Spot Treatment

Skin spots (hyperpigmentation) can occur as a result of many different factors such as sun exposure, hormonal changes, aging, genetic predisposition, and certain skin problems. Since the appearance and cause of spot formation can vary from person to person, it is important to determine the treatment approach according to the needs of the skin. Today, with lasers, medical products, chemical peels, and various skin rejuvenation procedures, it is possible to help reduce the appearance of spots and achieve a more balanced skin tone. Serving in Istanbul, Medical Aesthetic Specialist Dr. Lida Çiteli addresses frequently asked questions about spot treatment, covering everything from causes and treatment options to the application process and points to consider.

What is Spot Treatment?

An increase or irregularity in the pigment production of melanocytes, which are responsible for skin color, can cause spots of different shades to form on the skin. The methods applied to reduce this appearance, balance skin tone, and help eliminate pigmentation differences are broadly referred to as spot treatment. Spots observed on the skin can appear as a result of changes in pigment production or distribution. While the causes of formation vary from person to person, some spots may be congenital, while others can develop over time due to puberty, aging, sun exposure, hormonal changes, or environmental factors.

What is the Basic Information About Spot Treatment?

In spot treatment, first, the type, prevalence, and characteristics of the formation on the skin are evaluated. Then, an appropriate treatment plan is created by considering the individual's skin structure, needs, and expectations. Depending on the condition of the spot during the treatment process, medical products, lasers, and different skin renewal procedures can be utilized.

What Are Spot Types and Their Causes?

Sun Spots

These are pigmentations, mostly seen in brown tones, that can form on the skin as a result of long-term and intense sun exposure. They can appear on the face, hands, arms, and other areas exposed to the sun. Sun spots can also be medically referred to as lentigines (lentigo).

Melasma

It is a pigmentation problem that causes brown or grayish-brown areas to form on the skin, especially in the facial area. Hormonal changes, pregnancy, birth control pills, and sun exposure can play a role in making melasma more prominent. It usually presents a bilateral and similar distribution in areas such as the forehead, cheeks, nose, and upper lip.

Post-Inflammatory Hyperpigmentation

These are dark spots that can appear during the healing period following acne, wounds, burns, or skin irritation. They can form due to increased melanin production following an inflammatory process in the skin. Although they can fade spontaneously over time, in some cases they may remain on the skin for longer periods.

How Do Sun Spots Fade?

The most important step in the treatment of sun spots is using a high protection factor sunscreen every day. Ingredients such as vitamin C, niacinamide, retinoids, and azelaic acid can be preferred to reduce the appearance of spots.

In more prominent or resistant spots, treatments such as chemical peels, lasers, or cryotherapy can be applied by a dermatologist. However, the appropriate method should be determined according to the type and depth of the spot. Failing to protect against the sun during spot treatment can cause spots to darken and recur.

Which Laser is Used for Sun Spots?

For sun spots, methods such as Q-Switched Nd:YAG, Pico laser, Thulium laser, and IPL/BBL can be used. The most suitable option is determined by a dermatologist according to the type and depth of the spot and the skin type.

• Q-Switched Nd:YAG: Frequently used especially for prominent pigment spots.
• Pico laser: Aims to shatter pigment with extremely short pulses.
• Thulium laser: Preferred for sun damage and skin tone irregularities.
• IPL/BBL: Although not a laser, it is an effective light therapy for superficial sun spots.

When lasers are used incorrectly on certain spots like melasma, they can increase spot formation. Therefore, it is important to perform a dermatological evaluation before the procedure.

Is Nd:YAG Laser Used in Spot Treatment?

Yes. The Nd:YAG laser, especially with Q-Switched Nd:YAG technology, can be used in the treatment of sun spots and certain pigmentation problems.

• For sun and age spots: It can help lighten the spot by targeting the pigment.
• For freckles: It can be used especially on prominently pigmented freckles.
• For melasma: Low-energy applications may be preferred; however, caution is required in melasma as incorrect or excessive laser use can increase spot formation.
• Wavelength: 532 nm can be used for more superficial pigments, while 1064 nm can be used for deeper pigments.

