Treating unwanted pigment spots

How do I deal with unwanted pigment spots?

For practical purposes, pigmented skin spots are in two categories: Age spots (lentigines) and melasma.

Melasma is caused by the accumulation of pigment deep within the skin – often even in the dermis. It appears to be hormonally stimulated – common in pregnancy or when taking supplemental hormones, like birth control. What’s more, melasma is very resistant to treatment.

Age spots (lentigenes) are more superficial. Pigment producing cells (melanocytes) reside in the bottom layer of the epidermis. They produce pigment as a natural sunblock. Each melanocyte normally distributes pigment evenly to approximately 15-25 epidermal cells (keratinocytes). With age the coordination of pigment production and distribution gets out of sync. Pigment tends to get clumped into “age spots”.

Treatment of “age spots” is two pronged. There are topical products that diminish pigment production (hydroquinone is the “gold standard”). Once formed, age spots can be treated by (1) intense pulsed light [IPL, BBL], and (2) chemical peels, or superficial lasers.

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