Dr. Sam Breaks Down Dark Spots, Sun Damage, and How to Treat Them
Dermatologist Dr. Nancy Samolitis breaks down how to treat dark spots, melasma, and sun damage on the ‘Live + Well’ podcast. Discover what actually works and what to avoid.
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The Live + Well podcast officially launched October 23rd, from LA Times Studios. In each episode, host Melissa Magsaysay will break down buzzy health and wellness topics with experts who live and breathe them. To kick off the series, she sat down with dermatologist and skincare entrepreneur Dr. Nancy Samolitis, aka Dr. Sam, to talk about something we all deal with... dark spots.
Whether you call them age spots, sunspots, melasma, hyperpigmentation, or something else, Dr. Sam explains why identifying what kind of dark spot you have is the first step toward treating it effectively.
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Are Those Dark Spots or Something Else?
Pigment issues may show up as harmless specks or persist as stubborn discoloration that no serum can touch. To most of us, they’re confusing and frustrating. Dr. Sam wants you to stop guessing. “People often come in assuming they have sunspots when in fact, what they have are seborrheic keratoses,” she says. These growths, often called age spots or, her preferred term, “wisdom spots,” aren’t caused by the sun. They’re genetic. “They can show up in your 30s and 40s, sometimes even earlier,” she explains. “They’re technically growths, not pigment changes.”
These SKs (as Dr. Sam abbreviates them) can appear anywhere...including areas not exposed to the sun like the scalp or under the bra line. “Some people literally have hundreds,” she adds. SKs are flat or raised, but they often share one trait: a textured surface that causes self-tanner, makeup, or hair dye to stick to them, making them more visible.
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Wisdom Spots vs. Freckles: Why Treatment Plans Matter
While freckles may fade with sun avoidance and brightening serums, SKs won’t budge without in-office removal. “You can’t fade them with serums or creams. They have to be removed,” says Dr. Sam. She typically treats them with cryotherapy, electrocautery, or a gentle, layered removal to avoid hypopigmentation and scarring. “You can chip away at them. Think of it like peeling off a layer at a time,” she says.
Do you need to remove them? Only if you want to. “They’re completely benign,” Dr. Sam emphasizes. “It’s strictly cosmetic.”
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What Causes Dark Spots on Skin?
Not all hyperpigmentation is created equal. There’s a subtype of an SK called dermatosis papulosa nigra (DPNs) that are more common in Asian and African American skin types,” says Dr. Sam. These appear as small, flat-topped dark dots typically on the cheeks and temples. Though benign, their visibility and distribution often lead patients to seek treatment. Melanin-rich skin tones are more likely to develop these forms of dark spots, and sun exposure only worsens their appearance. This underscores the importance of understanding your skin type and background before starting any treatment.
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Melasma Explained: Why Sun and Hormones Trigger Pigmentation
Sun-induced hyperpigmentation is something most Californians can relate to. Enter melasma, a hormonal skin condition that’s more complex than typical dark spots. “Melasma is triggered by estrogen, thyroid changes, heat, and inflammation,” Dr. Sam explains. “It’s chronic and can flare seasonally or from internal imbalances.”
Melasma can worsen if treated improperly. Lasers, heat, or aggressive peels often make things worse. “I compare it to managing acne or rosacea. It’s something we control rather than cure,” she says.
Melasma often appears as symmetrical patches across the cheeks, forehead, or upper lip. Sun exposure, pregnancy, or even stress can trigger its onset. That’s why a holistic approach, including stress management and hormonal balance, can be just as important as topical treatments.
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Top Dermatologist-Recommended Ingredients to Treat Dark Spots
There’s no shortage of products promising to fade dark spots, but few are backed by research. Dr. Sam recommends ingredients with proven clinical benefits:
- Tranexamic Acid: Once used to control heavy menstrual bleeding, now a hero ingredient in melasma treatment.
- Azelaic Acid: Used in treating acne, this multitasker brightens pigmentation and is safe for sensitive skin.
