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    Learn what hyperpigmentation is and what you can do about it.

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    Reviewed by Mohiba Tareen, MD

    WebMD Magazine - Feature

    How to Fight Dark Spots on Your Skin

    No one likes marks on their record -- or complexion. You've probably heard words like melasma and liver spots. Both refer to the same condition: hyperpigmentation.

    "Damage due to inflammation, UV exposure, and other environmental insults causes the cells to produce more pigment to protect themselves," says Carl R. Thornfeldt, MD, a dermatologist in Fruitland, ID. Changes in estrogen levels (due to birth control pills or pregnancy) can also play a role.

    This results in uneven pigmentation, a common condition that can affect any skin tone, "but in different ways," says Elizabeth Tanzi, MD, assistant clinical professor of dermatology at George Washington University. Lighter skin tones tend to develop freckles and sun spots, while darker skin looks shadowed or patchy, she says.

    Since the causes of uneven pigmentation are so common -- and the demand to correct the condition is so high -- many options exist for treating brown spots and patches. But you can't treat all spots equally. Before you pick a course of action, see your dermatologist, Tanzi says. Ingredients can be harsh and irritating, so get advice about which to use and how to safely use them the right way.

    One option is hydroquinone, a prescription topical cream that slows down the pigment-making processes in the skin, Tanzi says. "Hydroquinone is one of the strongest and most effective brightening agents we have," she says. But at high concentrations it can be toxic to the skin, she says. (Some countries have banned it. In the U.S., most doctors think a low dose is safe, but they closely watch their patients.)

    Doctors usually prescribe a 4% hydroquinone cream, and a 2% version is available over the counter. "Hydroquinone can be irritating and can actually increase pigmentation if used for too long, so I have patients take a ‘holiday' every 3 months and use other lightening agents," Tanzi says. Your doctor may suggest alternating hydroquinone with over-the-counter (OTC) treatments to limit irritation and avoid an adverse reaction.

    Retin-A (tretinoin) and steroids may be prescribed in addition to or in place of hydroquinone, but they might not work as well, says William Rietkerk, MD, an associate professor of dermatology at New York Medical College.

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