Viewpoint: Are Hyperpigmentation Treatments Doing More Harm Than Good?


Editor’s note: The opinions expressed in this article are not necessarily those of Skin Inc. magazine. Be sure to perform thorough research and training before offering any new treatment or retail item.

For decades, people have lamented the spots that develop on the face as they age. What if those spots were actually beneficial to the health of your skin? Should that change your approach to treating them? It is possible that some of the current strategies that are being employed to treat hyperpigmentation result in more spots throughout time. This article addresses the common misconceptions about the role of age spots, liver spots and melasma, and offers new ways to correct these issues without compromising the health of the skin.

Causes of common hyperpigmentation

Research suggests that the majority of age spots result from DNA-damaged melanocytes.1 Hundreds of them exist in facial skin, and they are constantly being bombarded by the sun. However, just about every melanocyte has DNA damage and very few are overreacting. What does that mean? The answer is in what lies beneath those melanocytes.

Age spots. The epidermis is on the front lines of UV damage, which is one reason why it sheds damaged skin every month. However, one key part, the dermal-epidermal junction (DEJ), does not. In my opinion, the repeated damage to the DEJ may be the trigger for age spots. Essentially, years of repeated sun exposure lead to a nonhealing wound on the DEJ. The wounded DEJ sends a message to nearby melanocytes to help protect the skin from more sun damage. As a result, the melanocyte creates the equivalent of a “melanin umbrella”—also known as an age spot—that serves to provide extra protection to the damaged zone. If you think about it, this is no different than a tanning response, which creates melanin to protect a larger damaged zone caused by a sunburn. The skin always does what is best, even though it may not always seem like it and, in this case, the age spot is an appropriate response.

Melasma. A similar response can be tied to melasma. Underneath melasma is inflamed skin, and the excess pigment created is designed to protect that area from sun damage. However, I believe the difference between melasma and age spots is that melasma originates from liver damage usually caused by birth control pills. Sun damage makes it worse, because the skin is already inflamed and more damage will trigger the skin to create more pigment. The same is true for lasers and peels that “cause melasma.” The skin was already compromised from the liver effect and the inflammatory procedure pushed it to a higher level of inflammation, which triggered the “melanocyte shield.” These inflammatory treatments are not the cause, but they should be avoided for obvious reasons.

Liver spots. Liver spots may be the toughest challenge. Although these do originate from the liver, I believe spots that show up before age 55 are from environmental sources and those after 55 are from the natural aging process of the liver. Liver spots that arrive after age 55 do not respond to liver-repair strategies, because the damage is more DNA-based and looks similar to the DNA damage that all other cells face, so the body is not inclined to repair it. For this reason, spot-treating with traditional lighteners makes sense for this over-55 category of liver spots, because nothing else will probably work … alas.

Ingredient and treatment options

The exciting news is that options now exist for the majority of the pigmentation people develop. I have found great success with repairing the DEJ by using DNA-repair strategies, such as AC-11 from Optigenex Inc., a natural, water-soluble extract of a tropical plant known as Uncaria tomentosa, and zinc finger nuclease technology, a class of engineered DNA-binding proteins that help facilitate genome-editing by creating a double-stranded break in DNA at a user-specified location. AC-11 and zinc fingers help perform DNA repair and wound-healing combined.

Another successful ingredient for healing the DEJ is sweet wormwood extract. However, to address liver spots that form before 55 and melasma, liver health should be addressed. Although there are many herbs that support liver health, I have only found one that works well to help treat liver damage: sweet wormwood extract. DNA repair probably requires ongoing therapy to keep up with the accruing damage. AC-11 and zinc finger technology perform better with twice daily applications, but visible benefits may be seen using them once a day, as well. AC-11 can also be consumed internally. Backbar treatments are enhanced whenever DNA repair technologies can be added to your facials.

Are lighteners doing more harm than good?

Melanocytes are one of the most important skin-protecting cells in the body. As you may know, the more pigment the skin has naturally, the slower it ages. Black skin, for example, has a natural SPF of about 14 and, as a result, rarely develops a wrinkle before the age of 60. Caucasian skin, however, has an average SPF of about 4 and often develops wrinkles by the age of 30. The pigment the body produces is called melanin, and it absorbs UV light remarkably well. That is why the skin puts melanocytes on its surface , so they can provide the most protection possible. One of the great benefits of the aforementioned ingredient solutions to pigmentation is that they only normalize the pigment if the damaged skin beneath is healed at the same time. Traditional lightening strategies may actually increase damage to the delicate DEJ and dermal inflammation (melasma), because they increase the amount of sun exposure by reducing melanin content.

Many estheticians believe that when ingredients, such as hydroquinone, are applied to the skin, the condition is being treated. This is not the case. Instead, the production of melanin is simply being suppressed. Even when using acids, such as glycolic or other alpha hydroxy acids, the spots are not being treated, the amount of protective pigment being deposited in your epidermis is being reduced, which can temporarily make an age spot fade. The melanocyte is not being repaired in any way and melanin is being removed from the skin’s protective barrier. The added inflammation to skin that occurs with the use of hydroquinone and other lighteners may increase a client’s risk of skin cancer, age them even faster, add inflammation to the skin and even increases the presence on new age spots throughout time.

Truly treating hyperpigmentation

The skin is remarkable and operates almost flawlessly throughout a person’s lifetime. By understanding why extra pigment is produced, you can focus your attention on the causes of these conditions so you are not simply setting your clients up for a lifetime of lighteners. The future of skin care is a source-based approach that must include looking at internal causes for conditions, such as melasma. Treating—not just lightening—hyperpigmentation is now a real possibility.


  1. 1. ZP Harsanyi, PW Post, et. al, Mutagenicity of melanin from human red hair, Experientia 36 291–292 (1980)

Ben Johnson, MD, is a physician, internationally renowned educator, entrepreneur and inventor who has spent most of his career in esthetics. He is the founder and formulator of two innovative and successful skin care lines, most recently Osmosis Skincare.

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