One of the most common skin concerns we see in the office are dark brown spots or areas of hyperpigmentation. These can occur in fair or darker skin-toned patients, usually on more sun-exposed areas of the face such as the upper cheeks. This problem can be unsettling and can give a “dirty” look to one’s complexion. Patients often come in having read about laser treatments for these spots, but there are a few things we need to consider prior to any treatment.
If we are dealing with flat, brown hyperpigmented spots on the face, then the most common cause is benign “solar lentigines,” or sunspots — essentially the skin’s response to longterm sun exposure. The diagnosis can become more complex if a patient has many sunspots, some of which are larger or more confluent. This appearance can sometimes be confused with another hyperpigmenting condition known as melasma. What’s more, melasma and sunspots can occur simultaneously!
It is important to think of these different diagnoses as treatment options have some overlap but are not entirely the same. For example, the main treatments for melasma are topical lightening creams and/or chemical peels, often for initial and longer term maintenance treatment. Laser treatments are almost categorically effective for sunspots, but may darken or have no effect for melasma. These are important distinctions that may have a lasting effect on one’s appearance.