What can a doctor do for brown spots?

Dr. Ellen Marmur, MD
Topical hydroquinone, a derivative of benzene, does not literally bleach the skin but suppresses overactive melanocytes and slows down the pigment-making process. Hydroquinone alone is applied directly onto the dark spot and slowly erases it within at least six months (although it could be sooner). It works by blocking the enzyme tyrosinase inside the melanocytes that makes melanin. A doctor's prescription increases the concentration from 2% (what you get OTC) to 4% or 6%, but beyond that is unsafe. In fact, the FDA proposed a ban on over-the counter sales of hydroquinone in 2006 because too strong a dose or using even a lower dose for an extended period of time causes side effects such as darkening and thickening of the skin (exogenous ochronosis). The chemical has also been shown to act as a carcinogen in mice. Other topical treatments combine hydroquinone with a retinoid and a light anti-inflammatory steroid. Another uses hydroquinone with glycolic acid to lighten and exfoliate the skin.
Lasers that target pigment, such as the Ruby and the Q-switched ND:YAG, work better than more surface-level treatments like chemical peels, microdermabrasion, or intense pulsed light (IPL) treatments. A laser can reach melanosomes deep in the skin and might even be able to get rid of a brown spot in one treatment (although two or three treatments may be necessary to do the trick). I use topical medications and laser treatments together, but many people have not had success with hydroquinone or do not want to use it, so lasers alone can be very effective. Laser light converts to heat and blows up the melanosomes, after which they flake off the skin. (It feels like a hot snap against your skin but lasts only a few seconds; then it stings for a few minutes right afterward.) Strangely enough, darker spots go away faster than lighter ones because there is more pigment for the laser to aim for; a pale spot is an almost invisible target. The procedure takes just a few minutes (and, as always, numbing cream is applied to the skin first), but the downtime is up to a week. The skin will get red and then scab, so recovery time takes at least five days.
Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

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Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

What if a leading dermatologist just happened to be your best friend and you could ask her anything? DR. ELLEN MARMUR, a world-renowned New York City dermatologist, answers all your questions with...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.