What is a Dark Spot?
Hyperpigmentation, commonly referred to as dark spots, is the process in which the skin begins to darken and patches of dark skin appear on the face etc.
While there are a number of reasons that the appearance of the dark spots on skin can be attributed to, there also exist a number of ways to treat them. However, before choosing a treatment procedure, one needs to identify the underlying pathology that triggers the formation of the dark spots. Typically there are two forms in which hyperpigmentation or dark spots may appear;
Subtypes of Dark Spots
Though all the dark spots on skin may appear to be the same, there are various types of the dark spots. It is necessary to identify the particular kind of dark spots because this will determine the course of future treatment. Here are a few types of dark spots.
Let’s have a look at what makes these types differentiated from each other:
1. Moles: Typically known as moles, the dermatologists refer to them as pigment naevi. With the thickening of the melanin, the area can darken in color. However the moles may or may not be raised. Some moles stay for the lifetime, while others may disappear with the passage of time.
2. Melasma: These types of dark spots are typical to women and appear in the face, nose and chest areas. They are usually asymmetric brown macules. The patients of melisma predominantly include the women of the Oriental and Asian origin. The known patterns of melisma include;
- In the center of the face
- Along the jawline
- On the skin overlying the Zygomatic bone
3. Liver Spots: Contrary to the popular belief, this type of dark spots is not associated with liver diseases. The formation of liver spots is usually reported in late ages i.e. 40+. They usually appear on face and arms.
4. Birthmarks: The type of dark spots that appear at the time of birth or immediately after are known as birthmarks. Much like moles, the birthmarks can also stay for a lifetime or fade away later. There may be a single or multiple birthmarks.
5. Age Spots: As the name suggests, the formation of age spots is attributed to the advanced years. They usually appear on face and hands. With age, the cells atrophy and begin to die. The cellular debris, their released pigments, cytoplasmic granules, etc. accumulate within the skin as present as age spots.
6. Post-Inflammatory Hyperpigmentation: This type of hyperpigmentation develops due to the aggregation of the melanocytes at the skin site that has suffered from inflammation or swelling in the middle layer of skin, the dermis. It is usually due to accumulation of mediators of inflammation including various sorts of cytokines.
What are the Causes of Dark Spots?
Usually the formation of dark spots is attributed to:
- Excessive exposure to the sun
- Excess production of melanin
- Skin Infection and wounds
- Acne vulgaris
- Skin Fairness/lightening creams and lotions
- Birth Control Medicines
- Skin burns
- Systemic lupus erythematosus (SLE)
- Chronic use of certain drugs (like contraceptives)
Pathophysiology Behind Dark Spots
The formation of dark spots is more prominent in the persons with darker complexions. Therefore, the problem is reported mainly in the people of Asia Pacific, Middle East and African origin, as the two factors of dark complexion and sun exposure are combined together. Racial factor, therefore, plays a significant role in determining the prevalence of hyperpigmentation.
While these observations are true, the dermatologists have a sound explanation of the underlying process that leads to the formation of the dark spots. Hyperpigmentation is basically related to the presence of melanin in excessive amounts due to its high production.
Melanin is the pigment that is responsible for giving the skin and other structures like iris, their specific color. The higher the concentration of melanin in skin, the darker is the complexion and the reverse is true for lighter complexions. The production of melanin occurs in the cells named melanocytes which are located in the uppermost layer of the skin, epidermis. Melanin is the compound which imparts color to the body. It is a common misconception that melanin only gives color to the skin. Melanin is also responsible for imparting their specific color to the eyes and hairs.
With aging, the melanocytes do not remain uniformly distributed in the body. On exposure to ultraviolet radiations, the melanocytes are activated. Thus the areas of the body that are rich in melanocytes become pigmented more as compared to the surrounding skin sites and the process is named as hyperpigmentation.
Symptoms of Dark Spots
In general, hyperpigmentation can be easily recognized by the darkened skin. Various types of dark spots are recognized and thus diagnosed by their characteristic appearances.
Here is a list of symptoms that allows the dermatologists to differentiate between various kinds of dark spots.
1. Moles: The presence of moles is by far most easy to recognize because they are characterized by slight circular protrusion. However there are other moles that may be flat or even indurated. Typically the moles are brown or black in color but the red, colorless or even blue moles have also been found. The characteristic trait of moles is their static nature as they don’t change shape or form. But some moles may fade away over time.
2. Melasma: As mentioned earlier melisma generally develops on the sun-exposed sites, thus it is characterized by the tan or brown colored patches on the facial skin.
