Brown spots on the skin which are commonly referred to as “age spots” or “liver spots” or common part of the aging process of our skin and are caused by the overproduction of melanin. Melanin is a pigment that gives our skin color and is produced by cells called melanocytes. When these melanocytes absorb ultraviolet (UV) light from the sun, melanocytes are stimulated to produce melanin pigment. While some individuals call the spots “wisdom spots”, because we develop them as we get older and hopefully wiser, the precise medical terminology is “solar lentigo” (lentigines pleural).
Essentially there are 4 reasons for developing brown spots on our skin:
-Sun exposure
-Age
-Genetics
-Hormonal changes
Women can develop brown spots or darkening of the skin secondary to hormonal changes during pregnancy. This is commonly called melasma and is known as the “mask of pregnancy”. It commonly appears as brown patches on the upper lip, forehead, and cheeks. While it is very common in pregnant women, it can also occur in women who are taking birth control pills. This is simply due to changes in estrogen and progesterone levels and can also occur during a woman’s regular menstrual cycle.
Brown spots are not hazardous to your health, and the only reason to treat them is cosmetic. Treating existing hyperpigmentation is more difficult and more expensive than preventing it. In most cases sun exposure is the biggest contributing factor to darkening of the skin and development of brown spots. Taking the following pro-active steps can be very effective in reducing your risk of developing brown spots:
-Wearing a sunscreen daily with an SPF 30 or higher
-Wearing sun protective clothing with ultraviolet protection factor on (UPF)
-Wearing a wide–brimmed hat to block the sun
-Avoiding outdoor activities during the peak sun exposure hours
Diagnosing Age Spots
The diagnosis of age spots can usually be made by visually inspecting your skin. However, it is important to distinguish age spots from other skin disorders such as lentigo maligna, which is a type of skin cancer. In some cases, the diagnosis can be made by visual inspection. In other cases, special magnification using what is called polarized light is used to further examine the area. In still other cases, and actual biopsy of the skin is necessary to make the proper diagnosis.
Is It Just An Age Spot Or Skin Cancer?
The acronym ABCDE can be used to distinguish the potential signs of skin cancer as opposed to a simple benign age spot:
A–Asymmetry
One half looks different than the other
B–Border
If the borders are irregular jagged are not perfectly round
C–Color
The color is darker or uneven with multiple shades
D–Diameter
The diameter is larger than the size of a pencil eraser (4 mm)
E–Evolving
You noted changes in size, color or shape in the past few months or weeks or the area is bleeding, itchy, or painful
Common Questions The Doctor May Ask You When Evaluating Brown Spots:
-When did you first notices the spots?
-Have the spots changed in color or size?
-Did the spots occur gradually or quickly–over what period of time?
-Are the areas tender or itchy?
-Have you noticed any other changes in the appearance of your skin?
-Do you have any history of any dermatologic problems such as psoriasis, eczema, fever blisters or cold sores?
-Have you experienced frequent or severe sunburns?
-How often are you out in the sun?
-Do you use sunscreen on a regular basis?
-Do you have a history and / or does your family have a history for skin cancer?
-What medications do you take?
-What skin care and skin rejuvenation products do you use a regular basis?
How are Brown Spots Treated?
Pigmentation associated with brown spots is typically located in the top layers of the skin. For this reason, they can oftentimes be effectively treated with topical creams and lotions, lasers, dermabrasion, light chemical peels, or micro-dermabrasion. The deeper the pigmentation extends, the more difficult it is to treat. In some cases one can only obtain improvement and not total removal of the pigmented area. While the typical brown spots are more easily treated, melasma can be more difficult to treat.
Lightning Creams
There are numerous over–the–counter skin–lightning creams that can be utilized to help lighten brown spots. These creams contain ingredients such as kojic acid, vitamin C serum, lactic acid, azelaic acid, and glycolic acid. There also over-the-counter and prescription strength hydroquinone creams which in many cases can be very effective. However they can only be used for 4-6 weeks or there is a potential that they can actually increase pigmentation and result in a skin condition called ochronosis. This is a blue–grade pigmentation which is caused by long-term use of the hydroquinone. This pigmentation change can be permanent, so hydroquinones should be used with caution.
Retinoids
Retinoids are vitamin A derivatives and can stimulate production of collagen and exfoliate the epidermis (top layer of the skin), resulting in increased cell turnover. They can be effective in gradually removing brown spots, but have to use be used cautiously, as they can cause skin irritation. Milder strength retinoids are available as over-the-counter, but stronger concentrations require a prescription.
Cryotherapy
In this procedure a cotton tip swab is used to apply liquid nitrogen for 5 seconds or less to the brown spot. This destroys extra pigmentation and the skin develops a lighter appearance. However, there is a slight risk of permanent scarring and discoloration.
Dermabrasion
Dermabrasion sands down the superficial layer of the skin with a rapidly rotating brush. An ointment such as bacitracin or Vaseline is applied to the area several times a day, and over several days a new layer skin resurfaces the area. Temporarily, there may be redness and scabbing. The redness can take several weeks to subside.
Micro-Dermabrasion
Micro-dermabrasion is a less aggressive approach then dermabrasion. Small sand-like particles are sprayed against the skin to gradually remove the mild skin blemish and create a smoother appearance. Temporarily there may be some redness and irritation. Lotions or creams may need to be reapplied several times a day to promote healing.
Laser Treatment
Special lasers can be used to remove brown spots. Lotions or creams may need to be applied several times a day to promote healing. In dark skinned individuals there is a risk of pigmentation change and discoloration.
Intense Pulse Light Treatments (IPL)
IPL is a light device which uses a broad wavelength of light which is absorbed by the pigment in the brown spot and destroys it. Several treatments may be necessary. Frequently lotions or creams may need to be applied to promote healing.
Chemical Peels
Light chemical peels using trichloracetic acid (TCA) or glycolic acid can be very effective in removing sun spots by exfoliating the skin and removing the top layer of pigmented skin. Lotions or creams may need to be applied several times a day to promote the healing process and several treatments may be necessary to achieve the desired results.
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