Pigment spots

Dr. Wu's analysis

What are pigment spots?

Pigmentation spots are areas in the skin where the pigment, or melanin, is unevenly distributed. This results in visible color differences, which can range from dark brown to black spots or lighter spots.

How is melanin formed?

Melanin determines skin color and is produced by melanocytes in the basal layer of the epidermis. The amino acid tyrosine plays a key role in this and is converted by the enzyme tyrosinase into:

Pheomelanin (yellow-red): Reacts more strongly to light and offers less protection. Lighter skin types (Fitzpatrick I & II) produce more pheomelanin, which increases the risk of burning.
Eumelanin (brown-black): Provides natural protection against UV radiation. Dark skin types (Fitzpatrick III-VI) have more eumelanin, which provides better UV protection and an even pigment distribution.

More about Fitzpatrick skin types

Transport and distribution of melanin

Within the melanocytes, the produced melanin is packaged into melanosomes. These pigment packets are transferred to keratinocytes (skin cells) via protrusions from the pigment cells; typically, one melanocyte is connected to about 40 keratinocytes. As the keratinocytes move from the bottom layer to the surface of the epidermis, the melanin spreads, contributing to the final skin color.

Unequal melanin production

Pigmentation spots occur when there is a local excessive stimulation of melanin production. This results in an uneven distribution of melanin in the skin, causing clear color differences.

Pigment Approach

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What causes pigmentation spots?

Pigmentation spots occur when external influences disrupt the production and distribution of melanin (the substance that determines skin color). These factors work together and influence the formation and distribution of melanin in the skin, resulting in the development of pigmentation spots, regardless of whether someone is genetically predisposed to it. Below is an overview of the main causes:

UV Radiation

Exposure to the sun activates melanocytes, the cells that produce melanin. This results in extra pigment production, which can lead to sunspots and an acceleration of skin aging.

Visible sunlight

In addition to UV radiation, exposure to visible light can also affect melanin production. In particular, blue and green visible daylight can activate melanocytes, which in some cases leads to extra pigmentation. This effect is especially relevant in people with dark skin, where visible light can contribute to the formation of pigment spots. As far as artificial light stimulates melanin production, it does not.

Inflammatory reactions

After skin irritations, such as acne or small wounds, the skin reacts by producing extra melanin as part of the healing process. This can result in post-inflammatory hyperpigmentation, where the skin temporarily darkens in those areas.

Hormonal changes

Changes in hormone levels, such as during pregnancy, when using contraception, or during menopause, can overactivate the melanocytes. This leads to conditions like melasma, where dark, often symmetrical spots appear on the face.

Medicines

Certain medications (for example, some antibiotics, heart medication, and chemotherapy) and aggressive cosmetics, such as perfumes, can make the skin more sensitive to changes in pigmentation, which can result in pigment shifts.

Oxidative stress

Factors such as smoking and air pollution cause the formation of free radicals, which damage skin cells. This damage can disrupt the pigmentation process and contribute to an uneven distribution of melanin.

Air pollution

Air pollution, especially the inhalation of pollutants, increases oxidative stress in the skin. This can directly lead to disruptions in melanin production and the formation of pigment spots.

Who is susceptible to pigment spots?

Pigmentation spots can occur in anyone, but certain factors increase the chance of their occurrence.

Skin type

Your skin type influences the formation and fading of pigmentation spots.

Light skin (Fitzpatrick I-II): Burns quickly, hardly tans. Sensitive to sunspots, but less chance of post-inflammatory hyperpigmentation (PIH).
Moderate skin (Fitzpatrick III-IV): Tans gradually to well, rarely burns. Risk of both sunspots and PIH.
Dark skin (Fitzpatrick V-VI): Tans quickly, hardly burns. Higher chance of hyperpigmentation after acne, wounds, or irritation.

