Top 5 Tips to Get Rid of Brown Spots - Appalachian Spring Dermatology

There are many other treatments out there, but I am going with the tried and true options from my experience, not only as a dermatologist but also as a very freckly sun-damaged girl.

I generally do NOT recommend actively pursuing brown spot treatment with a procedure or bleaching cream between June and September because, during these months, we get much more sun exposure. I have found that I can SOMETIMES maintain my brown spots in the summer if I am extremely diligent, but often it is a losing battle. Starting an active treatment plan during these months will feel like a waste of your time and money. October is a different story. I often recommend aggressively targeting brown spots in the fall. This generally leads to excellent results by January and can be easily maintained through the spring.

1-Sunscreen, hats, protective clothing, and blue light blockers are my number one recommendations for freckles, lentigines, and melasma. For more details on sunscreen, see my prior posts on sunscreen at the end of this article. I recommend a daily sunscreen with ZINC every single day.

2- Retin A and its derivatives, including adapalene, Differin, tretinoin, tazarotene, are the next most important. Retinoids help rejuvenate the skin, shed old skin, and reduce pigment production by freckles, melasma, and lentigines. These products should be used nightly but can be very irritating at first. For tips on using RetinA, see my prior post. Topical retinoids can also be used to induce a chemical peel to rejuvenate the skin. See my prior post on doing a 5-day chemical peel with ZO Retinol.

3- Hydroquinone based bleaching creams – While these are available OTC in 2%, I recommend the prescription 4% once or twice a day, depending on the severity of the brown spots. These are used at least nightly until the brown spots are clear, and then a decreased maintenance regimen can be established. When I started in dermatology, we use these year-round, but newer studies suggest continual use may result in some resistance. Generally, I usually recommend starting with a combination of tretinoin 0.025% or 0.05% cream at night and ZO Blending Crème once or twice a day. In the older variations of Obagi and ZO products Blending crème was called Blender and Melamix.

Pigment Control + Blending Crème 4% HQ – RX

Triluma is a cream that is a combination of tretinoin and hydroquinone bleaching cream that I often prescribe as well.

4- Photodynamic Therapy (PDT) – As many of my patients know, I am a big fan of photodynamic therapy to treat precancerous cells and its excellent skin rejuvenation properties. For those in a hurry, I will often recommend that we jump-start things with PDT, which is available in a more traditional form and a newer cosmetic directed form called GlycoALA.

5-Cryosurgery or Freezing – Cryosurgery works very well for some lentigines and seborrheic keratoses. The risk is that the skin may respond by leaving a pale or very rarely tan spot. This works well for large, isolated lesions and is not a good treatment for melasma or freckles.

Notice, I did not recommend Intense pulsed light, laser and chemical peels. While all of these work some, they are never intended to be a one stop quick fix. Patients are almost always better served, both with skin health and finances, to start a good skin care regimen than to do a one-time procedure. More importantly, many of these procedures may worsen melasma.

References

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