes, or the cells responsible for producing said pigment.
Significant hormonal fluctuations occur during certain stages of reproductive life - namely puberty, pregnancy, postpartum (including breastfeeding), and menopause. The dark spots that appear during each reproductive stage vary depending on the type of hormonal imbalance, the individual's own melanocytes, and other factors, including environmental.
Types of Dark Skin Spots
There are several ways in which dark skin spots present themselves on the female body, each type having different causes and treatment options.
- Acanthosis nigricans. These patches appear under the armpits, on the neck, and on other skin folds. They are velvety, sometimes thick, and uniformly cover the affected area. This disorder almost always indicates a more serious underlying disease, such as type II diabetes or polycystic ovary syndrome (PCOS), which are both hormonal disorders. Click on the link to learn more about brown and velvety skin patches.
- Age spots. Also known as liver spots or solar lentigines, age spots are brown spots on the skin that vary in size, usually appearing on areas that have received most sun exposure, such as the face, hands, shoulders, and arms. They are more common in those over the age of 50. They do not need treatment, yet can be effectively managed for aesthetic reasons.
- Melasma. Skin hyperpigmentation from melasma is largely due to excessive sun exposure or as a result of hormonal changes, especially during pregnancy, during which it is called the “mask of pregnancy.” It most commonly concentrated on the face, appearing as brown or gray-brown patches. Although not inherently dangerous for one's health, women with melasma may wish to take action to clear up their complexion. Read more about melasma by clicking on the previous link.
- Post-inflammatory hyperpigmentation. These dark skin spots usually appear on the face or neck after an inflammatory skin condition, such as acne. They are also not malignant, yet can be aesthetically displeasing, leading many women to look for effective management techniques to get rid of the hyperpigmentation.
To better understand the various causes behind dark spots on the skin, continue reading the next section.
Understanding the causes behind various types of dark skin spots is essential for knowing how to appropriately manage and treat them as necessary. In most cases of dark spots on the skin that women experience, a major cause is hormonal change or imbalance. In addition to hormonal causes, there are other factors that may provoke or aggravate them.
Read further to learn more about both the hormonal and additional causes of dark skin spots.
Hormonal Causes of Dark Skin Spots
The endocrine system, or the group of glands and organs that produce hormones, experiences natural changes in the different stages of a woman's reproductive life. The resulting hormonal imbalances can have negative effects on all parts of the body, including the skin.
A hormonal imbalance of estrogen and progesterone - the chief female sex hormones - can trigger melanocytes (pigment-making cells in the skin) to produce additional pigment, or melanin, which can give rise to dark spots or patches on the skin. Because one function of estrogen is regulating melanocytes, changes in its levels can have a profound effect on the amount of melanin produced. Similarly, other types of hormonal imbalances can also result in skin hyperpigmentation as a change in the production of melanin occurs.
Typical cases of dark skin spots experienced throughout a woman's life are the result of natural hormonal changes during the reproductive stages: puberty, pregnancy, post-partum, and menopause.
Puberty brings the first hormonal changes and imbalances in a young woman's life. These natural fluctuations, such as those behind acne, can cause dark skin spots.
During puberty, hormone levels change drastically and rapidly in a young woman's body. Estrogen and progesterone levels increase, and there may also be a rise in testosterone, an androgen hormone that women also need to maintain regular body functions, though in smaller amounts than among men. Several factors can result in dark patches on the skin during this time:
- High androgen levels. The increase of androgens, or male sex hormones, causes pores to enlarge, making it easier for them to get dirty or infected. This, in turn, causes acne. Sometimes, after the pimple disappears, a dark spot takes its place, known as post-inflammatory hyperpigmentation.
- McCune-Albright syndrome.1 While very rare, this hormone-related genetic disorder can also cause dark skin discoloration in young girls. The disease typically involves the appearance of café-au-lait spots, precocious puberty (early onset puberty at age 8 or earlier), and fibrous dysplasia, in which some bones are replaced by fibrous tissue. However, sometimes only the symptoms of precocious puberty and dark skin spots are present. Therefore, while it is very rare, it is important to be aware of this hormonal disorder.
