How to remove spots on the face by an expert dermatologist?

Dr. Sebastian Podlipnik on a leaflet stating that not all facial blemishes are the same

When we think of signs of aging, we often put wrinkles at the top of our list. However, wrinkles different types of hyperpigmentation or brown spots on the face denote much more marked aging.The most important thing to keep in mind is that not all spots on the face have the same origin and the differential diagnosis of these is very broad. Therefore, removing spots on the face is a challenge that requires a thorough examination of the skin in order to recommend the best treatment. 

What will I talk about in this article?

Why do facial blemishes occur?

Generally speaking, we can say that the ultraviolet radiation from the sun or tanning beds, is the most important cause of the. Hyperpigmentation usually starts to appear after the age of 30, when the skin begins to show the consequences of chronic sun exposure. This happens especially if sunscreens and other protective measures were not used during adolescence. In addition, thehe sun increases the level of melanin in the skin regardless of the type of facial blemish, which is why skin blemishes always look worse after the summer. 

In addition, hormones, both estrogens and progesterone, can increase the level of melanin. This is why pregnant women or women under hormonal treatments have dark spots on their faces that usually lighten after childbirth, but do not always improve.  

Finally, people with light hair or skin and who have suffered severe and/or numerous sunburns are particularly at risk of developing these spots in the future. 

What types of stains are there?

Undoubtedly the most important thing when receiving a new patient in our office is to make a proper skin diagnosis. In this sense, dermatologists have an advantage and a lot of experience not only in aesthetic blemishes but also in those secondary to diseases. Fortunately, most of them are benign but in some cases there are also some facial blemishes that can be produced by the melanoma skin cancer. Here are the ones I see most frequently in my practice, although there are hundreds of different causes listed. 

  • Melasma: also known as pregnancy spots or chloasma. Clinically they look like a diffuse hyperpigmentation that is more related to hormones and is aggravated by sun exposure and blue light (I will explain this later). If you want to know more about treatment of melasma, I wrote a specific article about it.
  • Post-inflammatory: after an inflammatory process, spots may appear on the skin.  such as severe acne, irritation from waxing or a rash. 
  • Solar lentigo or sun spots: Almost all of my patients blame age for these spots, but they are not really caused by aging, but by the progressive accumulation of ultraviolet radiation from the sun and tanning booths. 
  • Ephelides: also known as freckles. They are absolutely normal and tend to appear early in life. 
  • Skin cancer: fortunately Melanoma is not as frequent but it is the most important and can also manifest itself as a brown spot on the face. Like specialist in the Melanoma Unit of the Hospital Clínic de Barcelona. I see many of these lesions and it can be very difficult to differentiate them from sun spots if you are not a specialist dermatologist.  

How to prevent spots from appearing on the face?

Before going into the treatment and detailing the different methods to remove spots on the face, I will start with the most important, Prevention! 

Below I will tell you how different types of light can produce spots on the skin as well as perpetuate them over time despite the use of depigmenting creams. Prevention is very important before facial blemishes appear but it will also be essential after any treatment of the same. 

Year-round sun protection

If you are careful to limit your exposure to the sun, you will probably never get a brown spot. Regular application of sunscreen and protecting your skin when the sunlight is most intense are the most effective things to do to avoid getting a brown spot.

But beware, the sun is not the only source of radiation or light that can cause facial blemishes.  Now I will explain what types of staining light exist and what they are. check this link if you want to know more about sun protection.

The sun

The sun is the main culprit in the development, progression and maintenance of facial blemishes. When we expose ourselves to the sun we are exposed to Ultraviolet (UV) radiation that will cause damage to our DNA and the release of oxygen free radicals in our skin. 

To defend ourselves, our skin activates a defense mechanism against this radiation, producing a tan. So, even if you like your summer tan, you should be aware that lhe skin has memory and it will gradually accumulate all this radiation that we are providing it with.  All this cellular damage will surface years later in the form of brown spots on your face.

Many of my patients claim that they tan in order to produce vitamin D, However, more sunshine is not synonymous with more vitamin D.

Tanning booths (UVA rays)

Both ultraviolet A (UVA) and ultraviolet B (UVB) radiation cause cellular damage that can cause facial blemishes but also skin cancer.. When you lie in a tanning bed, you are mainly exposed to UVA rays, which are more harmful and penetrate deep into the surface of the skin, damaging the cells underneath and prematurely aging your skin.

Tanning booths use high-pressure sun lamps that can deliver up to 12 times the annual dose of UVA rays compared to the dose you receive from sun exposure. We would therefore be accelerating the production of spots and increasing the risk of skin cancer by up to 75%.Quote   Although Spain has no legislation to deal with them, other countries, such as France have banned the use of UVA booths for several years.

Blue light

Blue light is part of the visible light spectrum (HEVL), a high energy, short wavelength light. In a recent study, it was observed that blue light was capable of producing significant pigmentation. and thereby produce facial blemishes. This is why melasma is so difficult to treat, as the spectrum of action extends into the blue, visible and IR spectrum.Quote  

One of the reasons why blue light has become a cause for concern is that it usually comes from computer screens, cell phones and other digital devices, with which we interact for much of our day. However, the intensity of visible light emitted by the devices are 100-1000 times less than the emission from the sun. 

