Q. I have many brown spots on my face. I have tried several chemical peels without success.  What is available for getting rid of brown spots?

A. Brown spots on the face can have different etiologies.  The most common reason people have brown spots is due to environmental (sun) damage.  Over the years, with continued unprotected sun exposure, the melanin cells in the skin produce elevated amounts of pigment.  This process can create spots on the face that are called dyschromias, which are usually benign.  Another source of brown spots is usually seen in younger women who experience fluctuating hormones, often due to birth control pills or pregnancy, and this type of brown discoloration is called melasma.  Melasma can occur anywhere on the face, but classically is on both cheeks and nose, or on the forehead.  This is a benign condition as well.   Some brown discolorations can be due to an abnormal cell growth, such as a mole. If you have an area of pigmentation that is raised, seems to be enlarging, bleeds, ulcerated, is changing in shape or size, or is larger than a pencil eraser, it should be checked out by your dermatologist.  This condition is more worrisome and for that reason needs to be evaluated.

As for treatment of the first two types of pigmentation issues, I typically start with a good medically directed skin care program that includes the use of both Tretinoin (Retin-A(r)) and Hydroquinone which is a skin bleacher.  The Tretinoin will stimulate collagen and improve the quality, tone, and texture of the skin. The Hydroquinone will slow the production of melanin which will allow the dyschromia to lighten and often completely fade away. A physician monitored skin care program is very beneficial in maintaining good skin quality, and in your situation, correcting a problem and returning your skin to a healthier condition and better appearance.  If the skin care program does not fade the spots all the way, then laser treatment or trying a stronger chemical peel is the next option.  You should visit your board certified plastic surgeon or dermatologist for a consultation.