Inflammations

People with a dark skin (Fitzpatrick type III-VI) are at a higher risk of post-inflammatory hyperpigmentation, because their melanocytes - the pigment cells - react faster and more intensely to inflammations, such as those caused by injuries, infections or skin irritations. In addition, a sensitive or reactive skin can become extra irritated by external stimuli, which can also lead to increased pigmentation. As a result, after an inflammation has healed, such as with acne or a small wound, a dark spot may remain, especially in people with dark skin.

Age

Age spots are caused by the combined effects of UV damage and the natural aging of the skin. Exposure to sunlight causes damage to the skin cells, causing the melanocytes to produce extra melanin as a kind of protective mechanism. At the same time, as the skin ages, the rate of cell division decreases, causing the melanin to no longer be evenly distributed over the skin. This uneven distribution leads to the formation of dark spots, also known as age spots.

Hormonal fluctuations

Pregnancy, contraception, and hormone therapy can influence hormonal balance, which can lead to melasma in many women. Melasma is a pigment disorder that primarily manifests itself on the face, often in the form of symmetrical, dark-colored spots on the cheeks, forehead, or upper lip. These spots occur because hormonal fluctuations increase the activity of melanocytes, leading to an excessive production of melanin. The result is an uneven distribution of pigment, leading to the visible discolorations that are characteristic of melasma.

Genetic predisposition

Some people have a genetic predisposition to developing pigment spots. This can manifest in congenital patterns such as café-au-lait spots and congenital moles, but also in an increased sensitivity to conditions such as melasma. Hereditary factors influence the activity of melanocytes, causing more melanin to be produced in certain areas of the skin. This results in an uneven distribution of pigment, leading to visible color differences. People with a family history of pigment spots or related conditions often have a higher chance of developing these changes in their skin.

Video: Dark pigment spots on the skin

How do you recognize and distinguish pigmentation spots?

How can you recognize pigment spots?

Color, shape and depth

Pigmentation spots can vary in color, shape, and depth. Superficial spots, such as sun spots and age spots, usually have a light to dark brown color. When pigment is deeper in the skin, as with melasma, the color may appear gray-blue. Also, after inflammation, for example after acne or small wounds, the skin can produce extra pigment, leading to post-inflammatory hyperpigmentation with shades of reddish-brown to dark brown.

Place of pigment

The location of pigmentation spots often gives an indication of the cause. Age spots mainly appear on exposed areas such as the face and hands. Melasma is more common on the forehead, cheeks, and upper lip, often under the influence of hormones and UV radiation. Hyperpigmentation after skin irritation or inflammation is less predictable and can occur anywhere on the body.

Shape and edges

Spots with clear, sharp edges, such as with solar lentigo, often remain stable in shape and size. Diffuse or irregular spots, such as those with melasma, can vary in intensity, depending on the degree of sun exposure and hormonal fluctuations. Some pigment spots, such as post-inflammatory hyperpigmentation, fade over time, while others persist without treatment.

Benevolent or malevolent

Not every pigment spot is harmless. Although pigment spots are usually harmless, it is important to pay attention to certain characteristics. A typical pigment spot feels smooth and does not show flakes, crusts, or wounds. However, changes in shape, color or size, irregular edges, or the occurrence of multiple shades within one spot may indicate a deviation that needs to be further investigated.

Which skin problems resemble pigmentation spots?

Some skin problems may resemble pigmentation spots, but require a different cause and approach. To determine the difference between pigmentation spots and other skin problems, a skin analysis is necessary.

Post-Inflammatory Hyperpigmentation (PIH)

Brown or gray-blue spots that occur after skin damage, such as wounds, acne or eczema. This strongly resembles pigmentation spots, but is a reaction to inflammation and is more common in darker skin types.

Post-Inflammatory Erythema (PIE)

Red or pink spots that remain after acne or skin irritation. Unlike post-inflammatory hyperpigmentation (brown spots), these spots are the result of dilated blood vessels and not excessive melanin.

