You want to fade the spots that you can see now, prevent...

You want to fade the spots that you can see now, prevent them from coming back, and also limit the number that appear in the future.

To treat the brown spots you have, creams and lotions containing hydroquinone will give you the best results.

Kojic acid is another ingredient that can be helpful, but it is slightly less effective than hydroquinone.

Retinoid creams, which are derived from Vitamin A, are very helpful in lightening brown spots and they also help improve skin texture.

I often recommend creams that contain all 3 ingredients, but if you cannot find one like that, use a retinoid at night and a hydroquinone in the morning.

It is very, very important that you use a sunblock every day. The sun is the number one culprit in the appearance of brown spots. If you are going to spend time and money lightening your brown spots, you don't want to go out in the sun and undo all your hard work.

Some of these lightening agents also slightly increase your sun-sensitivity, so you want to be sure to protect yourself.

The most stubborn spots can be lightened or removed with chemical peels or lasers. The lasers most often used are the ruby, alexandrite, and Nd:YAG. Intense pulsed light, or IPL, can also be helpful.

I actually just completed a study with the Good Housekeeping Institute that tested several products claiming to reduce the appearance of age spots.

Of the five products that we tested, Murad’s Age Spot and Pigment Lightening Gel performed the best, with Good Skin’s All Bright Spot Treatment coming in second.

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The four steps to beautiful skin;

1- Good Sunblock - Always use a zinc oxide based sunblock. It has broader UVA and UVB coverage than anything else. It works immediatley upon application, not the case with avobenzone based products. It does not have estrogen mimetic effects like avobenzone based products. It won't make free radicals like avobenzone based products. Get the idea - Zinc is good! But it goes on too thick - wrong! In my practice we sell EltaMD sunblock that has 8 different products designed for any lifestyle or skintype.

2-Retin-A- The BEST skin care product - exfoliates, thickens the dermis, reduces the loss of elastin, improves acne, reduces skin cancer, and most importantly - Disperses Melanin granules, in other words it diminishes brown spots.

3- Hydroquinone - skin bleach that temporarily bleaches the skin to improve the sunspots.

4- Lasers and intense pulsed light treatments - Used as a last resort. They work too well sometimes. The loss of melanin sometimes results in Ivory white spots on the skin - this is worse than the alternative. The treatments are also far more expensive than the treatments described above.

Robert M. Freund, MD, FACS

New York, NY

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