One of the most common cosmetic skin concerns is dark spots on the skin. Dark spots affect people of all ages, skin types, and tones and can remain long-term (and worsen over time) if not treated properly.
What causes dark spots on the skin?
Dark spots (i.e., hyperpigmentation) are produced when melanosomes (melanin-containing small capsules) accumulate in the skin either in small concentrated spots or larger areas. The most common causes of dark spots on the face are;
1. Sun: long-term excessive sun exposure (sun spots, age spots, and lentigines)
2. Hormones: hormonal changes (melasma)
3. Acne: post-acne dark spots (post-inflammatory hyperpigmentation).
What is the best way to treat dark spots?
The dermatologist gold-standard formula for treating hyperpigmentation (caused by any of the above) is the Kligman formula, a prescription named after its inventor, dermatologist Dr. Albert Kilgman. It was originally formulated in 1975 and has remained the most effective topical treatment formula for fading dark spots ever since. Due to its proven, long-term efficacy and safety, it was the inspiration behind the Advanced Dark Spot remover, formulated by Dr. Yoram Harth, now available to achieve similar results without a prescription.
What is the Kligman formula?
The original Kligman formula has been—and still is—the most popular physician-prescribed treatment option for hyperpigmentation. Dr. Kligman's idea was to combine several key ingredients with helping fade dark spots quickly and effectively. The formula has been tweaked slightly over time and is typically found with the below triple combination of compounds;
1. Hydroquinone: a medical-grade skin lightening agent (~4-8%) reduces tyrosinase activity, an enzyme involved in the production of new melanin (i.e., pigment). It is more effective than other brightening ingredients such as kojic acid, glycolic acid, and azelaic acid.
2. Retinoids: prescription-strength vitamin-A derivative (.025% tretinoin) to increase penetration of hydroquinone
3. Hydrocortisone: a mild steroid (mometasone 1.0%) to reduce the side effects of skin irritation induced by the two other active ingredients.
How effective is the Kligman formula?
Kligman's formula is the most effective hyperpigmentation formula available. Combined with sunscreen, it can help treat melasma, fade sun-induced dark spots (age spots), and is especially helpful with the treatment of post-acne dark spots.
What are the disadvantages of the Kligman formula?
1. Hydroquinone percentage: The high percentage of hydroquinone (4-8%)used in the formulas prescribed by dermatologists causes some rare cases of local paradoxical skin darkening (AKA ochronosis). This adverse effect is more frequent in people with dark skin types.
2. Prescription: Since the Kligman formula is only available with a prescription, it requires a dermatologist's office visit. On top of the prescription cost, a pharmacy can put the prescription formula out of the price range for many.
3. Hydrocortisone: The weak link in the Kligman formula is hydrocortisone. Using topical steroids on the face for a long period of time can make the skin thinner, dilate skin capillaries, and lead to other skin conditions such as fungal acne and perioral dermatitis. Because of this, the Kligman formula should not be used for extended periods of time.
Is there a prescription-free alternative to the Kligman formula?
The MDacne Advanced Dark Spot remover provides a prescription-free alternative to the costly Kligman Formula with some additional tweaks that give it some advantage over its predecessor.
MDacne's Advanced Dark Spot remover combines Arbutine, a derivative of the gold-standard Hydroquinone 2%, with active retinoids along with AHAs and BHAs to replace the original tretinoin, which can be highly irritating. Arbutine is highly effective while safer for all skin types and tones (including Asian and darker skin). Additionally, it replaces the hydrocortisone with plant-based complexes such as bearberry extract and vitamin c to both enhance the effect on inflammatory hyperpigmentation and provide powerful anti-inflammatory compounds.
This new formulation is arguably as effective as the prescription versions with less irritation. Since it does not contain hydroquinone or hydrocortisone, it is safe for daily application and long-term use (as needed). Plus, because it is available without a prescription, it is much more affordable. This new Advanced Dark Spot remover is best combined with an active, oil-free sunscreen that both blocks UVB/UVA and protects the skin from sun-induced free radicals. This combination treatment will help fade existing dark spots and prevent new spots from forming.
Kligman AM, Willis I. A new formula for depigmenting human skin. Arch Dermatol. 1975;111:40–8.
The best way to get rid of post-acne dark spots
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