Identifying Skin Spots


By: Dr. Francesca Lewis, MD, FAAD Board Certified Dermatologist Special to the Boca and Delray newspapers

Dark spots, the bane of a perfect complexion. So how can we prevent or treat them?

First, we must know the cause. The most important first step is seeking the care of a board-certified dermatologist for an evaluation and to rule out pre-cancer or skin cancer.

The most common etiology of brown spots is freckles. The type that appears in childhood and darken in the summer are called “ephelides.” These are more common in fair-skinned people, but may occur in darker-skinned patients with a genetic predisposition. The best and only way to prevent these spots is to wear a broad-spectrum SPF of at least 30 daily.

The second source of sun spots are called “lentigines.” These are the brown spots that we develop from cumulative sun exposure as we age. Once these occur, they are permanent! With that being said, there are treatments to lighten or reverse lentigines.

In terms of prevention, a broad-spectrum SPF should be your skincare mainstay. Other topically applied cosmeceuticals, like Vitamin C serums and hydroxy acids, can help lighten sun-related pigmentation to a degree, but the strongest topical product is hydroquinone. This is used in lower percentages (2 percent) in over the counter products and in higher percentages in prescription grade medications (4-8 percent) often with Retin-A to help lighten brown spots and even the skin tone.

In addition, this topical regimen can be combined with a series of IPL (Intense Pulsed Light) treatments. IPL can target sun spots as well as redness and broken blood vessels. It is very effective, with best results seen in a series of 3-4 treatments spaced 1 month apart. Staying out of the sun during this time is critical to achieving the best results, and it is not suitable for tan or dark skinned patients.

Another common cause of hyper-pigmentation which occurs often on the upper lip, cheekbones, and forehead is called melasma. This condition occurs in women more commonly than men. Higher states of estrogen such as pregnancy and birth control use seem to trigger melasma, as well as past excessive sun exposure. When melasma appears during pregnancy it is more likely to eventually resolve than if it appears in other settings. The above treatment of hydroquinone and Retin-A is often employed as first-line (unless the patient is pregnant or breast-feeding). In addition, it is important to use a zinc, titanium or iron oxide containing broad-spectrum SPF rather than a typical chemical sunscreen. IPL is not recommended for this condition, and this is why seeking evaluation and treatment by a Dermatologist is paramount. Other treatments for melasma include chemical peels, low energy fractionated non-ablative laser treatments or microneedling (in select patients), and the cosmeceuticals mentioned above. Alternatives to hormonal birth control may be pursued. Tranexamic acid is a new oral treatment for melasma that has shown promising results with sustained remission over a 12 week course, however, the potential risk of blood clots may not make it suitable for all patients.

Other common causes for brown marks on the skin include nevi (benign moles), birth marks (café au lait macules), pigmented actinic keratoses (pre-cancers), atypical nevi (dysplastic moles), Malignant Melanoma and post-inflammatory hyper-pigmentation (spots that appear after injury or inflammation to the skin).

Make an appointment with a board-certified dermatologist to have your hyper-pigmentation evaluated and develop a personalized corrective treatment plan.