New You Magazine Feature

PHOTOGRAPH BY GET T Y IMAGES
beauty COMPLEXION
lighten up
If freckles, age spots, and skin discoloration spurred by hormonal imbalance
have got you down, the beauty business is primed to even you out.
BY CATHERINE WINTERS
N
o person on earth has as many
spots on their skin as I do. I am covered in freckles, and a few years back,
large brown dots—there’s no other
way to describe them—appeared on
my hands and legs. There’s a patch of brown
pigmentation on my left cheek. Strangers
have informed me that I have dirt on my
nose. I don’t. I have two freckles that are
larger and darker than the rest.
My lineage, on both sides of my family,
is fair-skinned, blue-eyed Irish. I also happen to be cursed with the freckle gene gone
wild. My parents would boost my morale by
assuring me, insisting, “Freckles are a sign
of beauty.” My dermatologist now says I
have hyperpigmentation.
Forgive me, ancestors, but I long to give
these dark spots the boot. The worldwide
market for skin lighteners is expected to hit
$10 billion by 2015. That’s quite a number of
people who have declared war on their pigment. A 2006 study published in the journal Evolution and Human Behavior found that
women with uneven skin tone were perceived
as older and less attractive than those with
more even pigmentation. Hmmmph.
You can’t blame people for wanting an
even complexion. According to Zoe Diana
Draelos, MD, a consulting professor of
dermatology at Duke University School
of Medicine and founder of Dermatology
Consulting Services in High Point, North
Carolina, it’s “hardwired into us.”
AN INSIDE LOOK AT PIGMENT
Melanin is the pigment that gives our skin,
hair, and eyes their color. Some people’s
melanocytes—or pigment-producing
cells—do what they’re supposed to. Other
genetically susceptible individuals experience an overproduction of melanin churned
out by their melanocytes, due to sun exposure, hormones, injury, or even medication.
The result is hyperpigmentation—freckles,
blotchy areas, or age spots.
Sun exposure is a common reason for
fired-up melanocytes. Sun damages skin,
then melanocytes produce more melanin to
protect against further damage. While many
individuals enjoy a nice, golden-brown tan,
others get sunburned. Still others (like me)
end up with uneven patches of color.
The age spots (otherwise known as liver
spots) on my hands and legs
can also be traced to sun
exposure. Dermatologists
call these “solar lentigines.”
They make their presence
known as one gets older, on
sun-exposed spots such as
the face, hands, and arms.
Solar lentigines occur when
melanocytes cluster together.
“Cells normally shed when
they reach the top layer of
skin,” says David Bank,
MD, director of the Center
for Dermatology, Cosmetic
& Laser Surgery in Mount
Kisco, New York. Over time,
pockets of these cells may
get “a little sticky,” he says.
They feel no thicker than surrounding areas, however, “they stack up on
top of each other and thicken slightly, looking a little darker. Under the microscope,
you see extra layers of skin piled on top of
each other.” Solar lentigines, which range
in color from tan to black, may be large in
some cases. Other times they may resemble
an ink spot. Though benign, some resemble
skin cancer. (Be sure to have your dermatologist check such spots out.)
Meanwhile, hormones and sun exposure
cause a condition called melasma—brown
or grayish-brown patches that appear on
the cheek, forehead, nose, chin, and upper
lip, according to the American Academy
of Dermatology. “It’s a lacy-brown discoloration,” says Dr. Draelos. Melasma can
appear during pregnancy (it has been called
the “mask of pregnancy”) or when a woman
takes birth control or undergoes hormone
replacement therapy (HRT).
Estrogen is the hormonal
culprit here. When the skin
of a genetically susceptible
woman is exposed to ultraviolet (UV) light. “Estrogen hormones turn pigment cells into
super responders,” says Dr.
Bank. Instead of producing
normal amounts of melanin,
they produce larger amounts.
Experts don’t know why, but
estrogen produces hypersensitive pockets of color. “You
get islands of increased pigment darkness against relatively normal skin,” Dr. Bank
says. Meanwhile, sun exposure
causes melasma to darken.
Melasma is most common
in individuals with darker skin—those of
Hispanic, African, Asian, or Indian descent.
While it will often disappear once a woman
gives birth or stops taking birth control pills
or HRT, in certain circumstances it can
hang around for life.
