As part of our long-term care and reconstructive services, Burn and Reconstructive Centers of America offers several treatment options for treating hyperpigmentation often suffered by many of our burn and trauma survivors. However, hyperpigmentation can occur in various ways outside of burn and trauma scars. Hyperpigmentation is a common dermatological phenomenon that occurs due to an overproduction of melanin. Melanin is what gives your skin its natural color. When certain skin cells produce too much melanin, it can cause your skin to darken. Hyperpigmentation is a word used to describe this darkening that is often seen in freckles, scars, discoloration, certain skin conditions and sunspots.
What is a sunspot?
Sunspots, also called age spots and liver spots, are a common and typically harmless form of hyperpigmentation. They are most likely to present in those older than fifty years. However, some people are more predisposed to the development of sunspots than others, but there has yet to be any scientific or medical reason behind this. Some who might be more at risk of developing sunspots include those with low skin pigmentation (pale), have blond or light-colored hair, light-colored eyes and those who spend extended periods in the sun or tanning booths. Those who develop sunspots typically experience spots of skin that are:
- Tan, brown or dark in color
- Flat (not raised like a mole)
- Round or oval in shape
- Small—typically the size of a freckle to the size of the tip of your finger
On average, sunspots appear in places that have experienced the most ultraviolet (UV) light or sun exposure, such as the face, chest, shoulders, back, arms and hands. An increase in the number of melanocytes (cells that produce melanin) can also cause sunspots.
Are sunspots bad?
Sunspots are typically harmless. However, just like their cousins the freckle and the mole, they can develop into skin cancer. It is important to see a dermatologist regularly, especially if your family has a history of skin cancer. Some signs and symptoms of skin cancer in a sunspot, freckle or mole include:
- An irregular shape (all three should be pretty uniform and round or oval)
- A change in color (turning) or a combination of colors
- Growing in size over time or within a short period
The diagnosis of sunspots can be made through a routine, non-invasive examination by your dermatologist. However, if there is a risk of a sunspot being cancerous, your dermatologist may perform a biopsy of the area. A biopsy is a procedure where a sample of the skin and underlying tissue is excised or cut away and sent to a laboratory for examination. If the results come back positive for skin cancer, some treatment options include further excision or removal of the tissue, a MOHs procedure, radiation and chemotherapy. A sunspot that is non-cancerous does not require treatment and will typically not be detrimental to your health.
How can you treat sunspots or reduce hyperpigmentation?
There are several treatment options available to help reduce the appearance of hyperpigmentation or to correct color. While there are homeopathic remedies for sunspots, such as vitamins and mild dermatologic acids, these are not guaranteed to improve the sunspots and may only provide temporary improvement. Though treatments aren’t necessary for non-cancerous sunspots, professional treatment options are available to treat them for cosmetic reasons.
Microdermabrasion is a minimally invasive procedure that resurfaces your skin by gently abrading or scraping away at it, removing the top layer of skin cells. The hyperpigmented cells should be removed or reduced by removing the top layer of skin, lightening the area. Anesthesia is not usually provided for microdermabrasion.
As mentioned above, certain dermatologic acids can be used to remove the top layer of skin. These include chemical peels containing salicylic acid and glycolic acid. Chemical peels are not a surgical procedure and do not involve anesthesia. Chemical peels can cause a burning sensation that some may find painful.
Several types of laser treatments work by resurfacing the skin, removing raised scars or hypertrophic scars, and melanin associated with hyperpigmentation. The more intense laser treatments, such as laser scar revision treatments offered at many facilities across Burn and Reconstructive Centers of America’s (BRCA) nationwide care system, are considered a procedure and may involve generalized anesthesia. Laser resurfacing treatments offered at many plastic surgery clinics are not as invasive and may involve only local anesthesia or no anesthesia. These lasers use concentrated beams of light to burn off the top layer of skin, essentially removing the hyperpigmented cells and allowing skin cell rejuvenation.
Opposite laser treatments, cryotherapy uses cold treatments to freeze the sunspots. Using liquid nitrogen, the dermatologist will freeze the sunspots. Freezing the sunspots, like frostbite, will kill the top layer of skin and allow for a new layer to grow in its place. Cryotherapy is used on skin blemishes such as warts, skin tags and moles. Anesthesia is not usually provided for cryotherapy.
Autologous epidermal autografts
Autologous epidermal autografts are when a biopsy or tissue is taken from the patient to be used elsewhere on their body. Often to assist with pigment changes, these autografts can be used on sunspots to help fill in a better color match and help prevent hyperpigmentation from reoccurring.
Many of these treatments may cause sun sensitivity for a few days up to two weeks. It is recommended to wear sunscreen and avoid going outside for extended periods unless your provider says that it is okay to do so. Before deciding on a treatment plan, please consult your dermatologist about which options are best for you.
How can you prevent the development of sunspots?
Better sun care is the best way to help prevent the future development of sunspots. While it is impossible to undo past damage to your skin and the current development of sunspots, you can prevent existing sunspots from getting darker and prevent new sunspots from developing. To help prevent the development of sunspots or the darkening of sunspots, take the following precautions:
- Thirty minutes before going outside, apply sunscreen with a high SPF.
- If you are sweating profusely or participating in a water activity during your time outside, make sure to reapply sunscreen often, at least every hour to two hours.
- Sunscreen should be used even if it’s cloudy or overcast. Clouds help to block some UV rays but not all of them. It is important to remember that even if it is not hot or sunny outside, you are still susceptible to getting a sunburn.
- For those with fair skin, thin hair, or light-colored eyes, try to cover up with a hat, long-sleeved shirt and sunglasses.
- Limit tanning both outside and in tanning booths.
- Even if you plan on being in the shade, you should still wear sunscreen. It is possible to get sunburned from indirect sunlight.
Radiation burns, such as sunburns, can cause damage to the cellular structure of the skin and lead to cell mutations or cancer. Some people are more likely to get skin cancer and hyperpigmentation than others. If there is a history of skin cancer in your family, avoid prolonged exposure to UV rays and always wear UV protection such as sunscreen, hats and sunglasses.
To learn more about radiation burns, click here.
For more information on laser scar revision, click here.
For more information about BRCA’s services, physicians and locations, please visit www.burncenters.com or call (855) 863-9595.