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Sun Spots, Age Spots, Hyperpigmentation

What is hyperpigmentation?

Melanin is the substance that gives our skin color. The sun is the most common cause of the production of excess melanin and results in a suntan.  Hyperpigmentation is a condition characterized by the production of excessive melanin which causes dark spots on the skin.

Dark spots include age spots, liver spots, freckles, sun spots, and melasma. Hyperpigmentation can affect any area but is most common on the face, ears, back of the hands, arms, neck, chest, shoulders and back.

What causes hyperpigmentation?

Excess melanin production develops in response to the sun, acne, melasma, aging, certain medical conditions, heredity, some prescription medications and hormone imbalances.

Age spots (Solar Lentigines)

Age spots and liver spots are the same thing. Age spots are flat pigmented spots on sun exposed skin. Sun damage may have occurred in the past but doesn’t show as age spots for years. Age spots are common. 90% of light-skinned people over the age of 60 have age spots. Age spots typically appear on the face, hands, forearms, chest, back and shins.

Common treatments include:

  • chemical peels
  • a photofacial
  • laser skin resurfacing
  • topical creams 

Combination treatment has been found to be the best approach, in addition to the daily use of a sunscreen.

Post-inflammatory hyperpigmentation (PIH)

PIH is hyperpigmentation caused by an inflammatory skin condition like acne; skin infections from bacteria, viruses, and fungus; skin eruptions due to certain medications; eczema and psoriasis or another skin inflammation.

Acne breakouts often result in PIH. PIH is the discoloration left after acne or other inflammation heals. PIH can be pink, red, purple, brown or black flat discolored areas. Acne scars may also be discolored. Overexposure to the sun, and drugs that cause hypersensitivity to the sun, such as some antibiotics, can cause PIH.

PIH discolorations may fade with time but take a long time to fade.  Some studies report that it can take 24 months or longer to fade superficial spots, and longer to treat deeper discolorations that may not fade on their own.  People with medium to dark complexions are more prone to PIH.

To control your risk for PIH from acne, the first step is to get your acne under control. If you already have PIH there are effective treatments.

Common treatments may include:

  • HydraFacial
  • Laser Genesis
  • Clear + Brilliant
  • Alpha hydroxy acids like glycolic acid speed exfoliation and can improve PIH.
  • Hydroquinone
  • Retin A
  • Azelaic acid
  • Chemical peels
  • Microdermabrasion


Melasma is a common problem that affects women. It is caused by hormone changes. In pregnancy it is called the “mask of pregnancy”. Melasma can also be caused by birth control pills and hormone replacement therapy.

It appears as brownish- gray patches on the face, bridge of the nose, forehead, chin and upper lip. Sun exposure can trigger the return of melasma after it has faded. Melasma is difficult to treat and may require maintenance therapy after it clears. Common treatments include Hydroquinone, Retin A, and Azelaic acid.

When you are distressed by dark spots, sunspots, melasma and acne discolorations professional treatments can help. Dr. Zeena is a board-certified dermatologist and expert in cosmetic and surgical dermatology in New Orleans, Louisiana. Contact Dr. Zeena to schedule a consultation to receive an accurate diagnosis and the correct treatments to brighten your skin and clear your dark spots, including laser therapy and chemical peels.

At a Glance

Dr. Zeena Al-Dujaili

  • Double board certified in dermatology and Mohs Surgery
  • Fellowship trained in cosmetic dermatology
  • Authored several chapters in clinical textbooks and peer-reviewed publications
  • Learn more

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