What is the most effective treatment for brown spots on legs?

Question

I have had 5 -6 IPL treatment on my legs. The machine was turned up high enough for me to receive some burns. I also had a technician try Bbl, pico, a machine that removes tattoos. She tried several spots and nothing happened on my legs. I also use hydroquinone which helps a little. The BBL/IPL worked great in one treatment on my arms and chest. Surely in this day and time there is something that can be used for these spots on the legs.

Harold J. Kaplan, MD · Answer

Hello - Yes!   There is an option in this 60th year of Laser technology.  In fact, it is one of our favorite lasers because it's the "work horse" for brown spots, age spots, freckles, dark birthmarks, etc.  
IPL's work well but usually only for diffuse and superficial discoloration on the skin.  As you've learned, using higher energy does not necessarily offer a better result if it's not the best technology for your condition regardless of skin type/color.  The Picosure is a good option but it's only as good as its practitioner and the settings chosen.  In our experience, IPL's and HQ (hydroquinone) may only be able to marginally fade a sun spot.  
Since 2004, we have used our Q-switched YAG laser to treat persistent and pesky sun spots.  Those sun spots that reside on legs tend to hold on tighter and require the power of a laser that was designed to "see" the cells of color.  A laser option will always have more power and precision than an IPL option.
See the below link for more info and B&A photos:

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

William Groff, DO · Answer

The device used is only as effective as the experience and expertise of the provider using it. Make sure you are working with an experienced, board-certified dermatologist who can accurately assess and diagnose the brown spots and then individualize a treatment plan that will meet your precise needs. With a qualified provider and a customized treatment plan, I would expect you to achieve a more satisfying result than you have thus far.

Rebecca Fitzgerald, MD · Answer

You mention a technician - was this a physician or skin-trained RN or PA?It's always wise to take the time and make the investment if necessary in a full consultation with a fully educated and trained medical specialist. BBL and Pico are both reliable treatment options for discoloration as you experienced on other treated areas. That the areas on your legs are more resistant could mean you have more than just a "brown spot".Without the proper diagnosis of the skin problem, a review of your lifestyle habits, medication intake, genetic background and more, it's easy to end up with a hit and miss scenario as you describe.There are countless machines and treatment options for brown spots but not all are appropriate for all patients and conditions or body areas. I'd advise you to seek out a board dermatologist who has long term experience and multiple devices to choose from. Of course sunscreens uses daily are an important part of any pigmentation reduction program. So if you aren't covering your legs with long pants, be sure to apply sunscreen to all exposed skin.

Kenneth Hughes, MD · Answer

The Lumecca IPL is one of the more popular treatments. It’s benefits include:
• The procedure can be customized to suit different skin tones and textures.• The intensity of the pulsed light can be varied accurately by the skin care specialist. This helps to improve the efficiency of the method.• Even severely damaged skin and pigmentation issues can be corrected thanks to the high power light technology being used.• The treatment on the whole is quick and can be used to address a large area.• Most conventional IPL methods might call for a lot of repetitions to obtain perfect results, but with Lumecca IPL, most cases may only require one to two treatment sessions to show results.• The procedure is non-invasive and does not cause any discomfort. Recovery after the procedure is also almost instantaneous.

Jason Emer, MD · Answer

Hyperpigmentation of any kind needs a combination approach of peels like Cosmelan; lasers like Clear + Brilliant, Aerolase or Laser Genesis; radiofrequency like Venus Viva; and constant skin care and sun protection. Bimonthly facials with SilkPeel DermalInfusion are essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin. If you have acne you can do additional treatments and peels to get more improvement. Hypopigmentation will need more of an evaluation and possibly additional lasers to get improvement. I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.

Dennis Gross, MD · Answer

Depending on the type of "spot" will determine the best course of action for treatment of that specific lesion. This is why it is important to consult with a board-licensed dermatologist for the correctly diagnose the spot for best results. At Dr. Dennis Gross Dermatology we specialize in diagnoses and treatment. With options from a focal pointed  IPL, Alexandrite, Chemical peels & liquid nitrogen we are confident for 100% elimination of desired lesion.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  Ask your dermatologist about treatment with more of an actual laser rather than IPL.  A combination of laser genesis or carbon peels, and freezing any other thicker lesions lightly with liquid nitrogen might yield better results that what you have been able to achieve so far.  Sometimes chemical peels can also be useful for brown spots.  Hydroquinone is probably a good idea to continue, and don't forget to always use a good quality sunscreen.  Please see an expert and best of luck!

Neda Vanden Bosch, MD · Answer

It sounds to me like you probably have something called Flat Seborrehic Keratosis..They are benign age spots that are too think (even though they look flat) for an IPL to penetrate no matter how high the energy is. There are a few ways to address them,  you can have them lightly frozen with Liquid Nitrogen by your Dermatologist, cauterized, or treated w/ an Alexandrite laser. All of these options will leave the lesions scabbed and will eventually peel off. The down side is that these treatment options can also leave a hypopigmented spot behind if treated too aggressively, especially on darker skin types. I would talk to your Dermatologist to discuss the best treatment options.

Laura A. Katz, MD · Answer

There has been  great success with brown spots all over the body with the Gentlemax Pro laser using the alex platform.   Great results are seen in as little as three weeks after the first treatment.  On average, the spots turn red, darken and then slough in about 9 days after the procedure.   Good Luck!