Fungal infections (Pityriasis Versicolor)

This condition causes light brown to whitish spots, especially on the torso and shoulders. It is caused by a yeast infection and usually disappears with an anti-fungal treatment.

Melanoma or atypical moles

Some pigmentation spots can be malignant. A melanoma is often asymmetrical, has irregular edges, multiple shades, and can change in size or shape. Dermatological examination is necessary in case of doubt.

Café-au-lait spots

These congenital, light brown spots are often uniform in color and do not change over time. Unlike sunspots, they do not occur due to UV radiation.

Hori's naevus or Ota's naevus

Blue-gray pigmentation on the skin, especially around the eyes or cheekbones. This is often confused with melasma, but it is deeper in the skin and requires a different treatment strategy.

Vitiligo

In contrast to pigment spots, which involve an accumulation of melanin, vitiligo actually causes pigment loss. This leads to sharply defined, milky white spots that can expand over time.

What types of pigment spots are there?

Various forms of pigmentation and their causes

Here are 3 common forms of pigment spots.

Freckles

Freckles, known in the medical world as ephelides, are benign spots. They are mainly located on the face and sun-exposed areas such as the upper body, forearms, and lower legs. They are caused by sunlight. Therefore, they become darker in color during the summer period and lighter in the winter months. Most people recognize freckles very easily. They occur more often in people with lighter hair color and skin type (red and blonde hair).

Lentigo

Lentigines are brown spots and are also caused by sunlight. These spots do not disappear on their own. They can occur from puberty, then they are called lentigines simplex. Lentigines solaris or lentigo senilis (liver spot or age spot) are also benign variants that occur at a later age. They are often seen on the backs of the hands and on the cheeks.

Birthmark

Moles can be present from birth and increase over the years. They can have different colors: black, brown, red or even skin-colored. The shape also varies from smooth, raised to spherical. A light brown mole is difficult to distinguish from a freckle or lentigo. Moles can suddenly increase from puberty, and during pregnancy existing moles can start to grow and increase in number.

How do you effectively treat pigment spots?

What can I do about it myself?

A good basic care is essential if you suffer from pigmentation spots. By following a consistent skin routine, you prevent worsening and support an even complexion.

Step 1: Cleanse without irritating the skin

Cleanse your face twice a day with a mild cleanser without alcohol or sulfates to protect the skin barrier and prevent pigmentation problems. Avoid harsh scrubs, as these can cause irritation, overload the skin, and disrupt the distribution of pigment. A gentle cleansing routine removes dirt and sebum, supports skin repair, and promotes the absorption of skincare products.

Step 2: Active ingredients to fade pigmentation spots

Use a serum or cream with arbutin, vitamin C, niacinamide, azelaic acid, or resveratrol to regulate melanin production and fade pigmentation spots. A combination of these ingredients works more effectively because they tackle pigmentation in different skin layers. For stubborn spots, especially with normal to oily skin, retinol or AHAs (such as glycolic acid) can accelerate cell renewal and further reduce pigmentation.

Step 3: Protection against the sun

Daily sun protection prevents pigmentation spots from worsening and new ones from forming. Use a broad-spectrum SPF 30+ with mineral filters such as zinc oxide and titanium dioxide for optimal protection against UVA and UVB radiation. UV radiation stimulates melanocytes and can worsen pigmentation. For tinted skin types (Fitzpatrick 3+), extra protection against visible light (blue/green) is important. Iron oxide helps block this light and thus reduce pigmentation spots.

Why this routine works This routine prevents further pigmentation and helps to even out the skin. The combination of mild cleansing, pigment-inhibiting ingredients, and SPF with visible light protection effectively reduces pigmentation spots. With consistent use, results are often visible within 4 to 12 weeks, depending on skin type and severity of the spots.

What treatments are there?

The choice of treatment depends on the cause and depth of the pigmentation spots. A combination of sun protection, active ingredients, and professional treatments offers the best results.

