Better known as "hyperpigmentation,” dark spots is a broadly and commonly used term for skin that appears darker than the surrounding area. The good news is that "dark spots" aren't generally harmful, and with proper treatment dark spots can fade on their own. However, it's essential to know that there is no single solution when treating dark spots. Treatment depends on a careful assessment of skin color, skin type, medical history, and other contributory factors.

Let's take a closer look at dark spot variables and whether using dark spot removers is the right solution.

Summary

• Dark spots are generally a form of hyperpigmentation, or an increase in melanin in patches on the skin. Hyperpigmentation has numerous causes. 
• Hyperpigmentation and dark spots can be treated effectively with over-the-counter formulations that contain hydroquinone, niacinamide, and tranexamic acid among other ingredients. 
• Proper sun protection can help to reduce the risk of developing dark spots.

What Are Dark Spots?

Dark spots are darker patches of skin of varying sizes resulting from an excess of melanin, the pigment that produces normal skin color, forming concentrated deposits on the skin. Melanin is produced by special skin cells called melanocytes. When these cells are damaged, it influences melanin production. Dark spots can affect people of all races or skin colors and can occur in small patches, cover large areas, or affect the entire body. Several types of dark spots include sunspots and melasma; however, the most common type is post-inflammatory hyperpigmentation.

What Causes Dark Spots?

Sunspots

Sunspots, or as doctors refer to them, solar lentigines, are one of the most common forms of hyperpigmentation and are caused by sun damage. Sunspots are small, darkened patches usually found on areas frequently exposed to the sun, such as hands and face.

Melasma

Although similar in appearance to liver spots, melasma spots are larger areas of darkened skin most often caused by hormonal changes in the body. Some examples include melasma from pregnancy (sometimes known as the mask of pregnancy) and women taking birth control pills. Pregnancy can trigger an overproduction of melanin, which can cause darkened skin on the face and other areas, such as the abdomen.   

Post-inflammatory Hyperpigmentation

Skin conditions such as acne and eczema cause the release of excess melanin in affected areas, resulting in dark spots after the condition clears. Skin injuries, surgery, and freckles are more examples of post-inflammatory hyperpigmentation. Generally, people with lighter skin tones are more likely to develop solar lentigines, whereas darker skin tones are more prone to PIH.

What Treatment Is Available for Dark Spots?

The most non-invasive treatment is a prescription or over-the-counter dark spot remover cream. Other treatments include chemical peels in combination with topicals and laser therapy. 

For all treatments, wearing a "broad spectrum" sunscreen is essential for effective and long-lasting treatment or prevention.

Why Use Dark Spot Removers for the Face?

Dark spot remover creams or gels generally contain hydroquinone, a skin-lightening agent. When applied regularly, hydroquinone slows down the production of melanin, and dark spots gradually fade to match normal skin coloration. Dark spot removers are also designed to enhance cell renewal, shed pigmented cells, and calm pigment-producing inflammation. 

Prescription creams can contain twice the amount of hydroquinone than over-the-counter products. A dermatologist will prescribe creams with tretinoin or cortisone cream in severe cases.   

What Ingredients Are in Over-the-Counter Dark Spot Removers?

The most common ingredients in over-the-counter lightening products are hydroquinone, licorice extract, N-acetylglucosamine, and niacinamide (vitamin B3). They effectively work on most skin types and are best for flat spots such as melasma and sunspots.

• Hydroquinone. Hydroquinone is a skin-lightening agent that lightens skin and aids in reducing the appearance of freckles, sunspots, scars, and melasma. It works by stopping or lessening the activity of melanocytes in the area.
• Licorice extract. Licorice extract's primary benefit is inhibiting enzymes required to produce melanin pigment. It also helps to remove excess melanin and may have an anti-inflammatory effect on the skin.
• N-acetylglucosamine. N-acetyl glucosamine is a skin-lightening agent already present in our bodies. N-Acetyl Glucosamine is a more stable form of glucosamine. When combined with the vitamin-B derivative niacinamide, it can be an effective treatment for hyperpigmentation, sunspots, and uneven melanin distribution.
• Niacinamide. Niacinamide has multi-functional capabilities that not only brighten dark spots but also hydrate and even shrinks pores. This synthesized form of vitamin B helps to even skin tone and reduces patchy and uneven dark spots.
• Tranexamic Acid. Tranexamic acid is a compound that lightens skin tone, reduces the appearance of fine lines and wrinkles, and decreases inflammation. It’s effective in treating dark spots, patchy skin, and acne scarring.
• Magnesium Ascorbyl Phosphate: Magnesium ascorbyl phosphate (MAP), commonly known as vitamin C, is found in several over-the-counter dark spot removers and serums, including prescription-strength dark spot treatments, due to its supportive nature when combined with other ingredients.