Pregnancy also brings great changes in hormone levels in order for the body to support fetal development. Sudden dark patches on the skin are most common during this time of hormonal flux.
During pregnancy, the body begins producing the pregnancy hormone - hCG - which stimulates an increase in the production of the female sex hormones, estrogen and progesterone, in order to maintain pregnancy.2 All of these changes brought about by elevated hormone levels are completely harmless and usually disappear within a few months after birth.
- Melasma. Also called chloasma or “the mask of pregnancy,” it most commonly appears on the back, neck, and face - especially the cheeks. The spots can appear darker or more concentrated in some areas because of more melanocytes being present there.
- Linea nigra. Latin for “black line,” this vertical mark appears down the abdomen in over 90 percent of all pregnant women.3
- Increased pigmentation. Many women notice a darkening of their preexisting spots, such as freckles and birthmarks, as well as hyperpigmentation of the nipples, areola, and genital areas.3 This is because the melanocytes that already exist in greater concentrations in those areas are stimulated to produce more melanin due to the hormonal fluctuations.
Postpartum and breastfeeding is another stage in which hormones are changing constantly. This can lead to a continuation of the dark skin patches that appeared during pregnancy.
During postpartum, there is a sudden and rapid decrease in hormone levels, specifically of estrogen and progesterone. The amount of pregnancy hormones naturally declines while the level of breastfeeding hormones increases. Hormone levels stay low for the duration that a woman is nursing until the baby has been weaned.
Any dark skin patches that appeared during pregnancy may begin to fade, but they typically remain for at least the first three months of the post-partum period. However, on some occasions, the spots may last much longer. In such cases, management and treatment methods may be sought, though many instances of hyperpigmentation pose no threat to a woman's health.
Menopause refers to the stage in a woman's life in which hormone levels naturally decline as her fertile period comes to a close. The hormonal imbalances can cause skin hyperpigmentation, especially if a woman has had strong sun exposure throughout her lifetime.
During menopause, a woman's body undergoes a drastic decrease in estrogen and progesterone, causing a hormone imbalance. When considering other factors as well, one can see how menopausal women can be prone to developing melasma and other instances of hyperpigmentation.
- Sun exposure. If a woman has absorbed a lot of sun over the course of her life, the areas with the heaviest exposure will have an increased number of melanocytes, and age spots may appear. They are common on the tops of feet, the face, shoulders, and upper back.
- Hormone replacement therapy (HRT). Many menopausal women undergo HRT in an attempt to alleviate their menopause symptoms. However, due to the ongoing fluctuation of hormone levels, women receiving HRT are more susceptible to melasma than those who are not receiving the therapy.4
Other Causes of Melasma
While hormonal fluctuations are a primary cause of the types of dark skin spots that women most commonly experience, some blemishes have other causes, such as the use of some medications and strong sun exposure.
- Certain medications. Some drugs - such as non-steroidal anti-inflammatory drugs (NSAIDs), tetracyclines, antimalarials, cytotoxic, and psychotropics - can cause skin hyperpigmentation, sometimes being worsened by sun exposure.5
- Sunlight. Exposure to the sun's ultraviolent rays can cause increased melanocyte activity, leading to hyperpigmentation such as melasma and age spots later on in life. (This is also why freckles tend to get darker in the summertime, for example.)
Continue reading to learn about certain risk factors and external triggers that can make a woman more prone to having skin discoloration.
Risk Factors and Triggers
Risk Factors for Dark Skin Spots
Some women are more likely to develop dark brown spots on the skin than others because of certain health and personal reasons, such as obesity and genetics.
- Skin tone. Women of Indian, African, Hispanic, Middle Eastern, or Mediterranean descent are more susceptible to melasma because the melanocytes in darker skin tones are already more active.
- Family history. Those with a family history of melasma are also more likely to develop this type of dark skin patches.
- Lifetime sun exposure. The sun's ultraviolet rays can cause the skin to produce additional melanocytes in heavily-exposed areas of the skin. If these melanocytes are later triggered to produce more melanin, such as during a time of hormonal imbalance, it is likely that dark spots will emerge.
