The first question is whether you have had a dermatologist diagnose what kind of 'brown spots' you have: lentigines (the flat brown spots that arise from sun exposure also called 'sun spots'), melasma (the 'mask of pregancy' also associated with natural estrogen and taking birth control pills), seborrheic keratoses (the waxy, stuck-on looking brown or tan thin or thick bumps), nevi (what people call 'moles' that can be absolutely normal or dysplastic), or pigmented actinic keratoses (precancerous rough brown and red thin bumps or flat marks). You also need to make sure you don't have a malignant melanoma.Once you know the spots are benign, the treatment plan depends on the diagnosis. Faint lentigines can be imrproved over time with topical agents like retinoids, ahas and other ingredients. But more prominent lentigines require a series of IPL or a treatment with a pigment specific laser like the Q-switched Nd:YAG laser. If the background skin needs improvement in color and texture also, then a pigment laser can be combined with fractionated resurfacing like with a fraxel dual thulium. The thicker seborrheic keratoses generally need a destructive method like cryotherapy with liquid nitrogen or electrodessication. And remember that some brown spots will return after treatment with sun or just time. If it returns repeatedly and with darker pigmentation, it is important to see a dermatologist to rule out a malignancy.
