Hyperpigmentation

Sun spots, also known as solar lentigines, are flat brown or tan patches that form on areas frequently exposed to the sun, such as the face, hands, shoulders, and chest. They occur when ultraviolet (UV) radiation triggers an overproduction of melanin—the pigment responsible for skin color. Over time, these spots can become more noticeable, especially after years of sun exposure without adequate protection.

Age spots, sometimes referred to as liver spots, are similar in appearance to sun spots but are primarily linked to the natural aging process. As the skin matures, its ability to regenerate slows, and pigment cells (melanocytes) become more active in certain areas, producing localized dark patches. Although these spots are benign, they can make the skin appear older and uneven in tone.

Hyperpigmentation is a broader term that describes any condition in which patches of skin become darker than the surrounding area. It can result from sun exposure, inflammation, hormonal fluctuations, or certain medications. Common forms of hyperpigmentation include melasma (often triggered by hormones), post-inflammatory hyperpigmentation (after acne or injury), and freckles.

These pigmentary changes vary in size, shape, and color intensity. Most often, they appear as:

• Flat, round, or irregularly shaped brown, tan, or black patches on the skin
• Lesions that are darker than the surrounding skin but not raised or painful
• Clusters of small spots or larger patches that develop gradually over time

Sun spots and age spots are typically painless and smooth to the touch. They don’t fade like a temporary tan and may darken with further UV exposure. In some cases, hyperpigmentation may appear uneven or blotchy, particularly in individuals with medium to darker skin tones.

While most pigmentary spots are benign, sudden changes—such as rapid growth, irregular borders, multiple colors, or bleeding—should always be evaluated by a dermatologist to rule out skin cancer or other underlying conditions.

The main cause of sun spots and age spots is prolonged exposure to ultraviolet light from the sun or tanning beds. UV radiation accelerates melanin production as a protective response, leading to localized areas of darker pigment. Over time, these pigment clusters become permanent features on the skin.

Other factors can increase the likelihood of developing hyperpigmentation including:

1. Aging: As skin ages, cell turnover slows, allowing pigment irregularities to become more visible.
2. Hormonal changes: Pregnancy, birth control pills, and menopause can trigger melasma—a form of hormonal hyperpigmentation that presents as symmetrical brown patches on the cheeks, forehead, or upper lip.
3. Inflammation or injury: Skin trauma, acne, eczema, or even cosmetic procedures can leave behind dark marks as the skin heals, a condition known as post-inflammatory hyperpigmentation.
4. Genetics: Some individuals are naturally predisposed to developing sun spots or freckles due to inherited pigment cell activity.
5. Medications and chemicals: Certain drugs, such as antibiotics, chemotherapy agents, or hormonal treatments, can make the skin more sensitive to sunlight or alter melanin production.

Environmental exposure, lack of daily sunscreen use, and cumulative UV damage are the most common underlying causes across all skin types.

A proper diagnosis begins with a clinical skin examination board-certified dermatologist Dr. Joshua Freedman. During your consultation, Dr. Freedman evaluates the location, color, size, and texture of the spots to distinguish benign pigmentation from potentially precancerous or malignant lesions.

In most cases, visual inspection and dermoscopy (a magnified examination using a specialized surface microscope which allows the dermatologist to see through you upper layers of skin) are sufficient for diagnosis. However, if there is any concern about abnormal growth or irregular pigmentation, a skin biopsy may be performed to confirm that the spot is not cancerous.

Dr. Freedman also considers lifestyle, sun exposure history, medication use, and hormonal factors that might contribute to pigmentation changes. Advanced imaging tools or digital complexion analysis may be used to assess the depth of pigment and guide treatment recommendations.

While over-the-counter creams and home remedies are widely available, they are often ineffective or may even worsen pigmentation if the underlying cause is not properly identified. Dermatologists can accurately differentiate between surface-level pigmentation and deeper pigment deposits in the skin. This distinction is important because it determines the most effective treatment approach—whether through topical prescription creams, laser therapy, chemical peels, or other dermatologic procedures.

Additionally, professional evaluation ensures that serious conditions such as melanoma are not mistaken for benign age or sun spots. Dr. Freedman’s expertise in both medical and aesthetic dermatology allows him to provide a comprehensive evaluation that not only identifies the cause of pigmentation but also offers safe, evidence-based treatment solutions to restore clear, even-toned skin.