Skin care and creams

Daily sun protection with at least SPF30 prevents the worsening of pigmentation spots. Ingredients such as vitamin A (retinol), C, B3 (niacinamide), arbutin, kojic acid, resveratrol, and licorice root extract help reduce pigmentation. Avoid self-bleaching creams, as some contain harmful substances. Hydroquinone should only be used under the supervision of a specialist. For stubborn spots, a skin therapist can apply camouflage therapy for natural coverage.

Peelings

Chemical peels accelerate the natural exfoliation of the skin, which can contribute to the fading of pigmentation spots. This treatment is especially suitable for people with light skin, as it can reduce pigmentation abnormalities without overly straining the skin. It is important that the peel is performed superficially, so that the treatment is effective and the skin recovers quickly without excessive irritation.

Laser treatments

For superficial pigment, laser or IPL can be effective. The PicoWay laser offers faster results with fewer treatments and is safer for tinted skin types. The laser breaks down pigment particles, after which the body clears them up.

Microneedling

Microneedling with a dermapen stimulates skin renewal and gradually fades pigmentation. This technique is also suitable for dark skin types because it is controlled, reducing the risk of new pigmentation.

Oral supplements

Polypodium leucotomos extract (PLE) is an antioxidant from fern extract that reduces UV damage. A study suggests that PLE in combination with sunscreen and hydroquinone is more effective in melasma than local treatments alone.

Glutathione can regulate melanin production and brighten the skin. A study indicates that oral glutathione can lighten skin tone, but long-term effects and safety are still unclear.

Medication

Tranexamic acid: Inhibits pigment formation and is used off-label for melasma. Research shows that oral intake improves many patients, but due to an increased risk of thrombosis, medical supervision is necessary. Use is discouraged in combination with hormonal contraception.

What should you avoid with pigmentation spots?

With pigmentation spots, it is important to avoid certain habits and products, as these can worsen the spots or make the skin more sensitive. Preventing and treating pigmentation spots requires a thoughtful approach. Protection, gentle care, and the right treatments help to keep the skin smooth and healthy.

1. Unprotected exposure to the sun

UV radiation stimulates the production of melanin and can darken existing pigment spots. Using a sunscreen with at least SPF30 daily is essential, even on cloudy days.

2. Aggressive skin care products

Avoid products with irritating substances such as alcohol, perfume, and strong foaming agents (like sulfates). These can weaken the skin barrier and cause inflammation, which can trigger pigmentation.

3. Self-bleaching creams without guidance

Some over-the-counter creams contain harmful substances such as hydroquinone or corticosteroids, which can have harmful effects with prolonged use, such as thinning skin or even rebound hyperpigmentation. Only use pigment-reducing creams that have been dermatologically tested.

4. Scrubbing and harsh exfoliation

Excessive scrubbing or aggressive chemical exfoliants can irritate the skin and worsen post-inflammatory hyperpigmentation, especially in darker skin. Instead, opt for gentle exfoliation with ingredients such as glycolic acid or lactic acid.

5. Squeezing or scratching wounds and pimples.

This can damage the skin and lead to post-inflammatory hyperpigmentation. Let wounds heal naturally and use calming and restorative ingredients such as niacinamide or panthenol.

6. Skin treatments without professional advice

Not every laser or peel is suitable for every skin type. Incorrect treatments can worsen pigmentation spots, especially on tinted skin. Seek advice from a skin therapist or dermatologist before undergoing a treatment.

Iconic Elements products

The Iconic Elements skincare products are developed based on scientifically substantiated ingredients, have a skin-neutral pH of 5, and are free from microplastics. Awarded the Best Dermatologist Developed Skincare Brand 2024 and Best Holistic Skincare Line 2022 awards. More about the background and studies used can be found on the respective product pages.

🛈 These products are cosmetic and intended for the care of healthy, sensitive or unbalanced skin. They are not intended as a medical treatment or to replace professional medical advice. For personalized skin advice, we recommend consulting a skin therapist or doctor.