The worldwide
market for
skin lighteners
is expected
to hit $10 billion
by 2015.
People have
declared war on
their pigment.
NEW YOU
|2
Darker-skinned women are also at
higher risk for post-inflammatory hyperpigmentation (PIH), which is characterized by light brown or dark brown areas on
skin. “Following inflammation, skin pigment deepens,” says Valerie D. Callender,
MD, associate professor of dermatology at
Howard University College of Medicine in
Washington, D.C. The most common cause
of PIH in women of color is acne, says Dr.
Callender. But darker areas can also appear
after as a result of inflammatory conditions such as eczema or psoriasis, or after
an injury such as a burn has healed. PIH can
also be caused by medications, such as tetracycline or anti-cancer drugs.
TACKLING THE PROBLEM
The goal of over-the-counter and prescription skin lightening products is to lighten
or eradicate bothersome spots and patches
of uneven color. A more even skin tone is
achieved by inhibiting the production of
an enzyme called tyrosinase. This enzyme
regulates melanin production, keeping the
melanin from entering cells (called keratinocytes) in upper layers of the skin.
Your top layer of skin turns over about
every 28 days, explains Zakia Rahman, MD,
a clinical assistant professor of dermatology at Stanford University who specializes
in laser and aesthetic surgery at the Stanford
Hospital and Clinics. The pigmented cells
slough off. Over-the-counter and prescription lighteners can help fade whatever pigment remains. “The hope is that new skin
cells won’t have the pigment,” says Dr.
Rahman. Alas, some dark areas such as age
spots or melasma may be so entrenched that
cell turnover doesn’t make much difference.
Even if topical lighteners get rid of pigment, slight sun exposure can cause dark
spots to return or deepen. That’s why freckles may fade during the winter but return
with a vengeance during the summer when
a person spends more time outdoors.
A GLOSSARY OF LIGHTENERS
A wide range of active ingredients can help lighten skin. Here, a rundown of some of the most
common components.
F Hydroquinone “This is the workhorse pigment-lightening ingredient in the marketplace today,”
says Dr. Draelos. Two percent hydroquinone is “minimally effective. If you want to see a good
result, use 4 percent.”
F Retinoids After hydroquinone, retinoids are dermatologists’ top lightener. Derived from vitamin A,
retinoids inhibit the transfer of pigment from melanocytes to keratinocytes, cells in the top layer of
skin. OTC retinoids are known as retinol. Their prescription cousin is retinoic acid.
F Azelaic Acid Derived from a yeast that lives on skin, prescription azelaic acid is used to treat
rosacea and acne. However, it may be used off label to lighten melasma and post-inflammatory
hyperpigmentation. Ten percent strength azelaic acid is available over-the-counter. The
prescription form is generally 15 to 20 percent strength.
F Kojic Acid Derived from a fungus, kojic acid works like hydroquinone, inhibiting pigment
production. Kojic acid has been widely used in Asia to treat melasma and bleach skin.
F Glabridin The main ingredient in licorice extract, it inhibits pigment production and also acts as
an anti-inflammatory.
F Arbutin A derivative of hydroquinone that is less potent, arbutin inhibits pigment production,
though it may also cause hyperpigmentation. It has been typically used to treat PIH.
F Niacinamide A form of vitamin B3, this reduces the transfer of pigment to keratinocytes in a cell
culture by 35 to 68 percent, according to a 2002 study in the British Journal of Dermatology.
F Vitamin C This potent antioxidant interferes with the production of melanin. Because it’s unstable,
however, it’s hard to deliver the right dosage of vitamin C into skin. Often it’s combined with
other pigment-lightening ingredients. Because it’s an anti-inflammatory, it may prevent PIH. It
may cause redness, dry skin, and stinging.
3
| NEW YOU
Different lighteners have different active
ingredients; some may have more than one.
Choosing the right lightener can be a matter of trial and error and preference. If your
skin is sensitive, try a product containing
more natural ingredients. If your pigment
issue is mild, you might be fine with an overthe-counter formulation. If you have more
severe discoloration, you may need a prescription product. Your dermatologist may
also have you use more than one lightening
product simultaneously. “You get a team
effect,” says Dr. Bank.
