How Can I Treat Spots at Home? continued...
To try: Neutrogena Visibly Even Night Concentrate ($12, drugstores).
To skip: So-called brightening or lightening cleansers. They won't hurt you — but they also won't do anything more than wash your face. "They're not on the skin long enough to make a difference," says Dr. Hirsch.
Protect your results. "Sunscreen is essential," says Paul M. Friedman, M.D., clinical assistant professor of dermatology at the University of Texas at Houston. "Sun exposure can trigger production of the pigment you are trying to eliminate — and almost any treated dark spot can recur if exposed to UV light." And, yes, you still need the stuff if you have darker skin. A recent Johnson & Johnson study of hyperpigmentation in African-Americans found that participants who simply added an SPF 30 sunscreen to their daily routine (and used no other additional treatments) saw significant improvement in their pigmentation, skin tone, and radiance after eight weeks.
To try: La Roche-Posay Anthelios SX Daily Moisturizing Cream SPF 15 ($29, CVS), Aveeno Positively Radiant Daily Moisturizer SPF 30 ($14, drugstores), or Roc Retinol Correxion Hand Repair with SPF 15 ($15, drugstores).
What Can My Derm Do to Help?
These days? A lot. "Dermatologists and plastic surgeons have a whole arsenal of light-based treatments available," says Dr. Friedman, who recommends pigmented-lesion lasers such as ruby, Nd:YAG, or Alexandrite for specific spots, and the Fraxel laser for allover improvement of substantial irregular pigmentation. For more subtle, diffuse discoloration, Dr. Wattenberg prefers a series of intense pulsed-light photofacials. Some spots can be zapped in one session; more stubborn or severe discoloration can require multiple treatments. Another option: glycolic, alpha, or beta hydroxy acid peels, which slough off the surface layers of skin, softening the appearance of uneven tone. Some doctors will combine peels with laser or light therapy, and they will almost always prescribe at-home treatment as well. "In-office procedures are quicker, but they work best when accompanied by home therapy," says Dr. Wattenberg. Costs for most in-office treatments vary depending on several factors (the size of the area being treated, the severity of your condition, and the going rates where you live); the average is about $500 per session for pigmented-lesion lasers; $1,000 for Fraxel; $150 and up for peels. (Bonus: Many of the treatments will also help with wrinkles.)