- Pharmaceutical hormone treatments. Women receiving hormones - through hormone replacement therapy (HRT), oral contraceptives, or human growth hormone replacement - are more likely to develop hyperpigmentation, like melasma, because of the fluctuating hormone levels. Also, if a woman has had melasma in the past specifically because of hormone treatments, she is likely to develop melasma again if those treatments are resumed.
Triggers of Dark Skin Spots
In addition to long-term risk factors, dark skin spots can flare up suddenly because of certain triggers. Avoiding contact with these triggers - namely certain products - as much as possible will reduce the incidence or recurrence of dark patches on the skin.
- Skin care products. Some lotions, soaps, and creams can aggravate the skin, increasing the production of pigment, and therefore causing the emergence of dark spots.
Keep reading to find out more about the signs and symptoms of hyperpigmentation in order to choose a treatment specific to its cause.
Signs and Symptoms
The hormonal fluctuations in the female body will affect each individual woman differently throughout the course of her reproductive life. Women who do develop dark skin spots will find different types on different areas of their skin. However, there are some common symptoms that the majority of women have.
Common Symptoms of Melasma
- Flat, oval areas of increased pigmentation (age spots)
- Tan, brown, or dark skin discolorations after excessive sun exposure (melasma)
- Patches or spots that appear after inflammatory skin condition (post-inflammatory hyperpigmentation)
- Unfamiliar patches or spots on the face, neck, or upper body
- Patches or spots often symmetrical when occurring on the face
Diagnosis of Dark Skin Spots on the Face
To diagnose and identify the symptoms of darkened skin, a dermatologist typically performs nothing more than a simple skin exam. In some less common cases, they may also run some tests, especially if an underlying hormonal condition is the suspected cause.
- Medical history. A general doctor or dermatologist will ask questions about the patient's medical history in order to see if there is a family predisposition for dark skin spots or if there is an underlying cause.
- Skin exam. This is a simple visual examination of the skin. It may also involve a Wood's lamp test, in which a doctor uses an ultraviolet light in a dark room to detect any less visible changes in the skin.
- Other tests. In some cases, though uncommon, a doctor may order additional tests, such as a blood test to measure hormone levels or a biopsy to check for skin cancer.
Complications of Dark Skin Spots on the Face
Many dark skin spots are not associated with any health complications and are not a sign of cancer. Nonetheless, a woman may be concerned about the way the spots affect their appearance, especially if they emerge on the face and neck. This can lead to lower self-esteem.
Women who have large or embarrassing spots may wish to learn how to treat or prevent more of them. Continue reading to find some useful prevention methods and management techniques that may help with hyperpigmentation.
Prevention and Management
There is no single, surefire way to fully prevent dark skin spots, since there is no way to hold back the body's natural hormonal processes. However, there are some steps a woman can take to reduce the chances of developing dark skin patches or to minimize their appearance.
An important means of prevention is lifestyle changes, especially concerning diet, exercise, and healthy habits. Additionally, lifestyle adjustments can be complemented with supplements that help enhance the endocrine system and thus prevent or lessen hormonal imbalances.
Lifestyle Changes for Prevention
- Diet. A proper amount of vitamins A, C, and E can help keep the skin healthy, smooth, and free of toxins. Find them in dairy products, like eggs; orange and yellow fruits and vegetables; dark green leafy greens; nuts; and seeds.
- Exercise. Not only does regular physical activity promote the overall health of the endocrine system, but it also helps increase blood flow, thus nourishing skin cells to keep them healthy. Among its other benefits are lower cholesterol, stronger muscles, and weight loss.
- Habits. Women who smoke cigarettes are more likely to have skin discoloration around the lips and gums, known as smoker's lips.6 To reduce the appearance of smoker's lips, the most practical solution is to quit. In addition, applying sunscreen regularly can reduce skin problems caused mainly by excessive sun exposure, such as age spots and melasma.
