Myths vs. Fact: Dealing with Brown Spots

There are aisles of skin creams that promise to remove or reduce the appearance of brown spots and splotches, as well as a range of treatments that a doctor can do. To help sort truth from fiction about treating these unwanted marks on our skin, we spoke to Dr. Doris Day, a board-certified dermatologist who is a clinical assistant professor of dermatology at the New York University Langone Medical Center. (She also hosts a monthly live dermatology call-in radio show that we love; Doctor Radio, on Sirius 114 and XM 119.)

1. True or False? Brown spots are a natural part of aging.

False. Even though they are commonly referred to as "age spots," the brown, splotchy patches that show up on your face, chest, and arms are not a natural part of aging, says Dr. Day. "If you never went into the sun, you wouldn't have them," she says. Those spots, officially known as solar lentigos, are the result of sun damage over the course of your lifetime. The sun's UVA and UVB rays trigger overactivity in the melanocytes of your skin, causing the spots.

2. True or False? Brown spots on your skin could signal that you have skin cancer.

True. Most brown spots on the skin are benign. But sometimes spots; especially those that change shape or color; could be the first sign of skin cancer. On the other hand, says Day, "Most melanomas are flat, and they don't always look so bad. You really need a trained eye to evaluate all brown spots." If you are prone to getting spots, it's a good idea to let your dermatologist examine your skin at least once a year. If the spot changes in shape and/or color over a period of months, get it evaluated by a doctor right away. Sometimes a doctor may recommend you get a biopsy of the spot to rule out cancer.

3. True or False? If you wear sunscreen, hats, and proper clothing daily, you can prevent brown spots from appearing on your skin.

True. The key to preventing sun spots is to protect your skin from the sun's rays. Wear sunscreen on your face and body before you go out into the sun. (And use it liberally. Dr. Day recommends spreading at least a shot-glass-full of sunscreen on body and face; and don't forget your neck, ears, and shoulders.) Reapply every few hours as the day wears on. Stay out of the sun during peak hours from noon to 3 p.m. Use an umbrella on the beach and wear protective garments.

4. True or False? Lasers are the best treatment to remove brown spots.

True. There is a range of available treatments for brown spots, from over-the-counter bleaching creams like hydroquinone and kojic acid to Retin-A and alpha-hydroxy peels that your doctor can offer. But nothing is perfect. One problem with bleaching creams is if you get the product on the skin around the brown spot, you will lighten that skin as well. Bleaching creams often result in a ring around the brown spot. Retin-A and peels may fade age spots but can make your skin even more sun-sensitive, increasing your chances of getting new sun spots. Also, as with all treatments, vigilance is required. One hour back in the sun is likely to undo the fading and minimizing from treatments. Dermatologists seem to agree that lasers are the most effective treatment for brown spots. Day uses a laser in combination with glycolic acid or salicylic acid peels to help with cell turnover. If you go the laser route, she says, make sure you go to a board-certified physician with experience removing brown spots.

5. True or False? Lasers are painful.

False. Laser sessions last about 20 to 30 minutes and are not painful. According to Day, most patients find the treatment painless or at least tolerable. What could be painful for some is the cost: It can range from $300 to $1,500 per session, depending on where you live.

The key to treating brown "age spots," says Day, is to minimize your exposure to the sun. She also points out that that all brown spots are not equal, so it's important to get a physician's evaluation. Brown discoloration can also be caused by hormones during pregnancy, she notes, which would require different therapies.

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