When topicals don’t do the job, your
physician may recommend laser therapy
to vaporize pigment cells in deeper layers
of skin. Dr. Rahman may prime a patient’s
skin with a topical prior to performing laser
surgery. Treating an underlying problem is
also crucial. If acne sparked your pigment
issue, your dermatologist will tackle that
as well. “I get patients on a good acne regimen to prevent new break-outs,” says Dr.
Callender. That could consist of prescription medication or oral antibiotics.
One essential ingredient that can’t be formulated: patience. Dark spots don’t lighten
overnight. “Getting rid of pigment is a very
slow process,” says Dr. Draelos. It can take
at least three months to notice an improvement—longer to lighten super dark spots.
Even then, you aren’t necessarily going to
end up with unblemished skin. “You can
lighten dark spots, but it’s very difficult to
get rid of them,” says Dr. Draelos.
Skin lightening is only part of the equation. Reclaiming an even complexion
requires “a two-pronged attack,” says Dr.
Bank. “You need an active fading agent to
get rid of excess pigment, and sunblock to
prevent new pigment from being put down
and replacing the old pigment.”
This requires vigilance. Dr. Draelos has
her patients wear a sunscreen with an SPF
of at least 30 whenever they venture outdoors. “If you go one day without sunscreen,
all the pigment lightening that occurs may
be undone,” says Dr. Draelos. “You treat the
pigmentation for months to lighten it and it
darkens within an hour.” l
beauty COMPLEXION
CHOOSING A LIGHTENER
The skin lightener you use will depend upon preference, price, and your pigment issue. If you have mild discoloration, start with an over-the-counter
formulation. If you don’t get results, try a physician- or spa-dispensed product. If your problem is severe, you may need a prescription lightener.
While a physician-dispensed or prescription product may cost more, you’ll get better, faster results than you would with an over-the-counter lightener.
P H O T O G R A P H B Y K AT R I N A KO J I C
OVER-THE-COUNTER
Rapid Tone Repair, the
new line from Neutrogena,
promises results in as little
as one week. Products
feature “Accelerated
Retinol SA” technology to
diminish the appearance
of age spots, vitamin C to
even skin tone, hyaluronic
acid to rejuvenate skin, and
glucose complex to boost
skin’s cell turnover ($21
each, neutrogena.com).
L’Oréal Paris Youth Code
Dark Spot Correcting &
Illuminating Collection
features a Serum Corrector
to reduce the appearance
of pigment by 78 percent,
antioxidants to brighten
and protect skin, and
chestnut seed extract to
boost natural exfoliation. It
also features a day cream
containing vitamin B3 and
SPF 30 to shield skin
from further sun damage
($25 each, ulta.com).
Circadia White Veil
Brightener gently
diminishes age spots
and sunspots. Circadia’s
brightener can be used
as a moisturizer under
sunscreen. It contains
K3 Vita C (a stabilized form
of vitamin C), which has
a lightening effect. AlphaArbutin, SepiWhite MSH,
B-white, and Chromobright
work together to inhibit
the production of pigment
cell enzyme, tyrosinase
($65, circadia.com).
MD Complete Anti-Aging
Dark Spot Remover
promises to visibly fade
dark spots, even skin,
and brighten complexion
with consistent use.
Containing hydroquinone;
vitamins B, C, and E;
allantoin; and berry
extracts, this formula
lightens, promotes collagen
production, soothes the
skin, and evens everything
out—all without parabens
($40, target.com).
SPAS AND DOCS
SkinMedica Lytera Skin
Brightening Complex has
niacinamide, licorice root
extract, and other potent
ingredients to diminish the
appearance of dark spots
($125, skinmedica.com).
SkinCeuticals Advanced
Pigment Corrector is
considered as effective as
a RX hydroquinone and
0.025 percent tretinoin.
It contains salicylic acid
to exfoliate skin and
prime it for spot-reducing
ingredients, melanintaming hydroxyphenoxy
propionic and ellagic acids,
and yeast extract to help
skin resist spots ($90,
skinceuticals.com).
Epionce MelanoLyte
Pigment Perfecting
Serum is the latest entry
in the MelanoLyte Skin
Brightening System. It’s
a gentle, botanics-based
serum that brightens skin
and fights inflammation
($99, epionce.com).
Obagi Nu-Derm
System Products have
ingredients such as
hydroquinone that improve
hyperpigmentation, age
spots, and uneven skin
tone while smooththing
fine lines and wrinkles
($440, obagi.com).
NEW YOU
|4