How can I get rid of age spots?

The four steps to beautiful skin;

1- Good Sunblock - Always use a zinc oxide based sunblock. It has broader UVA and UVB coverage than anything else. It works immediatley upon application, not the case with avobenzone based products. It does not have estrogen mimetic effects like avobenzone based products. It won't make free radicals like avobenzone based products. Get the idea - Zinc is good! But it goes on too thick - wrong! In my practice we sell EltaMD sunblock that has 8 different products designed for any lifestyle or skintype.

2-Retin-A- The BEST skin care product - exfoliates, thickens the dermis, reduces the loss of elastin, improves acne, reduces skin cancer, and most importantly - Disperses Melanin granules, in other words it diminishes brown spots.

3- Hydroquinone - skin bleach that temporarily bleaches the skin to improve the sunspots.

4- Lasers and intense pulsed light treatments - Used as a last resort. They work too well sometimes. The loss of melanin sometimes results in Ivory white spots on the skin - this is worse than the alternative. The treatments are also far more expensive than the treatments described above.

Robert M. Freund, MD, FACS

New York, NY

There are a number of treatments that can be used in isolation or in conjunction.

1. Lasers such as Fraxel provide gradual improvement for age spots.
2. Hydroquinone creams such as Obagi provide excellent results for many patients.
3. A good sunscreen is a must.

The important aspect is to be under the care of a qualified professional who can guide you through the treatments and ensure their proper use.

Brown Spots are usually caused by excess sun exposure, which is a common problem in my Southwest Florida office. Certain lasers (such as the Fraxel laser and several Nd:YAG lasers), and also Intense Pulsed Light, also known as “IPL,” can be used to treat brown spots.

When lasers or IPL are used, “brown spots” get browner temporarily, then rise to the surface and flake off in roughly 10 days. “Brown spots” are usually made of pigment just below the skin surface.

Usually several Laser or Pulsed Light treatments are needed for best results. I usually space 4 treatments about 2 to 4 weeks apart in my office. Sometimes, I must wait until my patients’ tans have faded before I can get an effective treatment- their skin can be burned otherwise.

Keep in mind that some “brown spots” are like icebergs. Lasers and IPL usually can only get to a certain depth of our skin. If the brown spots extend deeper than lasers or IPL can reach, then only “the tip of the iceberg” gets treated. The deeper brown spots usually work their way to the surface over time.

Sometimes this means that brown spots look like they “came back.” In other instances, those brown spots, which were deep, rise up to the surface, and they appear to be “new brown spots.” In either case, occasional treatments, spaced 6-12 months apart, may be needed to keep brown spots away.

Topical bleaching agents like hydroquinone stop pigment production so long as they are being applied. I only recommend hydroquinone for short term use (3-4 months). After the bleaching agent is stopped, cells can start making pigment as usual. My experience is that some brown spots don’t come back, but some do. As a result, lasers and IPL remove brown spots on a more permanent basis.

If you are looking to decrease “brown spots,” and your skin is not tanned or darkly pigmented, lasers or IPL may be a good choice. Discuss laser or IPL treatment with a medical doctor who is experienced in these treatments.

You want to fade the spots that you can see now, prevent them from coming back, and also limit the number that appear in the future.

To treat the brown spots you have, creams and lotions containing hydroquinone will give you the best results.

Kojic acid is another ingredient that can be helpful, but it is slightly less effective than hydroquinone.

Retinoid creams, which are derived from Vitamin A, are very helpful in lightening brown spots and they also help improve skin texture.

I often recommend creams that contain all 3 ingredients, but if you cannot find one like that, use a retinoid at night and a hydroquinone in the morning.

It is very, very important that you use a sunblock every day. The sun is the number one culprit in the appearance of brown spots. If you are going to spend time and money lightening your brown spots, you don't want to go out in the sun and undo all your hard work.

Some of these lightening agents also slightly increase your sun-sensitivity, so you want to be sure to protect yourself.

The most stubborn spots can be lightened or removed with chemical peels or lasers. The lasers most often used are the ruby, alexandrite, and Nd:YAG. Intense pulsed light, or IPL, can also be helpful.

For age spots, we would use the the Q-switched Nd:Yg laser. Q-switched lasers have very short pulse widths and are easily able to remove the cells associated with age spots (we also use them for tattoos and birthmarks).

Although there are a lot of treatments for age spots, our goal at Celibre is to remove the lesions permanently. By heating the melanin in the spots with a q-switched laser, we can destroy (or ablate) the cells containing the melanin. Once completed, new cells without the melanin can replace those that were destroyed.

Although sunscreens and creams work fine, they do not have the permanent results that a few good laser treatments can accomplish. On the downside, laser treatments are more expensive than some of the options previously mentioned and they do require a trip to the doctor's office.

Dr. Scott Gerrish describes how the Fraxel laser is used in age spot treatment.

Pigment can be removed by a number of lasers - the Erbium YAG, the Nd YAG, Alexandrite, Carbon Dioxide - and the new PSR3 (plasma skin resurfacing) technology, but the correct one depends on your skin type, the type of pigmentation, the area, the colour and the depth at which it lies in the skin.

Choose a specialist with several types of laser at his or her disposal.

I actually just completed a study with the Good Housekeeping Institute that tested several products claiming to reduce the appearance of age spots.

Of the five products that we tested, Murad’s Age Spot and Pigment Lightening Gel performed the best, with Good Skin’s All Bright Spot Treatment coming in second.

• The best advice is to wear SPF30 every day and constantly exfoliate skin cells by use of chemical peels, microdermabrasion, and skin care products at home that have AHA's and enzymes.
• Having various laser treatments help with removing age spots, such as Photofacials.
• Other ingredients that help with lightening age spots are Hydraquinone and Kojic acid.

What are age spots?
Large brown spots on your hands that get worse in the summer are commonly called age spots, which is in fact pigmentation.

What can you do about age spots?
Age spots are made worse by UVA exposure (present all year round) but are exacerbated by the sun. The most important thing to do is wear a UVA/UVB protection SPF 15 or above all year round.

Secondly, exfoliate your skin with an AHA (alpha-hydroxy acid) like Glycolic Acid, for example, which will help fade the pigment.