The number of sessions varies according to the type of spot and skin structure; therefore, it would not be accurate to give an exact number of sessions. Furthermore, regular sun protection after the procedure is crucial for the success of the treatment.

Is Nd:YAG Laser Suitable for the Face?

Yes, Nd:YAG laser can be used on the facial area. It can be preferred especially in the treatment of sun spots, certain pigmentation problems, and capillary vessels.

Advantages:

• It can be applied to the facial area when adjusted appropriately for the skin type.
• It helps reduce the appearance of spots by targeting the pigment.
• Short-term redness is usually observed after application.

However, laser treatment can increase spot formation in certain spots such as melasma. Therefore, it is important for a dermatologist to determine the type of spot prior to the procedure. Regular use of broad-spectrum sunscreen is required after treatment.

What is Melasma?

Melasma is a pigmentation problem prone to recurrence that forms symmetrical brown or grayish-brown spots, particularly on the face. It is most commonly seen on the forehead, cheeks, nose, chin, and upper lip.

Main triggers:

• Sun and UV rays
• Hormonal changes
• Genetic predisposition
• Heat and visible light

Unlike sun spots, melasma can contain deeper pigment and may be more difficult to treat. The goal is usually to keep it under control rather than eliminating it completely.

Sun protection, anti-spot creams, and, when necessary, peels or laser treatments administered by a dermatologist can be used in treatment. Careful laser selection is especially vital in melasma; incorrect or aggressive applications can darken the spots.

What is the Difference Between Melasma and Sun Spots?

Although melasma and sun spots look similar, they are different pigmentation issues. Sun spots mostly form due to long-term sun exposure and usually present as small brown spots with distinct borders. Melasma, on the other hand, is associated with hormonal changes and genetic predisposition in addition to the sun; it is mostly seen on the face as symmetrical, broad, and irregular brown areas. While sun spots can be eliminated more easily with appropriate treatments, melasma is more prone to recurring. For this reason, in addition to sun protection and proper skin care, dermatologist evaluation is essential for melasma.

Does Melasma Completely Go Away?

Melasma can lighten significantly with applied treatments, but it is a pigmentation problem with a tendency to recur. Intense sun exposure, hormonal changes, and skin irritation in particular can cause pigmentation to become prominent again. Therefore, maintaining regular sun protection and personalized skin care is essential to preserve the appearance achieved after treatment.

Can Spot Treatment Be Done in Summer?

Yes, but not every spot treatment is suitable during the summer months. Procedures that irritate or heavily exfoliate the skin during periods of increased sun exposure can cause spots to darken.

In summer, spot treatment can be continued under dermatological supervision with milder treatments and products containing appropriate ingredients. Especially in melasma, the foundation of treatment consists of regular and high-protection sun protection.

Intense chemical peels, ablative lasers, or aggressive procedures are mostly left for periods with less sunlight. The type of treatment should be determined based on the structure of the spot and skin type.

Can You Go Out in the Sun After Spot Treatment?

Direct sunbathing should be avoided after spot treatment. Treated skin can be more sensitive to the sun, and intense sun exposure can cause spots to darken again.

If going outside is necessary for daily life, physical protection methods such as SPF 50+ broad-spectrum sunscreen, hats, and staying in the shade as much as possible should be used. How long you should avoid sun exposure—especially after procedures like lasers or chemical peels—varies depending on the applied treatment.

Therefore, following the sun protection recommendations of the practitioner dermatologist after the procedure is the safest approach.

Why Does Spot Treatment Sometimes Worsen the Spot?

Skin irritation or exposure to excessive heat after spot treatment can lead to post-inflammatory hyperpigmentation (PIH). The skin may produce more melanin to protect itself, causing the existing spot to darken.

The main causes include choosing the wrong laser or device, application settings unsuitable for the skin type, aggressive peels, irritation of the skin barrier, and inadequate sun protection after treatment. Particularly in melasma, intense heat and irritation can cause spots to become more prominent. For this reason, spot treatment should be planned by a dermatologist according to skin type and spot category, and regular sun protection must be applied post-procedure.

How Many Sessions Are Required for Spot Treatment?

