Brown spots on the face, neck, and arms are among one of the most common cosmetic complaints addressed by dermatologists. Brown spots in these locations may be due to numerous causes, including but not limited to: post-infammatory hyperpigmentation, lentigos, poikiloderma (sun damage), seborrheic keratoses, and even melanoma. The discussion of cosmetic treatment of lentigos and poikiloderma will be addressed here, but it can not be stressed enough that a consultation with your dermatologist to determine the nature of any brown spot present in any location is needed to make absolutely sure that you are not dealing with a melanoma or other malignancy.
For brown spots due to lentigos and poikiloderma, usual treatments include bleaching creams containing hydroquinone, mequinol, or kojic acid in various percentages. For creams or solutions containing hydroquinone or mequinol, there may also be a variety of other ingredients to augment the bleaching effect such as tretinoin, glycolic acid, sunscreen, or a topical steroid. In most cases, bleaching the affected area simply requires using the bleaching cream twice daily in addition to a protective sunscreen. It is wise to know that one day out in the sun may reverse all the effective bleaching that you might have done up to that point. Thus, effective sunscreen use and sun avoidance are essential in preventing recurrence of the brown lesions.
In addition to bleaching creams, liquid nitrogen cryotherapy, laser treatment with a 532nm Q-switched Nd:YAG laser for obvious lentigos, or an IPL / Flash-lamp Pulsed Dye laser for lentigos +/- photodamage may be used to achieve more immediate and even results. Discussion for use of these lasers require a consultation with an experienced dermatologist, and a coordinated treatment plan with either tretinoin products, hydroquinone / mequinol products, or other topical treatments may be the best method by which to achieve the most excellent results.
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