They may be called brown spots, age spots, or liver spots, but one thing is sure: nobody wants them. The Japanese spend a big percentage of their beauty dollars on targeting brown spots, which they call “shimi.” In the United States our demand for brown spot lightening is steadily rising, especially since these discolorations can add many years on to your perceived age.

It is important to understand that not all brown spots are the same. They vary in appearance and have different causes.

Brown spots from ultraviolet light

Spots crop up on cheeks, temples and the back of hands when extra melanin (pigment that gives skin color) clumps together. Ultraviolet light (sun exposure) increases production of melanin. Sun exposure and tanning beds promote brown spots, but the process can take years. Although heredity has a role, ultraviolet rays are the most common cause. Most people produce more melanin as they age, so your likelihood of having brown spots increases with age.

You can counteract brown spots with retinoids, but you will not see results for at least six weeks. If you want more aggressive treatment, ask about lasers. The number of treatments depends on the darkness of your spots. Expect a light scab that will peel in about seven days. For sun damage that is spread over a large area, intense pulsed light (IPL) emits multiple wavelengths that target many shades of red and brown. Chemical peels may also be useful. Sunscreen containing zinc oxide used year round, indoors and out, is your best protection.

Actinic and seborrheic keratosis

This condition shows up as facial spots or discoloration. Actinic keratosis, which appear as rough or scaly patches with a red to brown color, comes from sun exposure and may be a precursor to cancer. It can be treated effectively when caught early. Seborrheic keratosis, a common result of aging, produces spots that are harmless, though unattractive, with a brown mole- or wart-like appearance. Other than heredity, the exact cause of seborrheic keratosis is unknown, but it too may follow sun exposure. Raised lesions such as moles or keratosis spots are usually removed by freezing, excision or laser treatments.

Your physician is the best person to determine the nature of your lesions and whether or not you need more extensive treatment. Every adult should have an annual full body check. If your lesion is not dangerous, you may still want to remove it for cosmetic reasons.

Melanoma

A melanoma can appear as a changing mole with irregular borders in shades of brown and other colors. This cancerous lesion has the highest likelihood of spreading to lymph nodes and internal organs. With early detection and treatment, 95 percent of melanoma cases are curable. Most forms of melanoma progress rapidly. Treatment may include surgical removal, chemotherapy or immunotherapy. Use sun protection and have an annual full body check to stay healthy.

Melasma

This condition, which is more common in women, causes brown or grey facial skin discoloration. Spots can show up individually or cover large areas. Hormonal changes, certain medications and genetics are contributing factors, and sun exposure tends to make it worse. Melasma caused by hormonal changes, such as pregnancy, birth control or hormone therapy often resolves itself after pregnancy or when medication is stopped.

Your physician may prescribe an aggressive treatment of Retin-A (exfoliates so bleaching creams will better penetrate) and hydroquinone.  Melasma is difficult to treat because it has a memory; the slightest bit of sun will set it off.

Not all lasers work well for melasma. Fraxel, which can be used on a gentle low energy setting, is effective and Q-switched lasers are effective because they’re attracted to brown pigmentation and explode it. A newer option is the Lumixyl Brightening System – a four-part, doctor-dispensed topical regimen used twice daily that claims to fade melasma in as little as eight weeks. Be vigilant; melasma can return with sun exposure, so slather on sunscreen with at least a 30 SPF.

Phototoxic medication

Medicines such as tetracycline, sulfonamides, acne medications, some antihistamines and certain arthritis medications, such as quinine, may cause skin to become sensitive to sunlight. Initially, the symptoms of phototoxic light sensitivity appear much like a sunburn or rash. The results of this “sunburn” may include hyperpigmentation or brown spots on the skin.

Residue of acne

Acne can leave pinpoint spots after a pimple has healed. Acne pimples can leave scars, but squeezing will make matters worse, resulting in post pimple hyperpigmentation, also known as spots. While blemishes are healing, avoid the sun. If you have a pimple and you go out without sunscreen, you are essentially tanning your pimple. It may take up to two years for these spots to fade. To nudge healing along, try the same over-the-counter lighteners that are used to treat melisma. But limit application to the spots themselves or you may lighten surrounding skin areas. For more aggressive treatment, ask your doctor about lasers. The same lasers used to treat sunspots can help fade discoloration from blemishes.

Prevention

The number one weapon in the battle for even-toned and spot free skin is daily sunscreen (SPF 30 or more). Most brown spots on the face are preventable. Sun exposure is the most common culprit in skin discoloration. Sun damage may not show up until later in life, but too much sun, even as a child, can significantly increase the chances of developing hyperpigmentation. The second thing to remember is that when it comes to brown spots, not all lasers are equal. A board-certified plastic surgeon can select the correct treatment.