- Supplements. If not enough nutrients are consumed in the diet, a multivitamin that includes vitamins A, C, and E as well as fish oil can help maintain healthy skin. Also, Pycnogenol®, a strong antioxidant made from French marine pine bark extract, may also be taken as it has been clinically shown to provide photo protection and may even reduce hyperpigmentation.7 Consider the use of any supplements under the supervision of a trusted healthcare professional.
In some cases, prevention may not be possible. If dark skin patches have already appeared, there are some management techniques that can help to reduce the intensity of the hyperpigmentation. Continue reading to learn more about the various ways that the spots can be managed or lessened.
Managing Dark Skin Spots
Dark skin spots are usually benign, meaning they do not present any immediate health concern. However, because women may find hyperpigmentation embarrassing, they may wish to manage or mask dark spots once they have emerged. Makeup can be applied directly to skin to lessen the appearance of dark areas.
General Management Tips
- Decreasing sun exposure. The use of sunscreen can help keep dark skin spots - like melasma - at bay, since some spots are worsened by the sun's ultraviolet rays. Lotions should have a minimum SPF (sun protection factor) of 15, though some dermatologists recommend at least 30 for daily activity and 45 when spending a longer time outside. Broad-spectrum sunscreen - which protects against both UVA and UVB rays and often contains titanium oxide or zinc oxide - is also recommended. Staying in the shade and wearing hats and clothing that covers the shoulders and limbs can also help reduce sun exposure and the likelihood of the appearance of age spots later in life.
- Cosmetic covers. Using makeup such as concealer can help to hide dark skin spots of any nature.
- Acidic solutions. Since acidity helps to cleanse skin and enhance complexion, some solutions may be applied to the skin to reduce the appearance of hyperpigmentation. Hydroquinone, azelaic acid, kojic acid, and arbutin can effectively lighten dark skin patches, while using topical agents with vitamin C, certain licorice extracts, or vitamin A-derived retinoids may also function. No matter the solution used, it is important to use caution to prevent further irritation and worsening of the dark skin discoloration.
Read on to learn more about the various treatments for dark skin spots and which may be most suitable based on their underlying cause.
There are many possible treatments for hyperpigmentation. The most effective treatment depends on both the underlying cause - usually some form of hormonal imbalance - as well as the individual woman's lifestyle.
Three Approaches to Treat Dark Skin Spots
Three levels can be considered for treating dark skin spots. These are categorized as: (1) Lifestyle Changes, (2) Alternative Medicine, and (3) Pharmaceutical and Surgical Options.
Women are recommended to start with the least risky approach to get rid of hyperpigmentation - lifestyle changes - before proceeding to the next level of treatment. Medical intervention is not usually needed to treat them since they usually have no health ramifications. However, women who wish to remove them and are unable to do so through lifestyle adjustments and alternative medicine may consider pharmaceutical options, after properly assessing the risks related to those treatments.
The first level of treatment involves the least amount of risk, but it entails the highest amount of self-discipline. In many cases, simple lifestyle changes can lead to healthier skin and the fading of dark skin spots. Generally, a good diet and healthy habits for the skin can help in treating this condition.
As previously mentioned with preventing dark skin spots, it is important to choose fruits and vegetables high in vitamins A, C, and E; quit harmful addictions that could be aggravating the condition, such as smoking; and make sure to always apply sunscreen. Also, regular exercise of at least 30 minutes a day, five days a week should be performed in order to relieve stress, increase blood flow, and nourish skin cells.
Though these lifestyle changes may help reduce or eliminate the appearance of dark skin patches, they do not treat the hormonal imbalance that commonly lies behind their emergence. Therefore, further treatment may be necessary. Alternative medicines have proven to be a tremendous way of treating dark skin spots related to hormonal fluctuations in the body safely and naturally.
Alternative medicine and supplements often involve little to no risk and can be a very effective means of treating dark skin spots that have hormonal imbalance at the root of their cause. In terms of herbal supplements, there are two main kinds that can be used: phytoestrogenic and hormone-regulating supplements.