3. Liver Spots: The formation of liver spots starts with the development of the flat patches on the skin which are dark colored, usually brown or back. These dark spots develop on the forehead, shoulders, face, back of the hands and other such areas which are excessively exposed to the sun rays.
4. Birthmarks: The vascular birthmarks require elaborate testing in order to be identified. They are recognized by their transformation from small flat patches into large ones which may ultimately disappear leaving behind nothing but a scar.
5. Age Spots: These are usually found in fair-skinned people. Age spots vary in shapes and may be asymmetrical. Similarly the size of age spots varies from freckles to nearly half an inch. Age spots may also appear in an aggregated form thus changing the color of the entire area and becoming more pronounced. They are most common on face, neck and the dorsum of hands and feet where wrinkles usually appear.
6. Post-Inflammatory Hyperpigmentation: The post-inflammatory hyperpigmentation is identified by dirty brown colored pigmentation of the skin. This pigmentation is left over from the healing after acne, burns, cuts or even eczema. The coloration may vary from dirty to reddish brown.
How is Dark Spots Diagnosed?
The diagnosis of dark spots is dependent on co-existing symptoms. It occurs in conjugation with a variety of diseases some of which include:
- Addison’s Disease: The dark spots are scattered and are muddy brown in color, typically developed in armpits, around nipple and perineum.
- Hemochromatosis: In hemochromatosis, the dark spots are scattered but are grayish or bronze in appearance.
- Phototoxic Reaction: Diffuse swelling which leads to development of dark spots in areas which are most commonly exposed to sun.
- Melanoma: It is the malignancy of melanocytes. The lesions are asymmetrically distributed all over the skin and enlarge with the passage of time.
- Systemic Lupus Erythematosus (SLE): Thick erythematous scaly patches appear on the skin. The typical “butterfly rash” is the distinguishing feature of SLE.
- Acanthosis Nigricans: Characterized by velvety appearance of skin with focal areas of hyperpigmentation found on the neck, axillae, around the umbilicus, over the forehead and other areas of body.
Treatment for Dark Spots
The treatment of dark spots is a chronic process. There are many ways to treat dark spots. The choice of treatment method depends on the condition in which the dark spots present. Treatment of that particular disease usually cures the dark spots.
- Since Addison’s disease is an endocrinal problem caused by insufficiency of adrenal hormones, hormone replacement therapy along with oral and intravenous corticosteroids (like dexamethasone) can adequately treat the disease,
reversing all the signs and symptoms of the disease including hyperpigmentation. Hemochromatosis can be treated with phlebotomy. As body’s iron stores return to normal, hyperpigmentation disappears.
- The treatment of choice for a melanoma is complete surgical excision of the lesion.
- SLE is treated with immunosuppressive drugs.
- Acanthosis nigricans can be improved with changes in diet and exercise.
Specific Treatment Modalities for Dark Spots
Some of the well-known treatment methods include;
- Chemical Peel: The procedure of chemical peel is much like exfoliation, involving the application of a chemical to the skin surface which then allows the dermatologists to peel off the upper skin layer thus bringing smooth and fresh skin to the surface. Chemical peel may be superficial, medium or deep.
- Dermabrasion: The procedure involves smoothing of the rough skin and removal of upper layer of the skin using a diamond wheel.
- Laser Resurfacing: Laser resurfacing employs laser to remove the upper skin layer thus bringing the smooth skin to the surface.
Dark Spots and Diet
The dietitians have identified a number of food items which have shown positive results in avoiding the development of dark spots. These food items include fruits, dairy products, nuts, grains and vegetables thus allowing one a variety of choices to eat from while avoiding the dark spots. A few of the food items that help in prevention of dark spots are berries, walnuts, beans, eggs, fish etc.
What are the Prevention Tips for Dark Spots?
The preventive measures include
- Wearing a sunscreen when out in the sun.
- Avoiding stepping out into the sun more than absolutely necessary.
- Scratching or popping the zits and acne.
- Wisely choose the skin products that you use.
- Avoid hair removal through waxing.
- Immediately seek treatment for the skin problems before the matters get worse.
The pigment producing melanocytes aggregate in different skin sites and when triggered, produce excess melanin which imparts a dark color to the skin thus forming dark spots. There are various types of dark spots which can be treated depending on the diagnosis. In order to keep the dark spots at bay, it is advisable to limit the sun exposure and use SPF if sun exposure is inevitable. Other preventive measures include immediate treatment of skin problems like acne so as to avoid the development of dark spots.