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I have these Brown Spots

One of the most frequent questions we get is about brown spots, age spots, liver spots, freckles, etc-why do I have them and how do I get rid of them. All color darkening of the skin is caused predominantly from sun exposure. A temporary darkening also comes from injury. A darkened area of the skin is from sun over time (actinic bronzing) or hormones(melasma or pregnancy mask) and sun exposure. The sun exposure that causes any of these pigment changes starts from the first ray of sun to strike the skin and accumulates over time, leaving areas or spots. The rest of the discussion will focus on spots. The first spot one sees from sun exposure are freckles(lentigos). These are small brown spots, usually first seen across the bridge of the nose and other commonly sun exposed areas. The lighter the skin color, more and earlier freckles are seen. They also show up years after sun exposure. Sun burns usually leave them behind as well. As one gets more sun exposure, larger, darker spots appear, either by themselves or from a coalescence of freckles. These are also called  lentigos, but are more commonly known as age or liver spots.

All these spots are sun fueled. The more sun exposure, the more spots. Ultraviolet A(UVA) is the main culprit. Since UVA passes through glass untouched (Ultraviolet B (UVB) does not pass through glass), many have more such spots on the driver’s side, or passenger side if they don’t drive. Prevention is much easier than treatment. Hats, sunscreens(spf 30+ with broadband protection), car window treatments (UV block tint does NOT darken window as does visible light tinting) can certainly keep one from developing more and prevent new lesions.

Treatment, other than prevention, begins with topical therapy for mild cases, or maintenance. It is very important to remember that once or if the color is lessened or even removed, it will come right back with further sun exposure. There are several different creams in use, most usually use tretinoin(retin-a)with other compounds-usually glycolic, azelaic, or alpha hydroxy acids. These are all global creams in that one can apply over the entire area, not just the spots and they rejuvenate the skin as well as lighten the spots. Larger spots are usually treated first with a bleaching cream containing hydroquinone in varying percentages. The best effect is with a 7-8% hydroquinone mixed with tretinoin and a mild cortisone cream. This is best applied to spots only and should be used in a 6 week on 6 week off cycle. If topical therapy does not work, light chemical peels can be used, but the highest degree of success is with an intense pulsed light(IPL) treatment, which is very effective and relatively fast. Micro needling may also be helpful. Resistant spots can be treated with lasers, but one has to be  careful to avoid an inflammatory pigment response. Remember that the spots will return if exposed to more sun, and that is not ever going to change. Good Luck-

Robert S. Berger MD Dermatologist

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