ID your dark marks “Brown spots can refer to freckles, sunspots or brown blotchiness known as melasma,” says Howard Murad, MD, a Los Angeles dermatologist. Freckles, while similar in appearance to sunspots (round and brown) fade when sun exposure is decreased. Sunspots and melasma, by contrast, are deeper brown and stick around, even in the dead of winter.
Start fading at home Before you see a dermatologist, consider over-the-counter options, which do the job for some. Murad suggests formulas that contain one of the following: 2 percent hydroquinone, a skin-lightening ingredient; vitamin C; or a botanical brightener like mulberry, bayberry or kojic acid. All work to minimize melanin production. And Murad insists that whatever product you choose be topped by a sunscreen, since repeated UV exposure makes efforts at fading spots futile.
Upgrade to an Rx If your brown spots resist OTC products, visit a dermatologist to get a prescription for a retinoid such as Retin-A or Tazorac. Retinoids work by normalizing the epidermis (your skin’s outer layer), which in effect returns your complexion to the way it looked and behaved before you got the spot-triggering sun exposure, explains Jeffrey Dover, MD, an associate clinical professor of dermatology at Yale University School of Medicine. “But it can take three to six months to really see a difference, so be patient,” says Dover. To jump-start the fading process, some doctors put patients on Tri-Luma, a blend of Retin-A, hydroquinone and cortisone, for two months, then switch to a traditional product like Retin-A. “You can only use Tri-Luma for eight weeks at a time because cortisone gradually thins the skin. But it’s the quickest topical fading cream I’ve seen,” says Patricia Wexler, MD, a New York City dermatologist.
Pull out the big guns Certain in-office treatments can seriously accelerate the erasing process, and prices vary. Your least expensive options: glycolic acid peels and microdermabrasion (up to $200), which lighten pigmentation by exfoliating the skin’s surface so that you quickly shed darkened areas. The doctor will oversee those treatments, but for dramatic results, you must follow up at home with topical lighteners; the in-office peels and microdermabrasion can’t get you there on their own. Next on the price spectrum: new-to-the-U.S. Cosmelan, a concentrated hydroquinone mask applied at a doctor’s office, left on for six to eight hours and then washed off at home. (Many patients pay extra to have the mask applied at home, by a nurse or medical aesthetician, so they needn’t be seen in public with a face full of mustard-green cream.) “After removal, the skin is a little red and flaky for 24 to 48 hours, but results rival the faded pigmentation you’d find after three months on a dedicated retinoid regimen,” says Jon Turk, MD, a New York City plastic surgeon who offers this service. Average cost: $600 to $800 (which also includes a two-week skin-care regimen). Finally, the most aggressive — and most expensive — option is the Fraxel resurfacing laser (treatments start at about $1,000, and most people need two or three). “This laser is color-blind,” says Wexler. “It can be used on any skin tone to even out pigmentation and stimulate collagen production; the results are dramatic and nearly immediate.” Downtime is about a week, and you should expect extreme redness and peeling.
Originally published in the November 2010 issue of More.