Really stubborn brown spots.

My Dear Dr.Irwin, I am an asian female(55 year old) with fair complexion.Twenty Five years ago I got freckles on cheeks during pregnancy and was cured by Fade out cream with 2% HQ. Then these freckles re appeared 7 years ago and were treated with Ambi Fade cream 2% HQ.Then I quit this cream and got them larger and stubborn.Now since last 5 years I tried lot of stuff without HQ but all in vain even though I use physical sunblock regularly. Pls help me in this regard. Thanks, T.N

Here are a few things to remember about brown spots.

  1. The longer they’ve been there the deeper their “roots” are, and the harder it will be to lighten them.  So spots that have been around more than a few years may need more than a cream to improve them.
  2. Can you feel any of the spots, if you close your eyes and run your finger over them?  If you can feel them, they are deeper and will not improve with a cream alone.
  3. Some brown spots are skin cancer.  Have you had a skin exam with a dermatologist recently?  If not, please make one asap to have these checked.

Sun protection for brown spots.

  • Look at at the back of the label on your sunscreen.  You want at least 15-20% zinc oxide.  The lightly tinted ones are often the easiest to use.  Titanium is not the same.  It doesn’t block much of the UVA spectrum and UVA really activates the brown spots (melanin).
  • Try double or triple layering your sunscreens.  For example, use the Dermaquest (JEN CAN YOU LINK HERE TO THE TINTED) sunscreen first, then a tinted moisturizer with sunscreen like the Laura Mercier tinted moisturizer, then a mineral powder over that.
  • Wear a brimmed hat every time you go outside.
  • Remember that UVA comes through most window glass.

Possible treatments for brown spots

  • Use a plant based lightener or hydroquinone cream (see your derm) to help lighten
  • Liquid nitrogen.  Must be done very  lightly and carefully to prevent permanent lighter spots which can look worse.
  • Peels –  a series of light peels in the fall, winter may be helpful
  • IPL/BBL  (laser-cousin) IF you don’t have melasma – just sun damage.  See your derm to know the difference.
  • Fraxel Dual laser – same caution as above.
  • CO2 laser in some situations may be helpful.  Experts only please.

Hope this helps!

Dr. B


Dr. Brandith Irwin, MD

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