- Niacinamide: An anti-inflammatory that improves skin tone, reduces redness, and strengthens the skin barrier.
- Vitamin C: Fights free radicals and oxidative stress, which are major triggers of uneven skin tone.
- Tyrosinase Inhibitors: These block melanin production at its source. Hydroquinone is the gold standard, but plant-based alternatives are gaining popularity.
Combination formulas with multiple actives can be especially effective, targeting different pathways of pigment production and repair.
This guide covers the causes, types, and treatments for hyperpigmentation, including dark spots and melasma. It’s designed for anyone seeking to understand and manage skin discoloration, with expert-backed advice on prevention and care.
Best Treatment Plan for Dark Spots on Face: When Topicals Aren’t Enough
If your hyperpigmentation isn’t responding to skincare, it may be time to go deeper.
Here is Dr. Sam’s layered strategy:
- Start with a brightening serum that includes multiple actives
- Add a retinoid to speed up cell turnover and fade discoloration.
- Consider procedures like microneedling, IPL, or fractional lasers...but only when skin is calm and pre-treated.
“You need to stabilize pigment-producing cells first. Otherwise, you risk post-inflammatory hyperpigmentation, especially in skin of color,” says Dr. Sam.
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Facile Brighten Serum: Why Dermatologists Use It Daily
Dr. Sam co-created Facile Brighten Serum based on years of custom compounding for her patients. “We wanted a product that was gentle enough for pregnant patients but strong enough to actually work,” she says. It’s a staple in her own routine, used every morning under sunscreen.
The formula combines:
- 5% Tranexamic Acid
- 10% Niacinamide
- Azelaic Acid
- Lightweight, glowy finish ideal for layering
It is pregnancy-safe, fragrance-free, and designed to support ongoing skin maintenance.
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Expert Q&A: Hyperpigmentation and Melasma Advice from Dr. Sam
Q: What causes melasma?
Dr. Sam: “Hormones, heat, and sun. Even emotional stress and thyroid changes can trigger it.”
Q: How long does it take to fade dark spots?
Dr. Sam: “With the right treatment plan, 8 to 12 weeks to see significant change. But melasma is chronic and needs maintenance.”
Q: What lasers work best for pigmentation?
Dr. Sam: “Only certain lasers. I like microneedling or Clear + Brilliant for melasma. Fraxel and IPL can help sunspots, but not melasma.”
Q: Can you treat pigment from acne scars?
Dr. Sam: “Yes, that’s called post-inflammatory hyperpigmentation. Azelaic acid and niacinamide are great for that.”
Q: Are there any supplements that help fade dark spots?
Dr. Sam: “Yes, oral niacinamide and antioxidant supplements like Heliocare can support pigment-prone skin.”
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How to Prevent Dark Spots: Sunscreen, Supplements, and Smart Habits
Dr. Sam emphasizes SPF as your first line of defense. “Even the best dark spot correctors won’t help if you don’t wear sunscreen daily,” she says. For melasma or pigment-prone skin, she recommends mineral-based sunscreens with iron oxides.
Her go-to daily tools:
- Broad-spectrum SPF 50
- Heliocare (Polypodium leucotomos antioxidant supplement)
- Oral niacinamide for extra anti-inflammatory support
- Vitamin D supplementation if indoors often or wearing SPF consistently
Other habits include avoiding peak sun hours, wearing hats, and using antioxidant serums in the morning before SPF.
Dark Spots and Mental Health: Addressing the Emotional Impact
“There’s a lot of shame tied to pigmentation,” Dr. Sam says. “People think they caused it. But most of it is out of your control.” Her approach? Education, reassurance, and consistency. “I always tell patients: it’s not your fault. And there are solutions...we just have to find the right one for your skin.”
From hormonal melasma to post-acne discoloration and age-related spots, not all pigment is the same. And neither is the treatment. Diagnosis is key. So is consistency.
“Stop guessing, and get diagnosed. That’s how we treat smartly and effectively,” says Dr. Sam.
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