Therefore, efforts should be concentrated on photoprotection with the correct application of sunscreens every day. This includes frequency (a minimum of twice a day) and quantity, i.e. 2-3 ml on the face and 1.5 ml on the neck and décolleté. 

Recommendations to protect yourself from different types of light

A daily preventive routine should include the application of a broad-spectrum sunscreen with SPF 50 every morning. It should also have a mineral base that includes protection against UVA, UVB, blue visible light (HEVL) and infrared (IR-A).
  • Use sunscreen: apply sunscreen daily at the end of your care routine in the morning.
  • Repeat: reapply every two hours on sun-exposed areas.
  • Covering the skin: wear wide-brimmed hats, sunglasses and protective clothing against ultraviolet rays.
  • Avoid: avoid sun exposure during the hours of highest UV index (between 11 am and 4 pm).
My favorites: 

2. Depigmenting creams with antioxidants

The vitamin C can be used as a topical antioxidant that helps prevent free radicals from causing oxidative damage to the skin (which can lead to wrinkles and dull skin and blemishes, among other things). It also inhibits the enzymatic processes that produce melanin in the skin, so it can help prevent and reduce hyperpigmentation.

How to use it: Apply a few drops daily to cleansed skin, preferably before applying sunscreen in the morning.

My favorites:

3. Retinoids or vitamin A derivatives

Retinoids can work wonders to prevent and improve brown spots on the face by stimulating collagen production and accelerating cell turnover.  Retinol can irritate the skin at first, so start using these products gradually.  How to use it: Apply every night before going to sleep. Start a few times a week and then increase the frequency progressively until every night. My favorites: 

4. Other pharmacy creams

Chemical exfoliants typically use various types of mild acids to remove dead skin cells in the top layer of skin. Removing this layer can help reveal healthier, more even-toned skin and disguise blemishes. Although many of these are less potent than retinol, they can also cause skin irritation.

Depigmenting creams that use chemical exfoliants may contain the following ingredients:

  • alpha hydroxy acids (AHA)
  • beta hydroxy acids (BHA)
  • azelaic acid
  • glycolic acid
  • lactic acid
  • mandelic acid
  • salicylic acid

These products can be purchased over-the-counter or in more potent forms from a dermatologist. It is important to use chemical peels sparingly, as the skin needs time to rebuild and repair itself. Using a product more often than intended may cause irritation or inflammation. If you experience any side effects, stop using that product.

I have followed all the above steps but I still have spots!

Don't worry, there are still many treatment options left but it's time to visit your dermatologist. In an in-person or virtual consultation we can better assess your case and establish a diagnosis to customize your depigmentation treatment. 

I know that many of my readers are far away and not many times it is not possible to make a visit, so I also leave you a second option below. 

How to remove spots on the face with an expert dermatologist?

Now, if you've gotten this far, we will have to optimize the treatment and search for more potent and effective procedures to remove blemishes on the face more rebellious. Depending on the initial diagnosis that we will make in our office, we will start an individualized treatment plan and once you have improved, we will propose a maintenance treatment. 

Before and after treatment of melasma in a female patient

1. Magistral formulations with hydroquinone

Hydroquinone is one of the most most commonly used treatments to treat hyperpigmentation on the face for the last 50 years. This depigmenting cream is widely used in master formulas by dermatologists, often in combination with kojic acid, tranexamic acid and retinoic acid. At the biological level, hydroquinone acts by inhibiting an enzyme called tyrosinase, which contributes to the production of melanin. Naturally, the less tyrosinase is produced, the less melanin is produced.

In some cases, the effects of hydroquinone can be seen in as little as two weeks. However, the Most patients should wait at least 8 to 12 weeks of use to see a visible difference. The speed of response will depend on some factors such as the extent of the hyperpigmentation, the depth of the spots and how long you have had the spots.  

This depigmenting cream is especially indicated for facial spots after pregnancy and other diffuse hyperpigmentations. Due to its potential for irritation, it is necessary to be supervised by a dermatologist to avoid complications. Here is the case of a patient who had multiple spots on her face secondary to chronic sun exposure and aggravated by her hormonal profile. 

Dermatology tip: normally this depigmenting master formula will be used for 2 or 3 months always supervised by a dermatologist. Once suspended, it will be necessary to continue caring for your skin with photoprotection and a specific cream.

2. Lasers

A more aggressive option for improving and removing brown spots on the face is laser treatment, which uses concentrated light energy. Some laser treatments are directed against the pigment itself, while others work by removing the skin layer by layer.

Lasers are the best treatment to improve brown spots on the face caused by chronic sun damage (sun spots or age spots). Lasers use a beam of light that has a specific target or chromophore (pigment) that ends up destroying it and then the particles are eliminated through the skin. If you are interested in learning more how lasers work and what other indications they haveYou can see my page dedicated to this subject. 

