Dark Spots

Dark Spot services offered in Bellevue, WA

Dark spots or (hyperpigmentation) is the name that healthcare professionals give to patches of skin that become darker than surrounding areas of skin.  At Serenity Rejuvenation Center in Bellevue, Washington, Dr. Stephen O’Connell uses a comprehensive approach to treat dark spots,  To schedule your consultation, call Serenity Rejuvenation Center or request an appointment online today. 

What is hyperpigmentation?

Hyperpigmentation occurs when the skin produces more melanin, the pigment that gives skin its color. This can make spots or patches of skin appear darker than surrounding areas. Hyperpigmentation is a common skin condition. It effects people of all skin types. However, certain types of hyperpigmentation occur more frequently in darker skin types

What are the types of hyperpigmentation?

Dr. O’Connell’s simplified list of different types of Dark Spots ( Hyperpigmentation) falls into a simplified list of 5 categories:
1. Sun damage (photodamage)
2. Post inflammatory hyperpigmentation
3. Benign pigmented lesions ( example - moles)
4. Melasma
5. Melanoma

1. What is sun damage? 

Physicians refer to the damage the sun does to skin by several names including photoaging, photodamage, solar damage, or sun damage. It happens when ultraviolet ( UV) light hits the skin unprotected by sunscreen , causing DNA changes at a cellular level. It is a type of premature aging, sometimes referred to as extrinsic aging.

The sun’s rays can take a toll on your skin. In the short -term, that can mean contending with a sunburn. However, there can also be long -term consequences even if you don’t experience a burn. The sun prematurely ages the skin, as photodamage happens in the deepest layers of the skin-the dermis, and it can take years before the damage surfaces and becomes visible. Skin changes such as fine and coarse wrinkles, roughness, freckles and pigmentation changes occur as a result of prolonged exposure to the sun.

What are brown spots related to sun damage?

In the case of sun damaged induced brown spots, the body produces more melanin to protect the skin from prolonged exposure to the sun. This can cause dark spots or patches on the skin called age spots, sun spots, or even increased freckling.

2. What is Post Inflammatory Hyperpigmentation ( PIH)

PIH is acquired  ( dark spots ) or hyperpigmentation occurring after cutaneous inflammation or injury that can arise in all skin types, but more frequently affects skin-of-color patients, including African Americans Hispanics/Latinos, Asians. Native Americans, Pacific Islanders, and those of Middle Eastern descent.  In fact, epidemiological studies show that PIH is among the most common reasons darker racial/ethnic groups seek the care of a physician with expertise in dealing with this issue. 

PIH can be confined to the epidermis ( more superficial skin )  or can occur within the dermis ( deeper layers)

What causes (PIH)?

When your skin cells react to damage or irritation by making extra melanin, post -inflammatory hyperpigmentation is the result. This skin condition shows up as tan, brown, dark brown, or even blue -gray patches and spots on your skin. 

Common causes of PIH
* Acne
* Pseudofolliculitis barbae  (curved hairs grow back into the skin causing inflammation and a foreign body reaction) 
* Allergic reactions ( ex: insect bites)
* Infections  
* Medication induced hypersensitivity reactions 
* Cutaneous injury ( ex: irritants, burns, cosmetic procedures)
* Papulosquamous diseases ( ex: psoriasis or lichen planus) 

Acne and pseudofolliculitis barbae are the most common causes in darker skin types.

3. What are benign (harmless) brown spots or pigmented lesions? 

Benign pigmented lesions are ( harmless ) or non cancerous.  Benign pigmented lesions can take several forms .  However , moles in particular must be monitored as these can change and at times convert into a malignant or ( cancerous) pigmented lesion.  Note that the other 3 categories including sun damage, post inflammatory hyperpigmentation, and melasma are benign pigmented lesions, although they deserve a category in of themselves.  

 A common  examples  of benign pigmented Lesions include
* Seborrheic keratoses
* Lentigines
* Moles

 What is seborrheic keratosis? 

Seborrheic keratosis are superficial skin overgrowth which are brown and slightly raised. They are due to aging and sun exposure. They can be seen on the face as well as the sun exposed areas on the body. They do not transform to skin cancer.

What are Letigines? 

Letigines are larger flat brown spots on the face and hands arising in middle age also resulting from sun exposure. Commonly known as age spots or liver spots.

