What causes dark spots on the skin and what works to reduce them?

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Sun spots, or lentigines, are brown spots that develop on skin exposed to the sun. Sun spots occur in adults and are not harmful.

I often hear from patients expressing concern that their sun spots were caused by recent sunburn. In reality, these spots occur after years of repeated exposure to the sun. If you compare the exposed side of your forearm to the protected underside, you can see the impact of chronic sun exposure on the development of sunspots. If left untreated, sunspots slowly darken over time with continued exposure to the sun.

To reduce the appearance of sun spots, start with the “ABCs” of facial skin care:

  • A for retinoids, or vitamin A derivatives

  • B for broad spectrum sunscreen

Of course, always keep in mind that the best way to fight sun spots is prevention! Wearing UPF clothing and sunscreen is essential to prevent these stains from appearing or darkening over time.

Retinoids improve skin cell renewal, reduce pigment production, and stimulate collagen formation in the skin. If you’re new to retinoids, try an over-the-counter option first as they are better tolerated by the skin, before switching to more potent prescription retinoids. Apply a pea-sized amount all over your face at night and moisturize to combat common side effects of dryness and irritation. Use every other night at first and increase slowly until overnight use.

Vitamin C is an antioxidant that protects the skin against environmental stressors, including UV rays, pollution, and smoke. These over-the-counter topicals also stimulate collagen and reduce pigment production. Avoid vitamin C products in transparent bottles as the packaging should protect the product from exposure to light.

Consistent use of ABC for facial skin care ultimately leads to a healthier, brighter, and firmer appearance of the skin. Be aware that using topical products for a few days will not have a dramatic impact. Many patients express disappointment that a retinoid has not worked after only about a month. These products should be applied for months and ideally years for the greatest benefit.

There are also various in-office treatments that may provide faster improvement over topicals alone. Cryotherapy or “freezing” can be done, but this method carries a higher risk of dyspigmentation compared to more advanced device-based techniques. Chemical peels with ingredients such as retinoids, glycolic acid, and trichloroacetic acid are also effective. Lasers and light-based devices are commonly used to treat sunspots. Keep in mind that you may need more than one treatment to get the results you want.

When considering treatment, timing and preparation are key. Be aware of treatment costs, as insurance plans rarely cover cosmetic services. If you are preparing for a special event, start months in advance and be aware of any post-procedure downtime. Board-certified dermatologists and medical specialists have extensive knowledge of peels and devices to tailor treatment to your skin type and goals.

If you’re worried that a spot is cancerous, don’t wait. Call your dermatologist to have it checked.

Elizabeth Jones is Assistant Professor in the Department of Dermatology and Skin Biology at Jefferson.


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