Appropriate Diagnosis of “Brown Spots” & Treatment Plans
Treatment of brown spots is the most common condition patients inquire about during a consultation. Appropriate assessment and diagnosis of what the patient calls "brown spots" is essential to developing an appropriate treatment plan.
Brown spots may include but are not limited to:
- Brown patches
- PIH (post inflammatory hyperpigmentation) due to inflammation or trauma to the skin from acne, insect bites, abrasions, chemical peels, excision, laser procedures, etc.
- Sebaceous hyperplasia
- Solar keratosis
- Skin tags
- Skin cancers, etc.
Brown spots can be located various parts of the body, including, the face, trunk, legs, arms and hands.
After a careful medical history is taken, suspicious lesions are ruled out that may require referral, treatment options can be discussed. Many treatment options are available for various conditions that patients call brown spots. These can include topical creams, surgical excision, electrocautery, chemical peels, photodynamic therapy, various laser procedures including vascular lasers, Q-switch using 532nm or 1064nm laser for pigment, broadband light, laser resurfacing, etc.
Broadband or intense pulsed light, commonly referred to as photo- rejuvenation or foto-facial, is one of the most popular devices found in medical spas. Skin quality is improved with a series of treatments. One study conducted by a dermatologist showed more youthful gene patterns in skin biopsies of areas treated compared to untreated skin on the same individual. Due to the popularity of intense pulsed light (IPL), and the benefits patients have heard about, and seen, they may present to a clinic requesting a treatment believing that it will remove their spots as they have seen on their friends. In many patients a general improvement in the skin quality can be appreciated. However, it is not uncommon to have patient voice dissatisfaction after a series of treatments. "I spent all this money, and that spot is still there" is something we probably have heard over the years. No guarantees of treatment can ever be made, but some patients often require a combination of various modalities.
Melasma, a chronic hormone-related pigmentation is one of the most challenging conditions to treat. It is common to see practitioners increase energy delivery with lack of improvement of the pigmentation. This often results in worsening of the pigmentation due to excess inflammation in these individuals.
A treatment plan is crucial and must be thoroughly discussed. Realistic expectations must be set for patients regarding anticipated cost, number of treatments, and what to expect post procedure to plan for social downtime. In addition, limitations of particular treatments should be addressed.
During the initial evaluation of the patient's skin, standardized photographs and a VISIA skin analysis using a UV camera are great tools to document the baseline condition of the patient's skin and monitor the patient's progress throughout the treatment sessions.
Appropriate diagnosis and a treatment plan with discussion on anticipated cost, number of treatments, social downtime and discussion of possible need for other modalities. This provides patients a sense of control that they have been informed with the options of treatment. Realistic expectations are set with the plan developed together. There is less risk of surprises and leads to higher patient satisfaction.