The number of sessions required for spot treatment varies depending on the type, depth, skin type, and method used. Therefore, it is not correct to specify the same number of sessions for everyone.

For superficial sun spots, a few sessions with certain laser or light therapies may be sufficient. For spots prone to recurrence like melasma, a longer-term and gradual treatment may be required. Session intervals for peels, lasers, or other methods also vary depending on the application used.

The most accurate session plan is determined after the dermatologist evaluates the type of spot and skin structure.

Is Spot Treatment Permanent?

The permanence of spot treatment depends on the type and cause of the spot. Sun spots and post-acne pigmentation can be largely eliminated with appropriate treatment; however, exposure to the sun can cause new spots to form.

Melasma, on the other hand, is a chronic condition prone to recurrence. It can lighten significantly with treatment, but it may reappear with sun, heat, or hormonal changes. To maintain results, it is important to regularly use SPF 50+ sunscreen after treatment and avoid sun exposure as much as possible.

Laser or Skincare for Spot Treatment?

Which method is more suitable depends on the type, depth of the spot, and skin type. While regular skincare and appropriate products may suffice for superficial and mild spots, laser treatments planned by a dermatologist can be preferred for prominent sun spots.

However, lasers are not always the first choice in melasma; incorrect or aggressive applications can darken the spot. For this reason, sun protection and appropriate topical treatments take priority in melasma. The most accurate approach is for the spot to be evaluated by a dermatologist and treatment determined accordingly.

How is a Skin Spot Diagnosed?

In diagnostic evaluation, how long the spot has been present, whether it has shown changes, sun exposure, hormonal factors, medications used, and previous treatments are evaluated.

These questions are as follows:

• What symptoms occurred after the formation of the spot?
• What medical conditions were experienced prior to it?
• Whether the spots have changed since the first day they formed
• When the spots on the skin were first noticed and whether they have shown any changes over time

After gathering the necessary information with these and similar questions, your doctor may examine the spots with dermoscopy. In some cases, a skin biopsy may also be requested. This is a rarely occurring situation. A piece can be taken from the skin and examined in pathology.

Can Precautions Be Taken Against Spot Formation?

The causes of spot formation can differ for each individual. Intense and long-term sun exposure, genetic predisposition, hormonal changes, and certain lifestyle habits can be effective in skin spot formation. Nutritional habits and certain products or medications used can also play a role in skin pigment changes. Smoking is one of the factors that negatively affects the overall appearance and aging process of the skin.

To reduce the risk of skin spot formation, primary importance should be given to sun protection and regular skincare. Daily use of sunscreen, limiting direct exposure during peak sun hours, and maintaining the moisture balance of the skin can be beneficial. Unconscious products and applications that could irritate the skin should also be avoided. Especially during periods of hormonal changes such as pregnancy, extra care should be given to sun protection as pigmentation formation can become more prominent.

What Are Skin Spot Treatments?

Sun Spot Treatment

UVA and UVB rays from the sun cause an increase in melanin production in the skin, setting the stage for brown spots to form over time. Long-term sun exposure in particular can cause existing pigmentation to become more noticeable. Different treatment methods can be applied together to reduce sun-induced skin damage and lighten the appearance of spots.

In the treatment of sun spots, chemical peels, enzyme peels (Cosmelan and Dermamelan), mesotherapy, Dermapen, Q-Switched Nd:YAG laser, KTP laser, skin toning, carbon peeling, and supportive home products can be utilized. Which method will be applied is determined by evaluating the individual's skin structure, spot characteristics, and pigmentation depth.

Pregnancy Spot (Melasma) Treatment

In the treatment of melasma occurring during pregnancy, priority is given to sun protection and limiting external factors that can increase the skin's pigment production. Products and applications that can be used during pregnancy should be evaluated separately. Postpartum, chemical peels, mesotherapy, Dermapen, laser applications, or anti-spot medical products can be evaluated by a physician according to the individual's skin structure and spot characteristics. Which method to choose should be determined after examination.

