Sure, I wore my SPF religiously, but by October, my skin was a mess. I was less concerned about the texture (rough and definitely in need of an at-home peel) than I was about the splotchy sun spots. They looked like freckles gone haywire, and I still had my regular freckles on top of that. No problem, I thought. I'll just head to my trusty derm so she can laser them off. That's what all this Fraxel and CO2 hoopla is about, right? Actually, wrong—according to my personal dermatologist, Dendy Engelman, MD.
I’ve been writing about beauty for 12 years, so I’m not a skin-care novice, but Dr. Engelman's "no" came as a surprise. Turns out, for people with skin of color, like me (I’m pale and East Asian, but I tan very easily and my skin is prone to keloid scars), the in-office treatments for hyperpigmentation are extremely limited.
Why is hyperpigmentation in skin of color so tricky to treat?
All those wonderful stories you’ve heard about Fraxel and CO2 lasers? You can kiss those skin-brightening benefits goodbye if you have skin of color. The devices heat the skin and trigger inflammation, which can push the melanocytes (cells that produce our pigment) into overdrive and cause further skin darkening. Even gentler lasers like Clear & Brilliant, which is considered safe for skin of color, aren't all that helpful. “Clear and Brilliant: You’re not going to see much, and it only truly does overall brightening,” Dr. Engelman says. “You’d also have to go to the office so many times to see any results.” So, what does work? Here's what I discovered.
Which in-office treatments safely fade spots on skin of color?
IPL (Intense Pulsed Light) treatments—aka, the photofacials that my white girlfriends rave about—are specifically designed to tackle hyperpigmentation. IPL has gained popularity in Asia in recent years because it’s one of the few ways to treat spots on skin of color, says Heather Woolery-Lloyd, MD, a Miami-based dermatologist and the director of the Skin of the Color Division within the University of Miami's Department of Dermatology and Cutaneous Surgery. But, she adds, there’s still a risk of more hyperpigmentation. “It comes down to your risk tolerance of something going wrong—and I am very risk-averse,” says Dr. Woolery-Lloyd. Although she tends to avoid it in her practice, she admits that there aren't many other light-based treatments for fading a concentrated sunspot.
To add confusion to the matter, not all IPL devices are created equal. After consulting with Lumenis, the manufacturer of the Stellar M22, a multifunctional device, Dr. Engelman used its IPL applicator on me at a very low setting. “It is safe on darker skin types because the sub-pulse can be programmed differently for different indications,” she says. This helps to prevent overheating the skin. "Not having that lingering heat decreases the risk of post-inflammatory hyperpigmentation or a possible burn," she shares.
It ended up taking three treatments for me to see a difference, but that's normal, according to the experts like Arash Akhavan, MD, a Manhattan dermatologist who says he has been able to use lasers—specifically the PicoSure laser—to treat patients with skin of color. But that, too, takes multiple office visits, which means that it's expensive. “To ensure safety for skin of color, lowered settings will be used, necessitating more treatments to achieve the same results,” he explains. “It is important to convey this to patients from the outset so that realistic expectations are set.”
And, again, some doctors are still wary of using most types of laser and light treatments on skin of color. For example, Dr. Woolery-Lloyd says she's seen cases where the PicoSure laser has caused hypopigmentation—or a lightening of the skin around the treated area. Definitely not the look I'm after.
Another option is microneedling, wherein devices create tiny pin-pricks in the skin. At present, it's more well-known for its ability to improve skin texture; however, Dr. Akhavan says he uses this technique to break up certain types of stubborn pigmented spots in skin of color. The mechanism through which the pigmentation fades is a bit in question: The truth is microneedling studies really only focuses on texture so it's not totally clear if it's actually breaking up pigment too. Some docs tend to think so, like Dr. Akhavan, but almost all docs think this method is very limited. Instead, pros suspect that by creating small micro-channels within the skin, brightening ingredients that are applied after, can get deeper into the complexion and work on areas of hyperpigmentation. Dr. Woolery-Lloyd noted that colleagues in her practice have been trying this out, and there's a relatively safe risk-benefit ratio, but noted that it’s primarily designed to address scarring.
Medical-grade peels and exfoliation treatments
There are all sorts of medical-grade peels and acid-based treatments that can help with pigmentation issues. One service I loved was the HydraFacial, which is available at dermatologists' offices and med spas. The hand-held device is designed to gently vacuum up the dead skin cells and sebum that can clog pores at the same time it pushes topical treatments into the skin. My technician loaded it with a blend of glycolic and salicylic acids, which can brighten and smooth skin. It’s not going to get rid of individual dark spots in one treatment, but it can help to improve subtle discoloration over time, says Jared Jagdeo, MD, a dermatologist and the chief medical officer of Ever/Body, a med spa with locations in New York City.
Dr. Jagdeo suggests a course of five monthly HydraFacials (again, expensive). And, your technician can personalize the treatments with “booster” serums containing alpha arbutin, vitamin C, and bearberry extract to help with pigmentation. “Britenol is a booster serum that helps to minimize the appearance of dark spots, sun spots, and hyperpigmentation," he says. "ZO BrightAlive is another booster that…reduces the appearance of brown spots, evens skin tone, prevents new pigmentation formation, and restores hydration.”
Why are skin of color in-office solutions so limited?
The quest to fade my spots left me wondering why there aren't more in-office options for skin of color. Experts say one reason is a lack of research. Darker skin types are often more difficult and dangerous to treat, explains Dr. Engelman, so many device manufacturers don't include people with skin of color in their laser studies "due to the risk of an adverse event." Dr. Woolery-Lloyd, who has specialized in skin of color for almost 20 years, says there has been more research on skin of color when it comes to topical treatments, so things are improving in that area, but there’s still a lot of work to be done.
Another reason? "Regrettably, I think it comes down to less representation in the industry and therefore less demand," says Dr. Engelman. We'll remind you that, at present, dermatology remains among the least diverse medical specialties, but there have also been pushes to move beyond that. "I love that there is a huge shift to inclusion and solutions for all skin types, as it helps us to better serve our patients," says Dr. Engelman. "[We] need to continue to shed light on our shortcomings and highlight pioneering solutions for all skin types."
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