Top Dermatologist Shares Her Secrets for Perfect Skin

Uneven pigmentation or hyperpigmentation can be among the most vexing of skin problems. Jeanine Downie, MD, a dermatologist in Montclair, New Jersey, shares her expertise in handling blotchy skin — so you don’t have to see spots.

ishonest: Is there any way to prevent spots and discoloration from forming in the first place?

Dr. Jeanine Downie: Use a sunblock with an SPF of 30 or higher on your face, neck, and the backs of your hands every single day — it’s imperative to keep discoloration at bay. Also, when you get skin infections like acne or a bug bite, be sure not to pick, pop, or scratch the sores because that will leave marks and add to discoloration.

EH: What areas of the skin are more likely to develop uneven pigmentation and why?

JD: There are two areas that most commonly develop discoloration. The first includes elbows, knees, and under the arms, areas where there’s a lot of movement because there's a lot of pressure from rubbing and friction, which can disturb the skin tone. The second area comprises the face, neck, chest, and the backs of the hands; these are much more prone to discoloration because they experience the most exposure to the sun and sun damage — which causes sun spots and discolored skin.

EH: Are there any treatments or ingredients in skin products that can cause discoloration to become worse?

JD: Any topical treatments that irritate your skin or cause an allergic reaction can cause discoloration to become worse. For example, some people have an allergy to retinoids and hydroquinone (you’ll know your skin is allergic because it will feel tight or become red and itchy). And in the case of one of my patients, putting something as simple as lemon juice on the skin can cause aggravation and make discoloration worse. Also, avoid scrubbing your skin with a loofah or pouf because you’re basically sandpapering the area and then exposing it to the sun, inviting more damage to that vulnerable area.

EH: Why are some women prone to discoloration in their armpits? What can be done to correct it?

JD: Women with olive and dark skin tones, and Asian women, can get discoloration in their armpits, and usually it’s because of friction and rubbing — the chafing motion can cause irritation. Also, shaving cream and dull blades can make you more prone to cuts and scrapes, which can leave the skin discolored.

To correct the problem, make sure to change your shaving blade every other day, or frequently (depending on the thickness of your hair), use a good quality shaving gel to create some slip for the razor, and stretch your skin when shaving to make for a more even surface. For a more permanent option, try laser hair removal in the area.

EH: Can discoloration be reversed completely?

JD: Women who undergo consistent laser treatments or chemical peels, or who consistently use topical lightening agents and sunscreen, can see up to 80 percent of the discoloration reversed.

EH: What ingredients even out skin tone and diminish discoloration?

JD: Look for an over-the-counter treatment with 2 percent hydroquinone. I also recommend products with what I call naturalceuticals — like licorice, kojic acid, and soy, which all help even out discoloration.

EH: How do you make sure a treatment is restoring your skin to its natural color and not completely bleaching the skin?

JD: It seems simple, but check in with your doctor after each treatment you do. What I like to do is continually check on the patient. I would do one Fraxel treatment, for example, and see the patient in a month to monitor the results. After each treatment you do, see your doctor a month afterward and have him or her check the progress, because if you get too light, that would be another problem to deal with!

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