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August 18, 2010

How to Get Rid of Brown Spots

Even more than wrinkles, brown spots make you look older faster. In search of an immaculate complexion, freckle face Ning Chao investigates the best treatments for a spectrum of skin tones

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It was an innocent nickname, but when a new boyfriend recently looked into my eyes and said, "Hey, freckles," suddenly I was back in high school, worrying whether I could cover each splotch with concealer. I grew up in Southern California, and my hour-long, sunny school commute (UVA penetrates windows) and mandatory lifeguard training left me with a generous sprinkling of dark moles. Senior year, while some classmates got nose jobs and breast implants (this was L.A., after all), I begged my mom to let a dermatologist blast my spots with a hyfrecator, an electrosurgery tool commonly used to remove warts. When the burnt scabs fell off a week later, I was in the clear.

Now in my 30s, I'm still testing every brightener, while friends are obsessing over antiwrinkle creams. And my compulsion is entirely justified. According to a recent Austrian study, when photos of women were doctored to enhance uneven skin tone, the same women were judged as older and less attractive than when they had more abundant (and deeper) wrinkles. Bottom line: The more brown spots you have, the older you look.

Unlike the dark moles of my childhood, these new sun spots are lighter and more diffuse, like bits of burnt caramel scattered across my forehead and cheeks — and more typical of hormonally induced melasma (thanks to years on and off the Pill). If you don't believe that Asians can get freckles, just look closely at a photo of Lucy Liu. The spots that some observers call "cute"? I've got them in spades.

For a professional diagnosis, I booked an appointment at the Murad Medical Group Inclusive Health Center and Spa in El Segundo, California, to get my face scanned by Clarity Pro, a new machine that measures not only how much sun damage you currently have (like previous UV cameras), but also shows what's lurking below the surface, invisible to the human eye — for now. "A UV photo is an idea of what's to come. All of those pigmented spots won't surface at the same time, but if you don't treat your skin, you'll see most of them 10 years from now," explains Malibu dermatologist Dr. Rebecca Giles. "In general, the fairer your complexion, the easier it is to treat with IPL or lasers; the darker the skin, the greater the risk of burning, darkening, or hypopigmentation [spot bleaching]. Asian skin is especially tricky. It can look pale, but there's still a lot of underlying pigment that can discolor from light treatments."

People who tan easily and don't burn are more susceptible to skin darkening from a burn, wound, acne, or irritation. But according to dermatologist Dr. Susan Taylor, director of the Skin of Color Center at St. Luke's-Roosevelt Hospital in New York City, every tone is susceptible to UV-induced discoloration, which is why sunscreen is a must, no matter how dark you are naturally (or how much self-tanner you use). "In fairer skin, you get freckles or sun spots, and in darker complexions, an uneven skin tone," she says. Unfortunately for me, I have enough pigment to be prone to sun-related speckling, but the rest of my face is pretty pale, making each mark more apparent. "Your skin doesn't have the capacity to produce significant amounts of color, which is why you don't tan evenly. And only some pigment cells are stimulated, hence the freckles," explains Taylor.

Because UVB rays target the top layer of skin where freckles are, a high SPF is especially important. Giles recommends a broad-spectrum physical block (such as titanium dioxide or zinc oxide) rather than a chemical one (such as avobenzone): "If you're prone to pigmentation problems, you'd be a slave to reapplication with a chemical sunscreen. Chemicals neutralize UV radiation for a couple of hours, but titanium and zinc literally sit on the skin and physically deflect UV rays until you wash them off."

Chemical sunscreens can also be more irritating, and "when pigment-producing cells are more active, the slightest aggravation, even scrubbing, can turn them on," warns Miami dermatologist Dr. Heather Woolery-Lloyd. Hydroquinone bleaching creams are the standard prescription for darker complexions, "but 99 percent of them contain an irritating preservative. If you're sensitive to it, you'll see redness, which could lead to more skin darkening," says Woolery-Lloyd, who recommends chemical peels instead: deeper trichloroacetic acid (TCA) peels for fairer complexions; glycolic or salicylic acid for darker ones.

There's also the new Luma I peel that uses arbutin and vitamin A (instead of acid) to remove extra pigment. There's a minimal risk of skin darkening, but you have to leave the doctor's office with the peel mask on and remove it at home. Afraid of the responsibility, I asked my own dermatologist in NYC, Dr. Fredric Brandt, if I have any other options.

Since my spots are smaller and fainter than my strictly-sun-induced teenage moles, Brandt prefers a Q-switched ruby laser's pinpoint target to a larger probe or fractional (Fraxel) laser's wider treatment area. "There's a risk that Fraxel could burn darker skin. Or it can be fine for the first few treatments, but then cause melasma later," he warns. "The ruby laser is a nanosecond pulse that explodes the excess pigment in just that area," he says. A couple of quick zaps later and I've got a few tender red spots, which I have to moisturize with Aquaphor — until they scab and fall off after a week.

While Brandt tackles the visible marks, I'm on a mission to erase the ones waiting to surface. I have become a zinc oxide advocate (lifeguard favorite Zinka's clear formula is surprisingly invisible), and Stanford University's new peptide-based Lumixyl brightener sounds promising. I can't wait for my next Clarity Pro scan, which Giles recommends I do after nine months. But she also tells me to keep my expectations in check — sun damage removal is a slow uphill battle (unless you decide to go live in a dark cave). On the bright side, pigment protects collagen and DNA, so some more brown spots for me may mean fewer creases later on.


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