In melasma treatment, chemical peels, enzyme peels (Cosmelan and Dermamelan), mesotherapy, Dermapen, Thulium Laser, Q-Switched Nd:YAG laser, KTP laser, laser toning, carbon peeling, and home care products can be evaluated according to the person's skin characteristics. While determining the treatment plan, skin type and spot characteristics should be taken into account, and special importance should be given to sun protection.

Age Spots (Lentigo) Treatment

Lentigo, whose incidence increases with age, can appear as distinct brown color changes on the skin. Exposure to sunlight over the years is an important factor in the formation of these spots. Smoking and alcohol consumption can also negatively affect skin health and contribute to making signs of aging more prominent. Lentigo is mostly seen in sun-exposed areas such as the face, hands, shoulders, back, and chest.

In the treatment of age spots, applications such as CO₂ fractional laser, Q-Switched Nd:YAG, Fotona Q Max, KTP, and Thulium laser can be utilized. How the treatment will be administered and which method will be preferred is planned after evaluating the structure of the spot and the individual's skin characteristics.

Birthmark (Port-Wine Stain) Treatment

Port-wine stains, known as birthmarks, are vascular skin formations in pink, red, or purple tones mostly seen in the face and neck area. The goal in laser treatment is to target the vascular structures responsible for the color of the stain. Heat generated by the absorption of laser energy by the vessels can help these vessels shrink over time and lighten the color of the mark.

Treatment to be applied for port-wine stains is determined according to characteristics such as the color, size, and depth of the stain on the skin. Treatment options may include Q-Switched Nd:YAG, Fotona Q Max, and KTP laser applications. Changes in the appearance of the stain are usually evaluated after multiple applications.

Acne Spot Treatment

Different types of marks and color changes can occur on the skin following acne. Especially in severe acne cases, indentations and surface irregularities may remain as nodules and cystic structures under the skin heal. These marks can negatively affect not only skin appearance but also a person's self-perception.

Before starting acne mark treatment, the depth, prevalence of the marks, and skin structure are evaluated to create a suitable procedure plan for the individual. Methods such as CO₂ fractional laser, Q-Switched Nd:YAG, Fotona Q Max, Dermapen, and chemical peeling can be used in treatment. The selection of the method to be applied is personalized according to the characteristics of the acne marks.

Freckle Spot Treatment

Freckles are small brown pigment spots formed by the accumulation of melanin pigment, especially in sun-exposed areas. Genetic characteristics play an important role in freckle formation. Freckles, which can be seen more prominently in fair-skinned individuals, can darken and become more visible during spring and summer months when sunlight is intense.

Laser applications can be utilized in freckle treatment. Q-Switched Nd:YAG, Fotona Q Max, and KTP lasers are among the methods that can be evaluated for this purpose. Since there is a possibility of pigmentation becoming prominent again during periods of high sun exposure, treatment timing and post-procedure sun protection are of great importance.

What Are the Most Frequently Used Spot Treatment Methods?

Laser Treatments – In laser applications, different technologies can be used to target melanin pigment accumulated in the skin. While Q-Switch laser targets pigment formations, fractional laser supports the skin's renewal process, helping reduce the appearance of spots. The number of sessions to be applied may vary from person to person depending on the type, density, and depth of location in the skin of the spot.

Medical Creams – Topical products containing active ingredients such as kojic acid, vitamin C, retinol, and similar substances may be recommended by a physician to help reduce the appearance of pigmentation on the skin. When used regularly and correctly, these products can support a more balanced skin tone and help spots lighten over time.

Chemical Peeling – Aiming for the controlled removal of damaged and pigment-dense cells on the skin surface, chemical peeling can help reduce the appearance of spots by supporting skin renewal. Different peeling ingredients such as glycolic acid, salicylic acid, or TCA can be utilized in the application.

Mesotherapy and Youth Vaccines – Based on injecting active ingredients with spot-lightening effects, antioxidants, and vitamins directly into the middle layer of the skin, these treatments ensure the elimination of skin tone inequalities.

What Are the Types of Birthmarks?

