A: Freckles are small hyperpigmented "spots" on the skin. They occur on sun exposed areas and will darken in the summer and fade in the winter. Freckles are benign and are a sign of increased sun exposure and sun related damage. Retinol creams, bleaching creams and mild acid peels are used to lighten the dark areas. As freckles are related to sun exposure, sunscreen/block is mandatory. An SPF of 30 or above is recommended.

A: Melasma is a skin condition of hyperpigmentation related to female hormones and sun exposure. Traditionally, bleaching agents containing hydroquinones and sunscreen are used. For most people this is very effective. However, in a small percentage of darker skin people, the skin will actually get darker from the hydroquinone. In cases like this, retinoids, bleaching acids (such as kojic acid), exfoliating agents and sunscreen must be used. This is difficult, so be meticulous and persistent!

A: Hyperpigmentation is the result of over active melanocytes (pigment cells) in the skin. Why these cells get overactive is unclear. The stimulus may vary from person to person. For example: some people are exquisitely sensitive to birth control pills and others are not.

When I have patients with resistant hyperpigmentation, I stop everything that could be contributing to the problem. If the patient is on birth control pills, this is reviewed with the primary care physician or OB/GYN before stopping or changing treatment. There is also a very small fraction of people that are resistant to the hydroquinones (traditional bleaching agents). I then use other treatments including peels, Retinols and topical vitamin C. Sunscreen, SPF 15 or greater, is a must two to three times a day.

A: Melasma is a common skin condition of hyperpigmentaion on the face. It is more common in females especially during pregnancy. This condition is especially sensitive to sun exposure. Bleaching agents, hydroquinones, are a good start; however, there are other products that are also beneficial. Examples include home glycolic acid peels, retinoids, alpha hydroxy acid products and sunscreen. Read YourSkinDoctor.com article on Hyperpigmentation for a comprehensive overview.

A: Chloasma is another name for melasma which is hyperpigmentation of the cheeks, forehead, upper lip and nose. It is more common in women and is seen more commonly with pregnancy and oral contraceptives. It also seen with over sun exposure, some cosmetics, and sun sensitive drugs such as seizure medications or some antibiotics. Bleaching creams/gels (hydroquinone) is the most common treatment used with sunscreen. Bleaching creams/gels must be used twice a day along with sunscreen (SPF 15 or above) every 3-4 hours. Remember sunlight comes right through the car window. If the above is ineffective, I would add retinol and exfollients such as acid peels. (YSD Product Recommendations - Skin Lightening Gel, Retinol and Hydroxy Acids.) This is a condition that you can control but not cure. Stay consistent and it will improve!

A: Dark circles under the eyes are from the underlying vasculature and pigment (melanin) deposition in the skin. Topical vitamin C, bleaching agents and sun protection (such as YSD’s Youth Serum C, Skin Lightening Gel and Daily Protectant Sunscreen) are particularly useful. Alternate the products morning and night. Sun protection must be applied twice a day with at least an SPF 15.Concealers may be applied in addition. If the area is red or pink, use a pale yellow color. If the discoloration is bluish or purple, try a green or yellow concealer and then apply a powder or foundation to cover the green.

A: Dark areas around the neck and under the arms can represent a condition called acanthosis nigricans. This is a condition where the skin has a brown velvety texture and is associated with folds in the skin, especially around the neck and under the arms. There are hereditary and acquired forms of this condition. It is a condition that sometimes is associated with being overweight. There is also a distant association with diabetes mellitus.

If you are overweight, sometimes losing weight can help this condition. I would also contact your physician and discuss the possibility of diabetes mellitus.