Sun damage, hormonal influences, medications, inflammation from other skin conditions, injuries, and lack of being on an effective photoprotection skin care regimen can contribute to mottled hyperpigmentation, brown spots, and dark patches.
Combination therapies are associated with the best results. The unwanted excess melanin (pigment) in the skin must be addressed. Microneedling can help even skin tone and texture. Narrowband intense pulsed light and laser can target cells containing too much pigment. The light is absorbed as heat by the melanin inside the cells causing pigment to slough off at the surface as small scabs.
Skin inflammation must be corrected to prevent recurrence . This means that underlying skin problems such as acne or a dermatitis must be treated to decrease overactivation of melanocytes from inflammation. Topical and oral medications can be prescribed to block over production of melanin from occurring by melanocytes. Finally, excellent photoprotection must be followed daily to protect skin from ongoing injury; this includes wearing photoprotective UPF rated clothing, wearing hats with at least a 4 inch brim, and applying high SPF broad spectrum sunscreen.
A number of treatment options exist for treating excessive pigmentation: chemical peels, laser, intense pulsed light, prescription topical lightening agents, high protection UVB-UVA sunscreens, and various antioxidants. In general, the most effective approach to lightening unwanted pigmentation is a combination of therapies. Higher sun protection factor (SPF) sunscreens (> 30) decrease stimulation of melanin production by melanocytes in the skin. Bleaching agents inhibit the enzyme that produces pigment. Lasers, intense pulsed light (IPL), and chemical peels help remove cells containing pigment by sloughing away pigment containing layers of skin. Other prescription topical medications can be used to increase shedding of excess pigment containing cells and inhibit transfer of melanin from melanocytes to the cells in the more superficial layer of skin where the pigment is more noticeable.
Pigment that is more superficial is easier to remove than pigment located in the deeper layers of skin. Any therapy used will require time and patience to see results. Laser, intense pulsed light, and peels need to be done as a series of treatments to be beneficial.