Image

Product

Description

Spotreducer (AWARD WINNING)

14.95

With Niacinamide to reduce redness and inflammation and Ectoine to soothe and protect the skin from dehydration and moisture loss, this cream helps fade residual spots and hyperpigmentation without drying out the skin. Suitable for all skin types. In 2016, it was awarded a Beauty Award in Hong Kong.

In shopping cart

Targeted Pigment Serum

14.95

It contains Arbutin, which reduces the production of melanin and helps fade pigmentation spots. Niacinamide supports the skin barrier and evens out the complexion, while Malic Acid provides gentle exfoliation, gradually fading discoloration. It is suitable for people with pigmentation spots and a normal to oily skin.

In shopping cart

Tinted Mineral Sunscreen SPF30

14.95

The tinted mineral sunscreen combines Titanium Dioxide, Zinc Oxide and Iron Oxide to provide broad spectrum protection against both UVA and UVB radiation, as well as visible blue light (HEV light). This composition effectively protects against pigmentation spots, skin damage and premature skin aging.

In shopping cart

Tips when you have pigmentation spots

Tip 1: Prevention of stains

Pay close attention to your skin. If you suffer from an underlying skin condition, you should treat it as well as possible to prevent new pigment spots. Do you have a small wound or a healing spot? Then protect it well with sunscreen with at least SPF 30. Mineral sunscreen with titanium dioxide AND zinc oxide works immediately and causes the least irritation to your skin. Let wounds heal well and stay away from that scab. We all know how tempting it is to scratch it off, but try to touch it as little as possible. If you really can't help it, you can safely cover the spots with a bandage. Try to scratch as little as possible with itchy skin conditions.

Tip 2: Cleanse your face twice a day.

There is a relationship between air pollution and pigmentation spots.

A German study found that people from the Ruhr area (metropolitan area), who were highly exposed to nitrogen dioxide, suffered more from pigmentation spots than people from the countryside (around Borken). These discolorations were especially visible on the cheeks. It also turned out that the test subjects, who were exposed to more (10 µg/m3) nitrogen dioxide, had significantly more lentigines. As much as 20% to even 35% more pigmentation spots were visible on them.

Regularly cleaning your skin can reduce unwanted pigmentation spots.

Tip 3: Supplement Glutathione

Glutathione inhibits pigmentation through multiple mechanisms. It reduces the production of melanin in the pigment cells (melanocytes) and also has a strong antioxidant effect, which also slows down pigment production.

A randomized, placebo-controlled study from 2012 investigated the effect of 500 mg of glutathione per day for 4 weeks in 60 volunteers. The participants got a lighter skin color on the face and forearms. Although glutathione is considered safe as a supplement, more research is needed on the long-term effects.

Food sources of glutathione include fruit, vegetables, and meat.

Tip 4: Supplement with Polypodium leucotomos extract (PLE) - Melasma

PLE is an extract from ferns, belonging to the Polypodiaceae family, and is known for its antioxidant and immune-supporting properties.

In a double-blind, randomized study, 40 people with melasma were followed for 3 months. The participants were divided into two groups: one group used a placebo, SPF50+ sun protection and a 4% hydroquinone cream, while the other group used 480 mg of PLE extract twice a day, along with the same sun protection and cream. After 3 months, it turned out that the group that only used PLE achieved significantly better results than the group that received the placebo.

Tip 5: Sunscreen with visible light coverage

Mineral sunscreen filters such as zinc oxide and titanium dioxide together provide broad protection against both UVA and UVB radiation and are not absorbed by the skin, reducing the chance of skin reactions and providing protection immediately upon application.

In addition, visible light, especially blue and green light, plays a role in the formation of pigment spots. Iron oxide helps block these light waves, thus reducing the risk of pigmentation.

For the best protection, choose a sunscreen that contains a combination of these mineral filters, so that your skin is protected against both UV radiation and harmful visible light.

Read our articles about pigmentation spots here

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