Correcting white spots on the face. Can it be done?

Dear Dr Irwin, Thanks so much for taking the time to answer readers questions, this is my go-to resource and I have recommended your site to many people, we all love it! Maintaining a blog isn't easy when you juggle career, family, lift etc, so greatly appreciate what you do. My question relates to how do you treat hypo-pigmentation? You see, I went a little over board with laser (to rid of freckles with Q-switch type laser) and I now have white spots. I'm of oriental asian origin, light-med yellow skintone, NC25. Many thanks

Thank you! You made my day and I love it that you’re using the NC25 for skin tone accuracy. I’ll do a post on this sometime soon.

I’m hoping you don’t mind if I use your kindness in sharing with us, to make this point. Any time you just spot treat brown spots whether it’s with a laser, or a bleaching cream or peel solution, etc., there is a high risk of other pigment problems! In other words, spot treating by itself usually creates a different set of spots, often both white and/or brown.

Why does spot treating brown spots create white spots and/or more brown spots?

It seems logical that if you have a brown spot, why not just treat that? It’s logical right? And I totally get why most people think this.

And…..if you think a little more about it, its almost impossible to get an exact match between the size and shape of the individual brown spot and the method removing it. This is true even with the greater precision of a laser. Also, when you take brown pigment out, to get an exact match with the underlying skin color/tone is not possible. Thus white spots and brown spots occur after just spot treating a brown spot.

What is the fix or answer for this problem?

  • The goal is even, beautiful skin right? So something in addition is needed to blend skin color/tone of the whole face or body area together.
  • Some spot treating may be okay, if a different method is also used to blend the whole face together.   The entire face, arms …needs to be treated.

How does one blend the face or other area that is uneven?

This is the art and science of it. It depends on the person’s skin, the amount of sun/light exposure and extent of the problem.

  • Ways to blend include fractionated lasers like Fraxel Dual or even a light fractionated CO2, or erbium. These need to be done lightly over the whole face to encourage pigment cell migration into the whiter areas.
  • IPLs need to be done correctly or they may cause more problems. Having said that, we use them frequently in our office to help blend uneven pigment that is more superficial.
  • Peels and bleaching creams can make the situation better, again if used correctly. More on light peels and microdermabrasion here. Here’s a blog where I talk about when and how to cautiously proceed with trying bleaching creams.
  • High zinc sunscreens and hats are a must unless your doctor tells you not to.
  • With a laser treatment for white spots, sometimes we will have patients get a 5-10 min exposure to sun unprotected at midday. This is mostly UVB and helps encourage pigment cell (melanocyte) migration. This will need your doctor’s supervision. Please don’t try yourself!

***  The above does not apply to vitiligo which is a competely different problem. In vitiligo, one’s own immune system is attacking the pigment making cells.  

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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