 

Before and after of a patient who has undergone intense pulsed light laser treatment to remove facial mandas.
Excellent results after only one session of intense pulsed light (IPL) for the treatment of solar lentigines.
Before and after laser treatment of facial blemishes with intense pulsed light in a young woman
Intense pulsed light treatment of solar lentigines or also known as age spots. With only 1-3 sessions you can achieve very good results as this patient did.

Dermatology tip: Please note that 1 to 3 laser treatments (possibly even more) will be required four to six weeks apart and should only be performed by qualified laser professionals.

3. Microneedeling or microneedling

It is an excellent option for patients who have darker skin or who for other medical reasons cannot undergo the previously described procedures. It is a minimally invasive treatment that uses very fine titanium needles. which creates a series of micro lesions that increase the skin's collagen production and improve elasticity. 

To obtain the best results in case of facial blemishes, the microneedling is often combined with topical treatments. Once the small channels through the skin have been created, it is possible to infuse ingredients with depigmentation activity, such as tranexamic acid or vitamin C. 

Animation showing how microneedling is performed to remove blemishes on the face.

Dermatology tip: a minimum of 3 treatments separated by at least 6 weeks should be performed.

4. Chemical peels and masks for medical use.

Depigmenting exfoliating treatments and professional-use masks remove the top layers of skin. Over time, these treatments can stimulate collagen production, improve cell turnover and reduce the appearance of dark spots on the skin. However, always beware of an overly potent chemical peel, which can burn the skin. 

The most common active ingredients in professional peels are glycolic, mandelic, salicylic and lactic acid and trichloroacetic acid. Although at-home peels are available, they are gentler and will only remove superficial dead skin and will not go deep enough to treat brown spots on the skin. 

Of course, be aware that chemical peels can be irritating, especially on sensitive skin, so if you have a history of rosacea or sensitive skin be sure to talk to your dermatologist to assess if this is the best treatment for you. 

Dermatology tip: Usually several sessions are performed (between 3 to 6) separated by a month between them. If more powerful peels are performed, fewer sessions will be necessary but there are more risks of complications.

5. Oral treatments

That's right, there are also oral treatments to treat spots on the face, especially those secondary to melasma or pregnancy spots. The tranexamic acid is an oral medication that inhibits melanin synthesis and the transfer of pigment to the top layer of the skin. Since melasma occurs when skin cells produce too much melanin, this makes tranexamic acid an ideal way to counteract brown spots on the skin.

Many scientific studies have shown significant improvement in patients with melasma treated with oral tranexamic acid. In addition, oral treatments have been found to be more effective in treating melasma than topical or intradermal methods. (Wang). In a retrospective review conducted in Singapore, 91.7% of 561 patients taking oral tranexamic acid showed significant improvement. (Zhang).

Dermatology tip: We normally use tranexamic acid as a second-line treatment in patients with melasma. It is also possible to use it during the summer months when strong depigmenting creams should be discontinued.

I want to remove spots on my face but I don't know where to start.

Mockup of the facial blemish book

Facial blemishes book

For all those who are far away or do not have the possibility to go to a dermatologist, I have written this book on facial blemishes. 

In it I explain in depth the different causes of facial blemishes and leave you with specific guidelines for creams to start at home.

And, can home remedies remove spots on the face?

Now a final word about "natural" treatments or homemade products to remove blemishes on the face. Many of the home treatments recommended by different blogs or internet sites may not have any proof of efficacy or, more seriously, may not have any proof of efficacy, have side effects. Examples include lemon, baking soda and the apple cider vinegar. Actually, there are no scientific studies to back up claims that these treatments work.

In some cases, these depigmenting treatments may even can aggravate skin blemishes. In some patients these components can be irritants and produce a contact dermatitis (phytophotodermatosis) like lemon juice or some natural exfoliants. Consequently, they could generate a reaction called post-inflammatory hyperpigmentation that will worsen the spots and is then very difficult to improve. 

Other products may also contain ingredients that can damage the skin or overall health, such as mercury or corticosteroids. The application of these can cause iatrogenic acne, facial rashes and produce irreversibly fragile skin over time.

Final recommendations for the removal of facial blemishes

If there is only one rule you should follow out of this entire list, let it be this one: Use a broad-spectrum sunscreen every day.. Regular use of sunscreen not only helps prevent skin cancer, but also protects the skin from harmful UV rays, which are the culprit for most brown spots on the skin.

If prevention has not been enough and you have facial blemishes, it will be necessary to consult a specialist dermatologist in hyperpigmentation. The most important thing before performing an effective treatment is to take a proper medical history and establish a proper diagnosis. With this, it will be possible to establish the severity of the disease and together with the patient to evaluate the best combination of treatments to remove the spots on the face. 

Finally, it is important to know that facial blemishes, once removed, will always require a maintenance treatment so that they do not reappear. 

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Sebastian Podlipnik - Skin cancer

Sebastian Podlipnik

Dermatology Blog

I am a dermatologist and cum laude MD and author of multiple research studies. I specialize in skin cancer, laser technologies and cosmetic dermatology. The intention of this blog is to bring you closer to topics of interest in dermatology and research.

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