Brown spots on the skin appear as we age, and unlike freckles, are often less than adorable. Also unlike freckles, age spots (aka solar lentigines) do not fade in the winter months when we are exposed to less sun. In this blog post I’m going to explain what causes age spots, how to prevent them, and how to get rid of them.
What causes brown spots?
The pigment in your skin, called melanin, is produced by special cells called melanocytes. Exposure to ultraviolet light speeds up the production of melanin. And after years of sun exposure, the melanin can even clump together. This combination of increased production and clumping of the pigment causes age spots.
How is melasma different from age spots?
Melasma is patchy hyperpigmentation that appears on the face, especially the cheeks and forehead. Also called the “mask of pregnancy”, melasma is often related to hormonal changes such as pregnancy or starting birth control pills. It is extremely sensitive to sun exposure: more so than age spots. Even sun exposure on unaffected areas such as your forearm can cause melasma on the face to become darker. Sun protection, including sunglasses, is extremely important for improving melasma.
What about raised brown spots?
Another type of brown skin lesion, the seborrheic keratosis, also appears as brown patches. They are raised and waxy-looking. But when very thin, it’s easy to mistake them for solar lentigines. The differentiation is important as seborrheic keratoses are due to age and genetics, not sun exposure. And they can only be removed physically through cautery or cryotherapy, i.e. burning or freezing them off. Skin care products and BBL treatments will have no effect on seborrheic keratoses.
Warning signs of melanoma
If we’re talking about brown spots on the skin, it’s important to review the warning signs of melanoma. If you notice any of these characteristics you should have your brown spots checked out by a doctor before trying to remove them:
- A is for Asymmetry: if you draw an imaginary line through a melanoma the two halves don’t match.
- B is for irregular Borders: normal moles and solar lentigines have smooth, even borders.
- C is for Color: melanomas often have multiple colors within the same lesion, including different shades of brown, red, or even blue.
- D is for Diameter: a lesion larger than 6mm, about the size of a pencil eraser, should be looked at more closely.
- E is for Evolving: any new changes in a brown spot, such as new itching, bleeding, or crusting are a cause for concern.
How to remove age spots
Age spots are treated in two ways
- Physically removing them through BBL or laser
A solid skincare program is the first-line of treatment for sun-related hyperpigmentation and melasma. There are four components:
- Sun protection. Since UV light stimulates melanin production, anything else you do isn’t going to be effective if you aren’t decreasing UV exposure. It’s like trying to clean the house when you’re kids are creating a mess behind you. Not gonna work.
- Decrease further melanin production. Skin products that do this fall into two categories: Hydroquinone and non-hydroquinone products. More on this later.
- Exfoliation to remove pigment cells.
- Retinoids (tretinoin or retinol).
Step 1 – What sunscreen should I use?
I prefer sunscreen with a physical protectant rather than a chemical one. The chemical sunscreens break down over time, meaning they’re less effective. Look for zinc oxide or titanium dioxide in the ingredients. And unlike the pasty sunscreens of the 80s, today’s formulations are sheer and quick absorbing. They even come in tinted formulations so you can use them as foundation.
Step 2 – How does hydroquinone decrease brown spots?
Hydroquinone is the gold-standard of skin lightening products. It is available over-the-counter in a 2% concentration, and as a prescription in 4% or even higher concentrations. Hydroquinone inhibits tyrosinase, an enzyme needed to make melanin. Because you’re inhibiting the production of new pigment, you’ll have to wait for a cycle of skin turnover to reveal the brighter, more even skin. So it takes 4-6 weeks to see improvement.
Three important words of caution regarding hydroquinone:
- Don’t use hydroquinone if you’re pregnant. It does get taken up into the bloodstream, so we don’t recommend using it when pregnant.
- Do not use hydroquinone with benzoyl peroxide or other peroxide-based products. This can cause staining of the skin.
- Hydroquinone should not be used for more than 3-4 months- the melanocytes will develop resistance and you can get rebound hyperpigmentation.
After using hydroquinone for 3-4 months I recommend switching to a non-hydroquinone skin lightener to prevent rebound hyperpigmentation. These products contain several different ingredients:
- Licorice root contains glabridin and liquiritin which block the production of melanin and help break up the melanin that is already there.
- Gojic acid: decreases melanin production
- Arbutinin: a natural form of hydroquinone that is less toxic to melanocytes
One of my favorite non-hydroquinone skin lighteners is Intellibright by AlumierMD. After you’ve finished a bottle of Intellebright, you can switch back to hydroquinone for another few months.
Step 3 – Retinoids
Retinoids such as tretinoin and retinols increase cell turnover, so the surface skin cells die and are sloughed off, revealing brighter skin underneath. They also inhibit melanin production for a combination approach. Tretinoin, aka RetinA, is the strongest formulation and can cause redness, dryness, and skin irritation. Many people find this difficult to tolerate (including me!) so I recommend a retinol for everyday use. Retinols need to be metabolized into tretinoin, so they are more gentle on skin.
Step 4 – Exfoliants
Chemical exfoliants remove the outer layers of skin that are holding on to uneven pigment, to reveal the more evenly pigmented skin underneath. Common exfoliants in skincare are lactic acid and alpha hydroxy acid. I recommend using one of these products in the morning, and retinol at night; applying them at the same time can be too irritating.
How long will it take to remove age spots?
Using a combination of products you should see improvement in 6 weeks. If you have seen no significant improvement in that time, I like to add a couple of chemical peels to remove the outer layer of skin and help products penetrate better. Note that you aren’t going to see improvement in pigmentation using a chemical peel alone- it simply doesn’t penetrate deep down to the pigmented layer.
Physical removal of pigment
If you want to move things along a little faster, or you haven’t quite gotten the improvement you would like from skincare alone, we also have laser treatments to physically remove the pigment.
BBL or IPL
BBL (Broad-band light) and IPL (intense pulsed light) aren’t technically laser treatments, because the light isn’t produced in a single wavelength. But physics aside, the important thing to understand is that the energy targets the pigment itself. The melanin then works its way to the surface of the skin and is sloughed off. This doesn’t harm the surrounding skin, meaning it’s a non-ablative treatment. You’ll feel sunburned for a couple hours, and the pigmented areas of skin will darken for a few days. But you can wear makeup right away after a BBL treatment.
Fractionated laser (Pixel, Fraxel, and Halo) creates a pixelated pattern of injury to the deeper layers of the skin, so it is an ablative treatment. The pixellation is important because if you just peeled the skin that deeply it would take weeks to heal. Doing a pixellated pattern leaves healthy skin cells in between to heal the areas of injury. You’ll have several days of downtime after a laser peel where your skin will be red and flaky.
Where do I start?
As you can see, there are many great options for removing age spots. If you want to remove age spots at home, start with a good sunscreen to prevent them from getting worse. You can try over-the-counter retinol and hydroquinone as well, but you’ll see a much quicker improvement if you use prescription strength products. You can even request a customized skin-care plan right on our website, without leaving your house!