Brownspots on the face or Hyperpigmentation
Hyperpigmentation and Brownspots are a common concern for patients and can represent a variety of skin conditions. The most common cause of hyperpigmentation include melasma (chloasma), lentigines, cafe-au-lait macules as well as a variety of other causes. Since not all brownspots are the same, therefore not all treatment options are the same.
For practical purposes, our practice likes to divide skin hyperpigmentation and brownspots into either epidermal (superficial) or dermal (deeper). We treat these conditions with a variety of topicals, chemical peels, as well as lasers to help patients improve the appearance. We use the latest in skin analysis technologies to track improvement for patients. Analysis of the skin allows for accurate assessment in skin improvement more so than what standard photography can.
Hyperpigmentation and Brownspot Skin Conditions:
Melasma is the formation of patches, often hormonal, and often in women. It is the apperance of dark brown patches seen along the midportions of the face (cheeks, forehead, nose) although it can be seen along the temples as well. Often the best treatment options are a combination of modalities including the use of retinols, skin lightners and antioxidants.
- It is critical sun is avoided. Sun can exacerbate and cause reformation of melasma
- Topical treatments can be effective in some patients. Topical treatments include the use of hydroquinone often in combination with a retinol. The hydroquinone promotes skin lightening and takes 6 weeks to be effective, while the retinol can encourage skin turnover. Newer skin lighteners are also available with less side effects. Antioxidants can be helpful in this process as well.
- Chemical peels. Chemical peels can be beneficial in specifically targeting browns in the skin. The Melanage peel system is effective and can be tolerated by a variety of skin types.
- Intense pulsed light- Newer intense pulsed light modalities such as Lumeca can be helpful in specifically targeting brown areas in fewer treatments
- Laser- Both ablative and nonablative treatments can be effective. Resistant browns often respond to q-switched Nd:YAG as well as in some cases q-switched KTP. In some cases, Nd:YAG can be helpful. Ablative technologies including erbium can be helpful in improving browns as well. Sometimes lighter type fractionated C02 treatments can be of assistance.
Overall, melasma is a challenge to patients and providers alike. Conservative treatments are the mainstay. However, when conservative treatments are ineffective, patients can progress with other treatments especially in cases where melasma is highly visible.
Lentigines are a variety of areas which are also known as age spots. They are typically flat and brown. As we age brown spots increase, and sun exposure is thought to be a main culprit. Brown spots can be particularly concerning when seen on the face and hands. Lentigines are not all the same. Some lentigines respond well to IPL, while others need deeper penetration. Newer IPL’s such as Lumeca offer improvement in targeting browns while other lasers such as nd:YAG and q-switched nd:YAG and even q-switched KTp or q-switched ruby may be of help. Ablative treatments including erbium and fractionated C02 can be of help in combination or as standalones to treat lentigines.
Pigmented lesion Chart and Responsiveness Guide Based on LASER
IPL , KTP q-switched, Erbium
Some IPL’s (3rd generation only), Nd:YAG q-switched, Erbium, q-switched Ruby
Where is Dr. Shah’s office located?
It is located on the 9th floor in Watertower Chicago. He has a variety of lasers and peels to effectively treat brown spots and hyperpigmentation.
How many treatments will I need?
Some skin lesions are improved with 1 treatment. However, deeper skin lesions often require several treatments to be effective.
Does Dr. Shah’s office use the 2- pass technique?
The 2-pass technique is where a lower energy is used with a laser or IPL but the face is treated in 2 passes instead of 1 pass. We do employ different techniques based on a patients skin and skin limitations.
Is treating hyperpigmentation or brownspots covered by insurance?
Typically, hyperpigmentation or brownspot treatments are not covered by insurance.
How can I tell if I have a dermal or epidermal brown spot?
Melasma and lentigines can be both epidermal or dermal. Often times treatment options will be adjusted to accommodate for depth of lesion at Dr. Shah’s office in Chicago.