"Pigment-specific lasers are the best in-office treatment," says Alster. "At home, I recommend treating discoloration with ingredients that boost cell turnover," she says.
What the Derm Can Do
To zap off brown spots, ask your dermatologist if one of the Q-switched ruby, alexandrite, or Nd:YAG lasers is right for you. "These target spots, heating up melanin and destroying it after one to three treatments," says Alster. "Each pulse of the laser feels like a hot pinprick, and skin will feel tight and sunburned for a few days after." The cost is around $250 to $1,000, depending on the area treated, but results are long-term for those who stay out of the sun.
"For blotchiness, IPL [intense pulsed light] and peels are top choices," says Alster. IPL works similarly to the pigment-specific lasers mentioned above, heating up melanin and destroying it. Up to four sessions are required, spaced one month apart, at $400 to $1,000 per session. For faster results, your dermatologist can apply Levulan before treatment with IPL. "This will make dark areas more sensitive to light, so only one to three treatments are required," says Alster. IPL with Levulan costs about $1,000.
"In-office peels remove a layer of skin to reveal a more even complexion," says Brandt. A light TCA (trichloroacetic acid) or Resourcinol peel can be done once a month until pigment problems are resolved, at $250 to $1,000 per peel. There is no downtime, but skin will be a bit flaky for a few days. A medium TCA peel (which goes deeper than Resourcinol and which Brandt claims should be done annually at most) costs $1,500 and can clear up more serious blotchiness, but skin will be quite red and peel for a week.
"If you have rough, peeling brown spots, see a dermatologist," says Brandt. "It may be a sign of a precancerous lesion." These can often be treated topically with a prescription gel like Aldara, an immune-response modifier that stimulates the immune system to detect and eliminate abnormal cells. Pain and side effects are minimal. Treatment lasts from four to 16 weeks.
Best Skin-Care Options
The easiest way to keep brown spots at bay? Sunscreen. Mexoryl SX, a newly FDA-approved sun filter, blocks harmful short UVA rays. Lancôme UV Expert 20 with Mexoryl SX ($35) deflects long and short UVA rays and also contains UVB blockers.
"Products that increase cell turnover will improve pigmentation problems," says Alster, who recommends antioxidant-packed SkinCeuticals C E Ferulic serum ($122). We also like iS Clinical Super Serum ($125) with kojic acid and arbutin, ingredients that work to inhibit the production of melanin.