Brown Spots

Understanding Brown Spots

Freckles, age spots, solar lentigos and melasma can plague any of us.  Our spots darken and become more conspicuous with time, aging and sun exposure.  The sun rays stimulate pigment cells (melanocytes) to ramp up pigment production. The melanocytes then sprinkle their clumps of pigment (melanin) into our skin cells (epidermal cells). The result is that we have splotchy brown spots (such as in freckles, lentigos) and large areas of dark color (for example, in melasma). 

Melasma occurs on our faces with hormone stimulation and sun exposure. So a woman’s natural hormone, hormone in birth control pill and in IUDs, and increased hormone during pregnancy (the “mask of pregnancy”) can make melasma prominent and very noticeable. 

And commonly, after our skin is inflamed, such as with a red pimple of acne, the pigment production is stimulated to leave a dark spot at the previous pimple and area of inflammation. This “post inflammatory hyperpigmentation” or PIH is not scar tissue and does not need to be permanent. 

Moles (melanocytic nevi) can be pigmented spots and bumps. They are discussed in another section. Click here

Any brown spot should first be evaluated by Dr. Harrison. A dark, multi-colored or peculiar shaped freckle or mole can be a melanoma and should be evaluated, possibly sampled, not simply treated with cream or laser. In fact, freezing or lasering a melanoma skin cancer can remove some of the dark color, but not remove the melanoma skin cancer, and allow it to grow and delay its detection. All dark spots should be examined by Dr. Harrison or another board certified dermatologist before considering treatment options. 

The treatment approach of pigment is straightforward, but not always very fast in skin lightening. The approach includes a dermatologist’ (MD specializing in skin) evaluation of the pigment, dark spots and blemishes. Next, the approach is to decrease the pigment production (zinc oxide sunblock, lightening cream and sometimes pills) and then to try to lighten what extra, splotchy skin pigment you have (laser). Here is a more detailed explanation of the treatment approach.  

First, we recommend that you have an in-office evaluation and examination by Dr. Harrison to evaluate what is the cause of the pigment and what factors could be stimulating extra pigment production. The evaluation can be in connection with a medical dermatology visit billed to insurance or in a cosmetic consultation in our office with Dr. Harrison and his staff. 

Next, use a sunblock every day to block both UVB and UVA sun rays since UVA mostly stimulate our pigment production. A sunblock / sunscreen that contains zinc oxide blocks pigment causing rays (UVA rays) and sun burning rays (UVB rays). (Many commercial sunscreens only block UVB – very little UVA, and still let pigment causing rays hit your skin and make you splotchy.) The SPF number only tells you how well the sunscreen stops sun burn rays – not how well it stops pigment rays. We don’t have a number to say how well the pigment & tanning rays (UVA) are stopped. So the best is to find a sunscreen /sunblock product with zinc oxide as an ingredient – zinc oxide blocks both UVA and UVB.  

Also, lightening creams are commonly recommended. Lightening creams tell your pigment making cells (those pesky melanocytes) to slow down pigment production. The pigment already manufactured and deposited in epidermal cells cannot be bleached or lightened. We do though, expect that those epidermal cells to carry away their pigment with them as they grow to the skin surface and slough off. Lightening creams do lighten and make our skin a more uniform color – our natural color – with months of use.

Microdermabrasion gently exfoliates with fine grains of sand blown over the top layers of our skin – a kind of light buffing of the skin. The result is skin that is smoother and more even in tone and color. With microdermabrasion, the top layers are peeled off and exfoliated, taking with them excess pigment embedded in those skin cells. This procedure also allows topical medications to penetrate deeper and more evenly. Lastly, the mechanical surface “sanding” signals via cytokines (chemical messengers) to the deeper dermis layer to increase its collagen production – the result is tightening of fine lines and wrinkles. 

Microdermabrasion is liked as the “lunch time” peel because patients typically only experience 20 minutes of pinkness after treatment. It is a great help in reliably reducing fine lines & wrinkles. Also it is a proven treatment with minimal downtime, in fading acne blemishes and in lightening melasma through gently buffing off skin cells with excess pigment and helping melasma fighting lightening creams penetrate deeper into the skin.

Proven over the years, chemical peels are reliable and effective at reversing signs of skin aging. With minimal redness, frosting and peeling (hours to a few days), they are helpful in lightening brown spots, and in tightening and improving fine lines and wrinkles. 

At Trueskin DermSpa and Dermatology, all chemical peels are performed while Dr. Harrison, a board certified dermatologist, is on site and available for any questions in selecting the right chemical, the depth of chemical penetration, and neutralization phases. Equally as important is that Dr. Harrison expertly directs which treatment is best suited, with what frequency and strength, for every patient. The immediate, on site, physician directed and supervised care at Trueskin Dermspa is superior to other options in the community.

Oral medications and pills (tranexamic acid) are a new help to treat melasma. These pills that were developed and FDA approved for a different medical condition, are of a great help in improving melasma in the properly selected patient. A dermatologist, like Dr. Harrison, will review the benefits, possible limits and risks, and necessary monitoring to using a prescription strength pill in you.

Melasma is now recognized as a chronic and recurring condition that usually requires regular maintenance treatments through sunblock, topical cream, oral pills and laser. 

The latest and most exciting advancement in the improvement of lentigos (sun freckles) is the use of lasers to selectively target the dark pigment and not the surrounding skin. At Trueskin Dermatology and Surgery we use the latest laser technology including the Icon Laser System to lighten freckle, sun damage, age spots and solar lentigos. In that treatment, we may lighten redness and face vessels as well. The Icon Laser System is a proved and tried laser for most skin types. It has the advantage of targeting both pigment and redness in the same treatments. A series of treatments is recommended to lighten and improve the skin. 

The popular “3 for me” treatment package employs lasers to target three things: pigment, redness and wrinkles of the face. 

Another laser, a state of the art device called PicoSure Laser System, was specifically designed to target pigment. Instead of simply heating up the pigment, small and focused acoustic shock waves in a picosecond of time, are sent into the skin’s epidermis and dermis to break up pigment clumps, allowing them to be carried away by the skin’s lymphatics. Until this time, no laser was so effective at targeting superficial (epidermal) pigment and deeper (dermal) pigment. This PicoSure is a proven leading laser for improving the pigment of lentigos, sun damage, tattoos and melasma – a definite medical breakthrough in laser technology and science. The PicoSure Laser System is also designed to be used safely in many skin types from light to dark, in the experienced hands of Dr. Harrison and his staff. It is usual to be treated with a series of laser treatments for improvement, and then to design a maintenance program to help the ongoing challenges of sun spots, skin pigment, aging, and melasma. 

At an in-office consultation, Dr. Harrison and his staff can help you decide which treatment, laser, medications and creams are best to even out your splotchy skin, discoloration, melasma and blemishes. Call his office today at 801-255-7546 to schedule your consultation.