The origin of the spots could be summarized very schematically by saying that they can be produced through two mechanisms. On the one hand, there is the increase or synthesis of melanin, the natural substance that gives color to the skin, hair or the iris of the eye, and which also helps protect the skin from the sun. On the other, we have the proliferation or multiplication of melanocytes, cells responsible for the production of melanin.
As explained by Dr. Ignacio Sánchez-Carpintero Abaddermatologist of the and of (CDI), the skins that are more prone to developing spots are fair, known as low phototypes, but they can be seen in all skin types, including blacks.
“They are also seen more frequently in people who live in areas where there is greater exposure to solar radiation,” adds the dermatologist.
Solar lentigines are usually circular spots, less than one centimeter in size, with a brown hue, distributed in sun-exposed areas such as the face or the back of the hands.
Types of stains
There are many types of stains. Some are congenital or genetically determined, “such as the “café au lait spots” that we see from birth or in the first years of life,” says the dermatologist.
Another type of spot are moles, sometimes large, known as melanocytic nevus.
“These can appear at birth or they can be acquired and develop throughout life, usually in the first decades,” says Dr. Sánchez-Carpintero.
The reasons for many of the consultations attended by dermatologists also appear. “Solar lentigines are usually circular spots, less than one centimeter in size, with a brown hue, distributed in sun-exposed areas such as the face or the back of the hands. They usually appear after the age of 40”, explains the specialist.
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“On the other hand, melasma is another type of stain (commonly known as cloth) that appears on the face of women of childbearing age. They are usually large diffuse brown spots, symmetrically distributed affecting the cheeks, central or lateral area of the forehead and skin of the upper lip. These spots typically appear in relation to hormonal changes, during pregnancy or in patients taking contraceptives”, he emphasizes.
And finally, Dr. Ignacio Sánchez-Carpintero Abad, indicates that another stain that should be mentioned is seborrheic keratoses. Unlike solar lentigines, these spots are usually raised above the skin line, giving them a wart-like appearance.
These are small, completely benign tumors that should not worry the patient, even if their appearance is unpleasant.
According to the specialist from Hospital Ruber Internacional and CDI, these lesions “must be distinguished from lentigines, nevus or moles and can even be confused with malignant tumors such as pigmented basal cell carcinomas”, the doctor clarifies.
And if they are so similar, how can we distinguish what type of stain we suffer from? Well, this can only be done by a dermatologist in consultation using a dermatoscope, a kind of microscope equipped with a magnifying lens and a light, which clinically allows a more precise diagnosis and therefore the appropriate treatment to be applied afterwards.
Can the appearance of spots on the face be avoided?
Depending on the type of stain we are talking about, we will be able to avoid its appearance or not. It is obvious that those with a genetic origin cannot be prevented, but in other cases, such as lentigines or melasma, Dr. Sánchez-Carpintero explains that the necessary means can be put in place for them to appear.
“The most important of all is to avoid sun exposure. Both solar lentigines and melasma are closely related to this triggering factor. The continuous and repeated use of is also one of the recommendations that we dermatologists make to avoid the appearance of these common spots”.
As for seborrheic keratosis, we will not be able to avoid or reduce its appearance either.
As explained by the Healthy Skin Foundation, it is unknown what triggers the appearance of these skin lesions, so there is no way of knowing how to prevent them.
Laser treatment, for example, in the case of solar lentigines is very effective and it is usually possible to eliminate them with two or three sessions.
How to remove stains
As with prevention, the treatment of these spots, aimed primarily at making them disappear, will depend on the type of stain.
Thus, the application of depigmenting creams, in the case of solar lentigines, has a limited effectiveness and it is hardly possible to lighten them.
On the contrary, in the case of melasma, a better response can be seen with the application of cosmetic products that contain compounds with a direct or indirect depigmenting effect or action, such as hydroquinone, kojic acid, azeilaco acid, tranexamic and retinoic acid.
The dermatologist recommends that the application schedule will depend on the type of stain in question. “In many cases, to obtain a greater therapeutic response, it is necessary to apply a cream that combines several of the aforementioned compounds. The frequency of application will depend on the concentration of the compound, the degree of skin tolerance or the type of stain”, says the doctor.
But when cosmetics do not give the desired results, there are effective systems such as laser devices, Q-Switched, or intense pulsed light or IPL, or low-power thulium laser, among others, that act on the superficial skin layers.
“Laser treatment, for example, in the case of solar lentigines is very effective and it is usually possible to eliminate them with two or three sessions. It is a very well-tolerated outpatient treatment, which therefore does not require anesthesia”, the doctor points out.
This type of treatment is also used in patients with seborrheic keratosis who, for aesthetic reasons, want to make the skin lesions disappear.