Sun Spots – The most common type of brown spots, known as lentigo or lentigines, are often referred to as “sun spots.” These occur in areas such as the face and back of the hands where your skin has accumulated years of sun exposure. Historically, these spots were incorrectly associated with liver health, and were referred to as “liver spots.” As we age, areas of over-exposure to the sun can lead to brown spots (and also white spots where melanocytes have been too damaged by UV light to produce pigment at all). In fair-skinned individuals, these benign spots are most effectively treated for cosmetic reasons with a photofacial or IPL (Intense Pulse Light) device. If the skin is light and the brown spots stand out, IPL has the greatest chance of targeting the area of damage. The closer the spots become to the background skin color, the harder they are to treat and often require multiple treatments. The pigment may return over time with sun exposure so it is important to come in for treatment when your skin is the fairest (not right after a sunny vacation). The risks of IPL include blistering, hypo/hyperpigmentation and scarring.
Seborrheic Keratoses – While sun spots are always flat, you can also get raised brown spots called seborrheic keratoses. These benign warty growths commonly referred to as “barnacles” can occur anywhere on the body, are genetic and continue to pop up as you age. These will not respond well to the IPL device but can be treated with liquid nitrogen, electrocautery or laser.
Melasma – Melasma is a benign, mask-like hyperpigmentation usually occurring on the face in women. These brown patches are dynamic in that they can get darker or lighter depending upon hormone changes, heat and sun exposure. Pregnancy, birth control pills or hormone replacement therapy can make melasma worse. Extreme caution must be taken in treating melasma because overly-aggressive treatment will make it worse. Licorice extract, arbutin, tranexamic acid, azeleic acid, and niacinamide are all helpful ingredients when selecting a natural anti-inflammatory lightening cream. Hydroquinone is a stronger prescription chemical lightening cream that works best when combined with a retinoid, but it must be cycled in and out as long term use has risks. Be wary of lightening creams from other countries that can contain mercury, and high percentages of hydroquinone that can be dangerous, carcinogenic and cause systemic issues. Light chemical peels can help the superficial layers of melasma but the deeper pigment can be harder to treat. The prescription tranexamic acid in pill form is a newer treatment for melasma that has demonstrated success in stubborn and more severe cases. The most important goal for melasma is strict sun protection as the patches will darken again in the sun after treatment. Lights from computer screens and fluorescent lighting can also make melasma worse. Tinted sunscreens contain ferrous oxide that can help protect against visible light.
Post-Inflammatory Hyperpigmentation (PIH) – After inflammation in the skin (for example, due to acne, rashes or injury), medium to darker skin types can develop brown spots. Unlike fair-skinned individuals who are more likely to develop red marks or erythema from inflammation, patients with darker complexions commonly get hyperpigmentation, especially from acne. Ninety percent of the hyperpigmentation will improve but it can take 6-12 months even if practicing optimal sun protection. Treat the acne first with the help of your dermatologist and then the hyperpigmentation will likely fade. Lightening agents can be used simultaneously but care must be taken to not irritate theirskin.
While these are the four most common causes of brown spots there are others that occur less frequently such as pigmented basal cell carcinoma, notalgia paresthetica, erythema ab igne and lichen planus to name a few. Please keep in mind that malignant melanoma can also look like a brown spot and can be either flat (earlier stage) or raised (later stage). See your dermatologist to check out all your brown spots to make sure they are not skin cancer.