Phytoestrogenic herbal supplements
These supplements - such as black cohosh - contain estrogens produced by plants, which function as a complement or replacement for estrogen in a woman's body. The introduction of these plant hormones resolves an estrogen imbalance that could be contributing to the appearance of dark skin spots.
Nevertheless, because they contain strong concentrations of exogenous estrogen hormones, they are not safe for all women, especially those in pregnancy. They should be used short-term by others. In all cases, work with a certified herbalist, and closely monitor results.
Hormone-regulating herbal supplements
These supplements, including Macafem, stimulate natural hormone production by supporting the endocrine glands, which, in turn, helps the body produce hormones more efficiently and at the right levels. This results in a balance of all hormones in the body, not just estrogen.
This type of supplement is considered a safer and more natural way of treating a hormonal imbalance that can be behind the appearance of dark skin spots. In addition, they can be used throughout a women's life, except during pregnancy.
There are some other kinds of supplements that can also eliminate the appearance of dark skin patches or at least lighten them, including vitamins and other herbal supplements.
- Vitamin supplements. While they can be absorbed from foods, some vitamins may be taken as an additional supplement to help promote healthy skin. Vitamins A, C, and E - in addition to flavanoids - are a component of many of the prescription drugs on the market used to lighten dark skin spots. Pycnogenol®, as previously mentioned, also protects the skin against ultraviolet rays. For all vitamin supplements, the suggested dosage should always be followed in order to reduce the risk of potential side effects.
- Other herbal supplements. Some herbal supplements or extracts may help improve skin health to reduce the appearance of dark skin spots. For example, pine bark from the tree Pinus pinaster contains the aforementioned antioxidant pycnogenol and is available in tablet form. Also, a grape seed or orange extract may diminish dark spots due to their antioxidant effects.
A combination of these two approaches - lifestyle changes along with alternative medicine - is likely to be the most effective way of reducing the appearance of dark skin spots. However, sometimes the symptoms will be so severe or persistent that more drastic treatment becomes necessary.
Treatment at the third level involves the highest risk and is often the costliest. Not all treatments are appropriate for women at a given life stage. Therefore, it is highly recommended to consult a licensed medical professional before starting any pharmaceutical treatments for dark skin spots. In addition, some may require a doctor's prescription.
The majority of pharmaceutical options are topical medications. Dark skin spots can be tough to treat, resistant to treatments, and take a long time to show results. Moreover, very few of those treatments address the underlying hormonal imbalance.
- Hormonal replacement therapy (HRT). This treatment is commonly used for menopausal women as an attempt to alleviate the symptoms often experienced during menopause. However, it has many side effects, some of them dangerous, such as increased risk of cancer and cardiovascular disease. In fact, women undergoing HRT may be more susceptible to hyperpigmentation.
- Oral contraceptives. Birth control may be prescribed to regulate hormones and treat dark skin spots. However, women using oral contraceptives are also often more prone to hyperpigmentation, specifically melasma. Sometimes, the treatment may be to stop the use of birth control in order to clear up the dark skin patches.
- Topical creams. A bleaching or lightening cream may be suggested to treat dark skin spots that don't fade naturally. Creams that contain tretinoin (retinoids), hydroquinone, kojic acid, salicyclic acid, glycolic acid, lactic acid, azelaic acid, or a combination thereof have been shown to reduce the appearance of dark skin spots. However, tretinoin is harsh and may cause dermatitis, and concentrations of hydroquinone over 2% usually require a prescription. Tretinoin especially should not be used by women who are pregnant or breastfeeding.
- Chemical peels. his procedure causes the top layer of skin cells to die and peel away. It commonly uses alpha hydroxy acids. Side effects include redness, irritation, and dryness.
- Laser treatment. In this procedure, which is also referred to as intense pulsed light (IPL), a laser is used to destroy the dark pigment. This treatment method is reserved for extreme cases.
These three approaches to treatment - lifestyle changes, alternative medicine, and pharmaceutical options - are not mutually exclusive. A woman may choose to employ different approaches at different times or a combination thereof, depending on the severity and duration of the dark skin spots. Many women find that their symptoms are best alleviated through a combination of healthy lifestyle and alternative medicine treatments.
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