Dark spots or age spots or hyperpigmentation occurs when the skin produces more melanin than normal in some areas of skin. It is usually not a cause of concern and does not require treatment until the person feels offended. They also called d liver spots, senile lentigo, solar lentigines, or sun spots depending on the cause.

Symptoms:
They are flat brown, gray, or black. Their texture is similar to the rest of the skin and is not painful. They vary in size and develop on any part of the body such as the back of the hands, face, back, or shoulders. They appear most often on the sun-exposed area.

In people with dark colors, spots are darker but fade away in a few days. However, deeper coloration may take a few years to fade.

Causes:
Dark spots develop due to various reasons. However, in some cases the underlying reason is unclear. The causes include:

UV Light Exposure: UV light exposure from the sun or an artificial source, cause hyperpigmentation in middle-aged people with light hair or skin who are at risk of severe and many sunburns.

Skin Conditions: Various skin conditions and diseases contributed to the dark spots and areas.

  • Post-inflammatory hyperpigmentation: Skin discoloration/dark spots appear following trauma, burns, acne, or certain skincare products
  • Melasma: Type of dark spots after hormonal fluctuations especially during pregnancy.
  • Linea nigra: A dark, vertical line through the middle of the abdomen appear during pregnancy.
  • Chloasma: Hormonal changes that cause dark areas.
  • Riehl’s melanosis: Certain type of contact dermatitis caused by sun exposure
  • Poikiloderma of Civatte: It benign condition due to which parts of the neck turn reddish-brown.
  • Erythromelanosis follicularis: Condition with similar characteristics like poikiloderma of Civatte. It shows reddish-brown pigmentation on the face and neck

Medications: Certain photosensitive medications can cause dark spots by making the skin hypersensitive to sun exposure. Such medications include:

  • Estrogens
  • Tetracyclines
  • Amiodarone
  • Phenytoin
  • Phenothiazines
  • Sulfonamides

Other Factors That Cause Hyperpigmentation Of The Skin

  • Pregnancy
  • Liver disease
  • Addison’s disease
  • Hemochromatosis (excessive iron)
  • Pituitary tumors

Treatment:
The treatment for black spot reduction is mainly for cosmetic purposes. Treatment can completely remove dark spots.

Topical Prescription Medicines:
It includes hydroquinone, retinoids alpha hydroxy acid, glycolic acid, deoxyarbutin, and kojic acid containing bleaches. However, they just hide the appearance of spots. Sometimes, they are associated with side effects such as redness, swelling, and irritation due to the skin abrasives present in the bleach. They also make the skin sensitive to UV exposure in sunlight, hence it is recommended to apply SPF containing sunscreen products.

Laser Treatment: The concentrated light used to burn the dark spots. It is associated with the risk of bruising, swelling, redness, tightness, scarring, infection, and skin texture changes.

Chemical Peels: The chemicals such as salicylic acid and glycolic acid mask used to remove the upper layer of skin to reveal healthier and toned skin. It may also cause skin irritation.

Microdermabrasion: They physically erode the skin surface. There are two types of microdermabrasion: crystal and diamond-tipped

Cryosurgery: Freezing with a liquid nitrogen solution the dark skin peels away and cause fading.

Prevention:
With the help of certain preventive measures, dark spots can be avoided to some extent. The measures include:

  • Use SPF containing sunscreens: Practicing wearing and reapplying of sunscreen products every two hours or sooner if you’ve been swimming or sweating a lot.
  • Covering up when outdoors by wearing a hat, long sleeves, and pants. SPF fabrics can offer added protection.
  • Avoid UV exposure in the peak sun hours i.e. between 10 a.m.to 2 p.m.
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Frequently asked questions

We now have an FAQ list that we hope will help you answer some of the more common ones.

1. What is a chemical peel?

In this procedure, an agent is applied to the skin which causes exfoliation of the skin and gives a regenerated surface that looks younger and better.

2. Can we do chemical peels at home?

They should not be attempted at home and should be done by a qualified Dermatologist only.

3. What are the uses of chemical peels?

The chemical peel can be used for pre-party glow, superficial lines and wrinkles, active pimples and scarring to even tough to treat conditions like stretch marks. Depending on the type, most of the common skin concerns can be addressed with chemical peels.

4. Are chemical peels safe to use?

Chemical peels are safest to use if the choice of patient and the peel match with each other. A darker skin type like most of our Indian skin tones would be more suited for superficial to very superficial chemical peels while a Caucasian skin would require medium to deep peels for better results. An experienced clinician can examine and decide the safest peel and is the best person to perform a chemical peel procedure.

5. What are the types of chemical peels?

The peels are classified by their depth of penetration. They are of the following types:

  1. Very superficial chemical peels
    • Salicylic acid 20–30%
    • Glycolic acid 50%
    • Jessner’s solution, 1-3 coats
    • Modifiefd Jessner’s solution
    • Mandelic acid 30-40%
    • Triochloroacetic acid 10-20%, 1 coat
  2. Superficial  – Destruction of part or all of the epidermis
    • Glycolic acid 50-70% until redness
    • TCA 20-35%
    • Salicylic acid 30% + TCA 20%
  3. Medium depth chemical peel – involves epidermis and part of dermis
    • Glycolic acid 70% + TCA 35%
    • Jessner’s solution + TCA 35%
  4. Deep Chemical Peels – reaches upto the reticular dermis
    • Baker Gordon’s formula (2.1% croton in 50% phenol)

6. What are the various types of chemical peels?

The peels are of various types-

  • Uperficial peels that go up to stratum corneum e.g. Salicylic acid, Glycolic acid 30- 50%, and Jessner’s solution
  • Superficial light peels- They reach up to basal layer e.g. GA 50 to 70%
  • Medium depth peels- They reach up to dermis e.g. TCA 35- 50%, GA 70%, 88% Phenol
  • Deep peels like Baker Gordon phenol peel
  • Lipohydroxy acid (LHA) A new group of agents which are used to exfoliate and remove dead skin giving skin a smooth, shiny surface.

7. How do we prepare the skin before the chemical peel? Is it necessary?

The skin should be ideally prepared before the procedure to avoid any complication. Also the priming agent enhances the penetration and the effectiveness of the peeling agent. The pigmentary cells are subdued and this prevents any pigmentation. Various agents like hydroquinone, kojic acid, arbutin, and vitamin C can be used for priming the skin before procedure.

8. Are these agents 'chemicals' and harmful?

Most of these agents are naturally derived and purified to get the best ingredient. Generally, most of these peels, especially superficial and very superficial give gentle exfoliation and peeling. It is one of the biggest myths that these chemicals are harmful.

  • Priming of the skin is a must. Dr. Divya Sharma believes in a proper pre-peel regimen to avoid complications related to peeling.
  • The skin should not be tanned prior to treatment.
  • The patient should not have a keloidal tendency.
  • Any drugs causing increased photosensitivity, aspirin or blood thinners should be stopped one week before the procedure.

9. What are the common side effects of chemical peel?

Redness and slight itching sensation is common with superficial peels. A little outbreak of pimples can be commonly seen in the first few days after the peel. Swelling, crusting are common with medium to deep peels only.

10. Who is not a suitable candidate for the procedure?

Patients with a history of keloid, herpes labialis, SLE, photosensitivity, and suntanned skin should avoid doing chemical peels. Any pre-existing infection should be treated prior to a chemical peel procedure.

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