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Out Damn Spot!

It is officially fall. Gone are the long days of sun and the summer glow is starting to fade (I never had one of course). As the tan fades, those pesky brown spots become annoyingly obvious.  I probably have at least five people ask about getting rid of brown spots every day. Unfortunately I can never devote the time needed to the topic because insurance companies (who are always watching and auditing) don’t want me to discuss cosmetic issues if they are paying the bill. Now brown spots should be evaluated to ensure they are not cancerous (so making an appointment for brown spot evaluation is ok with most insurance companies), just last week one of those brown spots turned out to be a melanoma. Fortunatley, the majority are not melanoma and represent either solar lentigos (age spots), seborrheic keratoses (another type of age spot) or melasma. All three of these conditions are somewhat cosmetic in nature (if you are looking to remove them).

Solar lentigos (which look like brown spots) and melasma (often looks more like brown blotchy skin) are caused by the sun. They are very sun sensitive and are not prevented 100 % by sunscreen. So before treating, you have to be committed to protecting your skin from the sun with heavy sunscreen and hats.

Now how do you get rid of the spots?

Liquid nitrogen.      This treatment works very well if you have just a few solar lentigos or seborrheic keratoses. It does not work for melasma. The advantages of this treatment are speed and low cost. The disadvatages are possible lasting redness, post-inflammatory hyperpigmentation (a medical word for a brown spot) or even a scar.

Creams.      Creams don’t tend to work well for large solar lentigos, but are first line for mottled brown pigment and melasma. The most effecitive creams are a combination of prescription strength hydroquinone and Retin A. At my office we sell a 4 percent hydroquinone and .1 percent Retin A for $68 each, which is a pretty good deal. There are several commercial prescriptions available from the pharmacy as well. There is a commercial cream (Tri Luma) that adds a hydrocortisone which can help if you have irritation from Retin A tyoe creams. Hydroquinone creams must be used for limited time periods (8 weeks) before taking a break- or they can cause worsening of pigment. Retin A can be used continually but will cause increased sensitivity to the sun. If you prefer to avoid hydroquinone or you are breastfeeding, there are creams that can help lighten skin- though they are not as effective in most cases. Look for products with kojic acid, arbutin, licorice, azelaic acid, soy and vitamin C. We have one called Perle by Neocutis, but there are other brands available.

Peels.  Peels can be effective for brown spots as they contain the same ingredients as the creams above. A benefit is they can work faster than creams.

Laser and light treatments.  IPL (Intense Pulsed Light), is commonly the first light treatment used for dark spots. It has to be used cautiously on melasma (it can make this worse) but works very well on non-melasma brown spots. It can be safely used on the neck, chest and arms. It has low downtime and is pretty affordable ($300-400 for full face treatment). You may need more than one treatment (depending on the level of sun damage) but many have good results in one treatment. Other lasers used for brown spots include non-ablative resurfacing lasers such as Resurfx and Fraxel. CO2 laser is very intense, but does provide treatment for brown spots.

So how long do these treatments last? The great news is that they are long lasting- if you protect your investment. None of these treatments will prevent brown spots if you are out in the sun. In fact, they may make you at risk for more brown spots due to increased sun sensitivity. So if you decide to get rid of your spots, invest in a few good hats and good sunscreen!

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