In the Health Dermatology clinic, I get a lot of concerns regarding brown spots that occur on the skin and, more importantly, how to get rid of them. This is a particularly pertinent issue when the weather warms.

Let us begin by discussing why you have them and how to prevent them, and then we will discuss how to treat them.

Brown spots are formed by an excessive amount of melanin in the skin. Melanin is the pigment responsible for the color of your skin, hair, and eyes. Melanocytes generate melanin. Consider melanocytes as sunlight sponges. The more ultraviolet (UV) exposure your skin receives, the more melanin-saturated your sponges become.

Contrary to widespread assumption, persons with darker skin do not have more melanocytes. Both light and dark-skinned individuals have equal melanocytes on their skin. The distinction occurs in the pigment-containing organelles known as melanosomes, which are more extensive, more abundant, and pigmented in dark-skinned individuals than light-skinned individuals.

There are four primary reasons why you could notice brown marks on your skin:

  1. Exposure to the sun
  2. Hormonal fluctuations
  3. Genetics
  4. Age

Brown marks, medically referred to as solar lentigo (lentigines plural), are typical throughout the skin's aging process. While many people refer to them as "age spots" or "liver spots," dermatologists prefer the term "wisdom spots" since we accumulate more of them as we age/gain knowledge. Around 75% of Caucasians over 60 are expected to have one or more lesions. These patches appear as a result of solar damage. You must have neglected to wear sunscreen regularly at some point in your life, may have liked sunbathing in the sun a little too much, or may have utilized tanning beds.

Other factors contributing to brown marks or darkening of the skin on the face in women are hormone changes, particularly during pregnancy. Yes, pregnant women have an additional cause to be stressed. Do not panic, and the pregnant glow is still genuine. However, while your acne may clear up and your hair may begin to sprout like weeds, the skin on your face may start to darken as a result of hormonal changes called melasma. It is referred to as "the pregnant mask" and manifests as brown spots on the top lip, forehead, and cheeks. You have developed a brown mustache all of a sudden! It is pretty frequent in pregnant women and those who take birth control tablets. It might just be related to normal menstrual cycle fluctuations in estrogen and progesterone levels.

Is There Anything I Can Do to Avoid Acquiring Additional Brown Spots?

Certainly! Sun exposure is the primary element that contributes to skin darkening. Therefore, UV protection should include the following:

  • Daily use of sunscreen with an SPF of 30 or above
  • Wearing UV-protective clothes (UPF)
  • Utilize a wide-brimmed hat or an umbrella to shield yourself from the sun.
  • When out in the sun, reapply sunscreen every two hours.

I have had patients express, "I dislike the way sunscreen makes me appear," "I am allergic to all sunscreens," and "I dislike the way sunscreen makes my skin feel" — yeah, we have heard it all. So allow me to break the news to you: the ideal sunscreen for you does exist, but you will need to discover it via trial and error. I often remind my patients that the most excellent sunscreen is the one they will use!

The Environmental Protection Agency (EPA) forecasts the danger of overexposure to ultraviolet radiation (UV) radiation from the sun in your zip code. You can monitor it on your smartphone with the SunWise UV Index App, which can help you prepare wisely for your outdoor outings.

Sunface is another software that I recommend installing. If you are still not persuaded that sun protection is worthwhile, snap a picture with the Sunface App to see how your face will appear in five, ten, fifteen, twenty, and twenty-five years if you use tanning beds or do not use sun protection. It isn't very comforting.

Additionally, hydrate your face correctly and cleanse it gently with a light facial cleanser such as Cerave or Vanicream wash, as damage to the skin, dryness, or irritation can exacerbate skin darkening.

How Can I Treat the Brown marks on My Face That I Already Have?

Brown marks are not a cause for alarm. The sole reason we seek treatment for them is aesthetic — we believe it will enhance our looks, make us appear younger, and eventually boost our self-esteem. Unfortunately, treating existing hyperpigmentation is more complex and expensive than preventing it.

While whitening products are widely available, are they safe? Several generally safe over-the-counter skin-lightening lotions are available, including kojic acid serums, vitamin C serums, lactic, azelaic, and glycolic acid preparations. Additionally, there are over-the-counter and prescription-strength hydroquinone creams available, which are controversial because they raise the chance of developing a skin disorder known as ochronosis. This is a blue-gray pigmentation that has grown due to long-term hydroquinone usage. It may or may not resolve upon discontinuation of hydroquinone usage. My advice is to use extreme caution if you wish to avoid more complications.

Retinoids, or derivatives of Vitamin A, are also beneficial in the battle for younger, lighter skin. They promote collagen formation and gently exfoliate the skin by increasing cell turnover. However, they may irritate the skin, so begin using your retinoid gently – 2-3 times per week at first, then gradually increase the frequency of usage, hydrate, and wear enough sun protection. Previously, a prescription was required for an over-the-counter Vitamin A derivative called Differin (adapalene) gel. I recommend that you begin with this medicine before progressing to anything more powerful and annoying, such as Tazorac, which does require a prescription.

Cryotherapy: This technique can be performed in the office by your dermatologist or medical practitioner, but it is typically not reimbursed by insurance because it is deemed cosmetic. Additionally, it can result in persistent white patches or increased hyperpigmentation.

Numerous solutions are also accessible in dermatological clinics and medical spas. However, it is critical to choose the correct practitioner to execute such procedures on you to minimize scarring or further issues. Additionally, the laser technician must be conversant with the settings for your skin tone, particularly if you have dark skin; otherwise, you risk irreversible skin discoloration.

Chemical peels and intense pulse light (IPL) treatments can lighten the skin. IPL is a pulsed light device that delivers energy across a broad wavelength that is absorbed by and destroys the pigment in the brown spot. Chemical peels using TCL and glycolic acid are also highly efficient at removing sunspots by exfoliating the skin and removing the top layer of damaged skin.

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