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These Tenacious Age Spots!

Since I turned 45, more and more brown spots turn up on my face.  I first turned to a popular skin lightening cream recommended by my dermatologist, and this hydroquinone-containing cream causes irritation and added more dark spots.  I then tried two rounds of more expensive “photorejuvenation” treatments in my dermatologist’s office, and it did little to erase these brown spots.

How did these Age spots get here?

When we look at our face in the mirror, we are staring at accumulated lifetime sun exposure, inflammation, and other skin injuries such as those caused by acne.  Our age spots, also called sun spots, brown spots, or hyperpigmentation, are mainly caused by sun exposure.  Dark skin people are more likely to have age spots.  These dark spots can add years or a decade to our appearance.   

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When our skin is exposed to UV light, DNA damages occur, and our body fights back by producing melanin, the dark pigment, to protect us from further UV damage.  Melanin is produced in the base layer of our upper layer of skin (epidermis).  It is then transferred and dispersed into the cells right above base layer (spiny layer).  The dispersed melanin creates a tan that absorbs UV rays and turns them into harmless heat.

Age spots appear when melanin becomes clusters or when our skin starts produce more melanin either from excess sunlight and/or from becoming older.  Our genetic makeup also plays a large role in the degree of our age spots. 

Age Spots Prevention and Correction


To prevent age spots, we can either prevent the synthesis of melanin by inhibiting an enzyme called tyrosinase or by blocking the transfer of melanin into the normal skin cells (keratinocytes). The most effective way to prevent age spots is to use sun screen or wear a wide-brimmed hat when going out.  One should also minimize skin irritation and thus reduce the chance of dark spots resulted from skin trauma.

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Minimize uv exposure and minimize skin irritation will reduce the size and intensity of age spots, since some pigment will eventually moves to the outmost layer of our skin following the natural turnover cycle and be shed off.  However, some dark spots persist.  Treatments for these dark spots includes topical lightening agents, laser or intense pulsed light treatments, freezing (cryotherapy), and chemical peels. 

Topical skin lightening ingredients such as hydroquinone, kojic acid, arbutin, and licorice extract are tyrosinase inhibitors, and this means that they prevent the melanin formation in the first place.  Among the above mentioned ingredients, licorice root extract is my choice, due to the side effects and safety concerns related to hydroquinone, kojic acid, and arbutin.  Licorice root extract not only is safe for our skin, it also has a long history of use as a healing agent due to its anti-irritant and anti-inflammation properties.  Studies have shown that licorice contains 3 tyrosinase inhibitors, and they work together to block melanin formation. 

Niacinamide, the active form of vitamin B3, is another safe and effective ingredient of dark spots reducing ingredient.  It works by blocking the transfer of melanin to skin cells.  Niacinamide is a multi-functional ingredient.  Studies show that niacinamide not only lightens age spots, but also improves skin texture and reduces fine lines. 

A topical lotion contains both licorice root extract and niacinamide is likely to have a synergistic effect, since licorice root extract reduces melanin formation while niacinamide blocks transfer of melanin into skin cells. 

Skin exfoliation can help increase the turnover of epidermal skin cells, thus help flush out the melanin.  Therefore, chemical peels and mechanical dermabrasion are also used for dark spots reduction.  However, people with sensitive skin should be very cautious at using these techniques.  Skin irritation is a common side-effect of chemical peel and mechanical dermabrasion, and irritation can cause dark spots.  Safe exfoliation product, such as InaMei’s SafePeel Beauty Strips, can be safely used for this purpose. 

Keep in mind that it takes at least a few weeks to notice the lightening of dark spots by topical ingredients, since the existing melanin takes a relatively long time to migrate out of the skin in the process of natural exfoliation, so be patient and be persistent.  If you want fast results, try pulsed laser light or intense pulsed light treatment below.

Pulsed laser light and intense pulsed light (IPL) treatments are used for dark spot treatment.  Since melanin absorbs mostly green and yellow light high intensity light in the green to yellow light range is used to heat up and break down the pigment with little damage to the surrounding skin.  These treatments are expensive, and a series of treatments is usually required.  The results are not very predictable, loss of skin color (hypopigmentation) might also develop. 

If you notice a spot which are very dark, getting bigger quickly, has irregular shape, and causes discomfort, please see your doctor to rule out the possibility of melanoma, a form of skin cancer.

A Few Words Regarding Hydroquinone

Hydroquinone was the traditional skin lightening standard: up to 2% hydroquinone can be bought in US over-the-counter, and up to 4% hydroquinone can be obtained with prescription.  It works by inhibiting the enzyme tyrosinase, thus blocking a critical step in the synthesis of melanin.

Hydroquinone is now banned or restricted in most European countries and might be banned in US down the road.   On August 29, 2006, the FDA proposed a ban on over-the-counter sales of cosmetic products containing hydroquinone.  Long term and high dosage of hydroquinone has a chance of skin tissue discoloration, especially in dark-skinned people.  Hydroquinone is also a potential skin irritant, and it also has the potential to cause cancer.
 
Further Reading:
Hideya Ando et al. “Melanosomes Are Transferred from Melanocytes to Keratinocytes through the Processes of Packaging,Release, Uptake, and Dispersion”, 1222, Journal of Investigative Dermatology, Vol. 132, 2012
T. Hakozaki et al, “Hyperpigmentation in Aging Skin”, Chapter 51, Textbook of Aging Skin, Edited by Miranda A. Farage, Kenneth W. Miller and Howard I. Maibach, 2010
J. Nip et al, “The New Face of Pigmentation and Aging”, Chapter 53, Textbook of Aging Skin, Edited by Miranda A. Farage, Kenneth W. Miller and Howard I. Maibach, 2010
L. Baumann, The Skin Type Solution, Bantam Press, 2006