Dr. Paul Faringer on “sunspots” on the face

A patient asked about what could be done about the dark spots on her face:

The sunspots you describe are called melasma and occur frequently in patients of Asian descent who have a history of sun exposure. The circulating hormones during pregnancy frequently cause them to become more prominent. There are several effective methods to treat these but the one common factor with all treatments is that if you get further sun exposure, they will return. Most treatments do best if you pre-treat your skin with a pigment lightening cream or gel and these usually contain a combination of products including hydroquinone (a skin lightening chemical), a retinoid such as Retin-A, and a mild steroid cream like hydrocortisone. There are compounding companies that will mix all 3 into one cream and previously there was a prescription cream called Trilumina which contained all 3 but is no longer available. Most physicians recommend at least a month of pre-treatment with this cream regimen prior to a laser or chemical peel. Effective treatments include the IPL (intensed pulse light) which is not truly a laser as it is a mix of light wavelengths but very effective at removing sun spots, or the diode laser. I had very good success in my patients with the Obagi “Blue Peel” which is a trichloroacetic acid (TCA) peel. The downtime from this can be a few weeks though as your face looks like a “smurf” afterward and it takes at least a week for the blue to flake off. So IPL or laser may be less downtime. We have a combination laser here at our cosmetic dermatology clinic and we have a cosmetic physician assistant who performs all of these treatments so I don’t do many of these in my current practice as she performs all of this type of work. I would recommend doing some on-line research and make an appointment with Dorothy (the cosmetic dermatology PA) who can show you all the options.