What are moles?

Moles are due to abnormal collections of pigment cells (melanocytes) in the skin. They occur in childhood, adolescents and early adulthood. Most moles are dark and pigmented.  Moles are small, flat and pigmented when they appear but with aging, they become raised, dome shaped and often appear lighter. Moles that develop irregular borders, bleeding or sudden increase in size are a cause for concern ( see below). 

Malignant ( cancerous) pigmented lesions can take several forms, including:
* Basal Cell Carcinoma- one of the most common forms of skin cancer, has a pigmented variant and van be misdiagnosed.


Melanoma is a dangerous skin cancer  commonly caused by UV exposure, although approximately 25 percent of melanomas begin as moles. The visual appearance of melanoma is variable, with progressive changes in color and size often noticeable over a short period of time. However, any change in the following parameters could be indicative of a melanoma. 
Asymmetry: change in symmetry
Border: irregular borders & or bleeding
Color: darkening of the color
Diameter: increasing diameter.

Simple screening  using  the” ABCD”  acronym  for assessing change in dark  lesions, should routinely be performed   by the prospective .

At Serenity Rejuvenation Center , we educate our patients on the importance of screening for change in any dark spots or hyper-pigmented  lesions,  most notably moles. In Washington State , surprisingly we have one of the highest incidence of melanoma in the country. 

What is melasma?

Melasma is an acquired hyperpigmentation derived from the Greek word “ melas “ which means black. Melasma happens because of overproduction of the cells that make the color of your skin. It is common, harmless and some treatments may help.

Where does melasma most commonly occur?

Melasma appears most commonly on your cheeks, nose, chin, above the upper lip and the forehead.

How common is melasma?

Melasma is a very common skin disorder affecting over 5 million people in the United States. Predisposing factors are race , genetics, sex, pregnancy, sun exposure, and heat ( without UV exposure).

Epidemiology of melasma

Often referred to as “ the mask of pregnancy “ , I feel that this term is appropriate however confusing for patients, as men get melasma as well, and its only part of the picture.

Race and melasma

Persons of any race can be affected by melasma. However, melasma is much more common in constitutionally darker skin types than in lighter skin types.

Genetics and melasma

There is a clearly some role for genetic predisposition, as family history of melasma is known to be an important risk factor for its development. Somewhere in the range of 60 percent of patients with melasma have a family history of this condition.

Sex and melasma

Melasma is much more common in women than men. When men are affected, the clinical and histologic picture is identical.

Heat and melasma

Heat is a very common trigger for melasma as it increases vasodilation. Hot yoga studios, saunas and steam rooms are high heat areas that can exacerbate existing hyperpigmentation.

Most importantly , the vast majority of cosmetic lasers used by physicians to treat hyperpigmentation operate using heat as the mechanism the mechanism of action. This is extremely important to be aware of. In fact with the advent of picosecond pulsed duration lasers using a ( pressure) mechanism –the gold standard in the cosmetic laser treatment of melasma has changed. In fact, PicoSure is the worlds First & Only 755nm FDA-cleared Laser to Treat Melasma.

Is there a cure for melasma?

Melasma is notoriously difficult to treat. The pigment of melasma develops gradually, and resolution is also gradual. Resistant cases or recurrences of melasma occur often and are certain if strict avoidance of sunlight in not followed.

What is our approach to treating dark spots or hyperpigmentation? 

Comprehensive Approach
Evaluation: Dr. O’Connell & Serenity Rejuvenation Center will conduct a thorough assessment in helping you differentiate what type of “dark spots” that you may be dealing with and from there we will develop a treatment plan.

Treatment really depends on the type of dark spots in which we are dealing with . We often incorporate one or a combination of the following tools:

Specific skin care topical products
Chemical peels
IPL Photofacial
In the case of Melasma- the vast majority of cosmetic lasers used by physicians to treat hyperpigmentation operate using heat as the mechanism of action. This is extremely important to be aware of.

In fact, with the advent of picosecond pulsed duration lasers using a (pressure) mechanism –the gold standard in the cosmetic laser treatment of melasma has changed. In fact, PicoSure is the worlds First & Only 755nm FDA-cleared Laser to Treat Melasma. PicoSure is the corrective laser treatment of choice .

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