Spot is defined as the change of color at any site of the body.
Pigmentation is defined as coloring of the skin with the substances produced by the body. Skin spots result from the disorder of pigmentation. Reduced or increased production of melanin leads to change of skin color. Skin spots are usually seen in face, neck V, hands which are chronically exposed to sunlight and effect dark color people. Spots may be associated with the uppermost or subcutaneous layers of the skin.
The main principle of spot treatment is protection from sun. Proper treatment methods may be selected after achieving sun protection. Response to treatment increases if skin spot is superficial and new. Excessive pigmentation is defined as “hyper-pigmentation” and decreased pigmentation is defined as “hypo-pigmentation”. Hypo-pigmentation leads to light color spots.
Hypo-pigmentation leads to two main problems: albinism and vitiligo. Skin, hair is almost white in albinism as the result of the absence of pigments which give dark color to skin. In vitiligo, light patches develop due to death or dysfunction of pigment-producing cells. These spots which are very sensitive to sunlight are mostly evident in very dark people. Patients with vitiligo and albinism should be protected from sun.
Distribution of melanin is irregular as production increases. Ecchymosis, birth spots, pregnancy and aging spots develop with hyper-pigmentation.
Treatment of skin spots with laser has been widely applied. Effectiveness of treatment varies depending on the type of the skin spot. While some spots respond very well to treatment, some others have poorer outcomes. Therefore you should see a dermatologist prior to treatment.
Melanin, color substance of the skin, absorbs wave length between 250-1200 nm. Short wave lengths (532 nm) are absorbed better by melanin however cannot penetrate deep layers. Long wave lengths (1064 nm) are absorbed less by melanin however can reach deep layers of the skin. So short wave lengths are preferred for superficial brown spots and long wave lengths are preferred for deep brown spots.
Skin spot (lentigo) is a skin disorder which may be confused with freckles. Sun spots may be seen at every age, usually darker than freckles, they are larger, they remain on skin in every season and become darker in summer.
Sun spots are usually seen in skin fields which are exposed to sunlight like hand dorsum, face, shoulders, back and anterior part of the chest. They are seen as varying sizes of demarcated brown spots. They may arise following acute sunburns after desquamation on back, shoulders and trunk.
Sun spots on hand dorsum and face usually develop after 40 years of age (aging spots).
Sun spots do not convert to cancer. Treatment is done for cosmetic purposes. However some sun spots may be confused with a skin cancer defined as lentigo maligna. Therefore dermascopy should be performed for the rapidly growing spots.
Ota nevus is a benign nevus which arises as a blue-brown spot on face, which may be uni- or bilateral and which may usually involve the eye.
Its prevalence was found as 0.4-0.8% in a study from Japan. The nevus may develop at birth or puberty. Its etiology is not known.
- Q Switched Nd: YAG ( 1064nm ) Laser, it may proceed to deep layer of dermis due to wave length of 1064. Likelihood of epidermal injury is low due to low melanin absorption. So it may be preferred in patients with dark skin.
- Q Switched Alexandirite Laser ( 755 nm ),
- Q Switched Ruby Laser ( 694 nm ),
Treatment requires mean 4-8 sessions applied at every 2 months. Number of sessions is low in children. Blue-gray lesions may require more sessions than purple-blue lesions. Peri-orbital region is resistant to therapy.
Becker’s nevus has sharp borders, may be light or dark brown and usually higher than skin surface. It may include long and thick hair on it. The lesion is usually seen on shoulders, chest, back and thighs, it is unilateral, not a real nevus, more common among males than females. Prevalence is 0.5% among men. It usually develops in childhood or puberty. It may be light when develops in childhood and may become darker in adulthood and hair may increase and become thicker. It is not congenital and etiology is not known.
The lesion is not treated medically. The hair on the lesion may be removed with laser or other methods. Long Pulsed ND:Yag laser may remove hair without causing skin burn. However laser epilation methods like Long Pulsed Alexandirite, Diode and IPLmay contribute to opening of Becker’s nevus.
Laser treatment should be repeated for treatment of Becker’s nevus. Sometimes treatment may be insufficient and the lesion may recur.
The purpose of laser therapy should be fading because sometimes complete regression may not be achieved. Care should be taken in dark color patients.
532 nm wave lengths may be preferred in light skin patients due to higher melanin absorption.
Risk of discoloration is higher in dark skin patients. Spontaneous or UV-induced recurrence may occur in the ratio of 50% one year after recovery of CALM.
Successful outcomes were reported with superficial erbium ablation in CALM resistant to Q-switched laser. Combination with Long Pulsed lasers were reported as Q-switched laser is not very effective for color cells within hair follicle.
Red spots or scars may remain after acne development. Red spots regress within 2-4 months if new acne does not develop at the same region. Likelihood of acne scar is high if the acne is deep and long standing. Recurrent acnes at the same region may make scars permanent. Therefore acne treatment should be done early. Trying to remove acnes may increase the likelihood of acne scar development. A heel-like scar may develop if a red acne spot persists at the same site for longer than 6 months. So long standing acne scars should be treated.
The principle purpose of acne spot treatment is stopping new acne development and elimination of the present acne. Treatment for acne spots or scars may be started at this time.
All these methods may be successful in varying degrees depending on skin type, depth, size and severity of the spot. Fractional lasers have been started to be used widely in recent years.
A freckle is a benign, well demarcated, small brown spot. They are seen in blonde, red-haired people in body regions which are exposed to sunlight. They appear beginning from early puberty and may reduce with age. Differently from larger freckles defined as “lentigo”, they become dark after sun exposure and fade in absence of sun exposure. Freckles are most common on frontal region, cheek and nasal dorsum, may be severe to cover all face, light or dark brown.
Freckle treatment is performed with cosmetic purposes. Freckles may recur after treatment, and severity may be reduced with treatment. Each method yields different benefits. Laser treatment is the most successful. Trying shoot may be performed in dark skin people.
Whether spots are benign or malignant should be detected before treatment. Biopsy should be performed if needed. Some of these methods may be used in combination for treatment of benign spots. However some spots may recur if the patient does not use sunscreens. Sunscreens should be repeated at every 2 hours. Very high protection sun creams should not be preferred if not compelled as they may trigger black point development by plugging skin pores.
Mean 1-4 sessions are applied. Freckles may reduce 40-70% after treatment. Crusting may develop after treatment and may last for 3-5 days. KTP, Erbium and fractional lasers may be preferred. Long Pulsed Alexandrite laser may yield successful outcomes in dark skin people. Side effects are low, efficiency is high. Freckles may not completely disappear but relieve if freckles cover the whole face.