Dark Skin Spots from Melasma and Freckles

Dark Skin Spots from Melasma and Freckles

Melasma and freckles are common issues that can affect both men and women, causing distress.

There are 3 types of freckles:

1. Seborrheic Keratosis

Seborrheic keratosis is a brown, raised growth on the skin that can be large or small. The surface appears rough and usually affects older individuals. The frequency of occurrence varies with genetics. These growths are superficial and can be easily treated with carbon dioxide laser (CO2 Laser). After treatment, the area will scab for 4-7 days, depending on the depth of the growth. In people with darker skin or sun exposure, the treated area may have temporary light or dark spots.

Other treatment methods include using electric current, liquid nitrogen, or acid. However, the cosmetic results of these methods may not be as good as laser treatment. After treatment, seborrheic keratosis can recur over time.

2. Superficial Dark Spots

Freckles are small, well-defined brown spots that appear during adolescence, often in fair-skinned individuals. They tend to darken during sun exposure, such as during summer. Treatment includes using lasers, such as Q-switched Nd: YAG. After treatment, there may be temporary light spots, which usually do not recur. New spots may appear nearby if there is excessive sun exposure, and some spots can fade on their own.

Solar lentigines are age-related changes resulting from sun exposure (UV), often appearing on sun-exposed areas like cheeks, backs of hands, and arms. Treatment for superficial dark spots involves using lasers or intense pulsed light (IPL) targeting melanin granules. After treatment, scabs will form and peel off. If the spots are deep, repeated treatments may be necessary. After treatment, it is important to avoid intense sun exposure and use sunscreen to prevent dark spots from reappearing.

3. Deep Dark Spots

Hori's Nevus appears as brown or gray spots or patches on the cheeks, caused by genetics. They are commonly found in women aged 20 and above, usually on both sides of the face. The color may intensify with age. Treatment with skin-lightening creams, chemical peels, or ablative lasers is typically ineffective.

Nevus of Ota usually appears at birth or during adolescence, presenting as brown or gray patches on one side of the cheek, temple, and forehead. Sometimes, the gray color may also appear on the white part of the eye.

Deep dark spots are difficult to treat and require a long treatment period using lasers with appropriate wavelengths to minimize damage to the top layer of skin and provide enough energy to destroy the pigment cells without harming surrounding tissue. Treatments are usually spaced 6-8 weeks apart, with more than 5 sessions typically required. Recurrence is possible after treatment. The treated area may have temporary scabs and light or dark spots. It is important to avoid intense sun exposure.

Lasers used for treatment include Q-switched Nd: YAG, Q-switched Alexandrite, and Q-switched Ruby.

Melasma

• • Melasma appears as light brown to dark brown or gray patches, depending on the depth, on both sides of the face. There are several factors causing melasma, including exposure to sunlight and heat, hormonal changes (such as pregnancy), intake of sex hormones, and genetics.
  • Melasma treatment involves using topical medications in combination with oral intake, as well as treatments that facilitate the penetration of medication into the skin using electrical currents or sound waves, such as Ionto/Phonophoresis and Electroporation.
  • Lasers targeting specific pigments can help fade melasma, but the results are better for superficial melasma cases. For deeper melasma, the treatment results are still uncertain. Fractional skin resurfacing lasers, such as Fraxel, fractional Erbium, and fractional CO2, are increasingly being used to treat stubborn melasma.

The most important aspect of prevention and treatment is to avoid excessive sun exposure and to use sunscreen with an SPF greater than 30 and UVA PRO protection of more than 8, along with the application of medications.