Other dermatology-approved ingredients include:

• Topical retinoids. Retinoids are derived from vitamin A and come in OTC and prescription formula. OTC versions are generally weaker. Retinoids penetrate deep into the skin and accelerate how your skin makes new cells, smoothing wrinkles and pigmentation as new cells come to the surface.
• Topical steroids. In more severe cases of hyperpigmentation, a corticosteroid is combined with hydroquinone to promote healing.
• Zinc sulfate. Due to its anti-apoptotic and antioxidant activity, along with other micronutrients like copper and manganese, zinc sulfate can help to reduce the production of melanin pigments. Its ability to block UV damage is also effective in helping to prevent or treat melasma.
• Azelaic acid. Azelaic acid is a naturally occurring acid with gentle brightener properties. It's generally used to break up pigment in sensitive skin.
• Kojic acid. Kojic acid slows the production of tyrosine, an amino acid that contributes to melanin production. It also helps to reduce irritation and inflammation caused by other ingredients.
• Arbutin: Arbutin helps to prevent the formation of melanin and is comparable to kojic acid and licorice root. All three function as “tyrosinase” inhibitors to provide skin lightening.

Which Dark Spot Removers Work Best?

With so many skincare manufacturers dedicated to producing dark spot removers, the best spot remover is the one that targets your specific needs. Here are five dermatologist-recommended solutions that can help to pave the way to brighter, healthier-looking skin:

1. Ambi Fade Cream

Ambi Fade Cream is a two percent formulation of hydroquinone, which is gentle enough not to irritate your skin but effective enough to block melanin production and fade dark spots.

2. SkinMedica Lytera 2.0 Pigment Correcting Serum

SkinMedica Lytera is an effective treatment for melasma as it contains several lightening agents, including tranexamic acid and niacinamide. It's also safe for use during pregnancy as it doesn't contain hydroquinone or retinol.

3. PCA C&E Advanced with Hexylresorcinol and Silymarin

The key ingredients in this cream include the antioxidants L-Ascorbic Acid, Tocopherol (Vitamin E), and Silymarin, which are intended to help reduce hyperpigmentation and contain several brightening benefits. Another ingredient is hexylresorcinol which also brightens and promotes an even skin tone.

4. SkinCeuticals Discoloration Defense

SkinCeuticals is a skin-brightening serum rich in kojic acid, a natural ingredient derived from fungi. Kojic acid prevents dark spots by inhibiting tyrosinase, an enzyme that produces melanin.

5. SkinBetter Science Even Tone Correcting Serum

SkinBetter Science Even Tone is another alternative to hydroquinone. Its blend of skin brighteners and botanical ingredients are intended to reduce pigment, sun damage, and redness.

6. Nava MD’s Custom Prescription Formulas

Nava MD’s teledermatology approach helps men and women get hyperpigmentation treatments that are right for their skin. Our dermatologists can include ingredients like niacinamide, hydroquinone, prescription retinoids, and more. Your formulation is shipped directly to your door after a short, virtual visit.

Dermatologists generally agree that topical dark spot correctors can work safely to treat hyperpigmentation in most people.  If used with good sun protection and a regular moisturizing regime, dark spots can and will gradually fade to leave skin even-colored, bright, and more radiant. 

Whether you choose to invest in an over-the-counter dark spot remover or consult with a dermatologist, dark spot removers can be an effective solution for uneven skin color and hyperpigmentation. 

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142815/

https://pubmed.ncbi.nlm.nih.gov/19706225/

https://pubmed.ncbi.nlm.nih.gov/24719055/

https://pubmed.ncbi.nlm.nih.gov/27943085/