Birthmarks are formations that can be seen on the skin from birth and appear due to differences in color, appearance, or vascular structure. While some may lose their prominence spontaneously over time, others may remain on the skin for a long time. Generally, they are evaluated in two main groups: pigment-sourced and vascular-sourced. Spots in red or purple tones resulting from changes in vascular structure are called vascular birthmarks.

Vascular Birthmark Types

Strawberry Nevus: Also known as hemangioma, strawberry nevus is one of the common vascular birthmarks seen during infancy and childhood. It usually presents a red, slightly raised appearance and can appear in areas such as the face, scalp, chest, or back. In most cases, it may regress spontaneously over time and may not require treatment.

Salmon Patch: Also referred to as Nevus Simplex, this birthmark is usually seen in pink or light red color. It appears most commonly on the forehead, nape, and around the neck, and is a very common type among birthmarks.

Port-Wine Stain: A distinctively colored vascular birthmark ranging from red to purple. Laser applications or cosmetic camouflage methods can be utilized in suitable cases to reduce its appearance.

Pigmented Birthmarks: Pigmented birthmarks, which can be seen in white, blue, gray, or brown shades, can occur due to differences in melanin production or distribution in the skin.

Skin Pigmentation Disorders

If a person has darker or lighter skin spots, this situation clearly points to a pigmentation disorder. Skin pigmentation disorders present themselves as Melasma or Vitiligo.

Melasma: A skin problem that generally affects the facial area and causes brown spots to appear. It is encountered more frequently in female individuals compared to males. Sun exposure and hormonal changes are among the main factors that can trigger the onset of melasma or make existing pigmentation prominent.

Vitiligo: Vitiligo, which can appear in different parts of the body, causes light-colored or white areas to form due to a decrease in melanin pigment, which gives color to the skin. It can develop as melanocytes responsible for melanin production lose their function, and lightening of hair or body hair color can also be seen in some individuals. Although the exact cause of the disease has not been fully established, immune system-related mechanisms are thought to play a role.

Post-Inflammatory Hyperpigmentation and Hypopigmentation: A change in pigment production can occur following inflammation, irritation, or trauma to the skin. During this process, areas darker than normal (hyperpigmentation) or lighter-colored areas (hypopigmentation) can be seen on the skin.

Albinism: Albinism occurs in people who cannot produce sufficient amounts of melanin. It is the state of having very little or no pigment in the skin, eyes, and hair. This condition is a genetic disorder. It is inherited hereditarily.

Skin Rashes

Some skin diseases and rashes can cause color changes or spot appearances on the skin following the healing process. One of the conditions that can be encountered within this scope is Rosacea.

Rosacea: A chronic skin condition that can cause redness, sensitivity, and occasionally inflammatory lesions, especially in the facial area. It becomes most prominent around the nose, cheeks, forehead, and chin.

Psoriasis: A chronic skin disease that can appear in different parts of the body and manifest with redness and scaling on the skin surface. Dryness and prominent plaques can also be seen in affected areas in some individuals.

Contact Dermatitis: A skin reaction that can occur as a result of skin contact with an irritant substance or an allergic reaction developed against a specific substance. It can cause symptoms such as redness, itching, dryness, and rash.

Eczema: Eczema, also known as atopic dermatitis; can cause symptoms such as dryness, redness, intense itching, and cracking on the skin. Fluid leakage can occasionally be seen in affected areas, followed by crusting on the skin surface.

Skin Infections

Some skin infections also lead to color discolorations.

Tinea Versicolor: A superficial fungal infection that can lead to the formation of areas lighter or darker than normal skin tone on the skin. It usually develops slowly, and over time, spots in different areas can approach each other to form larger areas. It is most commonly seen on the trunk, neck, and upper arm areas.

Fungus: Produces red-colored or silver ring-shaped spots. Infections can cause symptoms such as redness, ring-shaped rashes, dryness, and scaling on the skin. Depending on the affected area, itching can also be seen. These infections can occur in different parts of the body such as feet, hands, trunk, scalp, and nails.

Candidiasis of the Skin: A type of fungal infection that causes itchy skin spots. It occurs at skin folds such as the groin and armpits.

Melasma

Melasma is a condition that causes areas of pigmentation in brown tones on the skin and is seen more frequently in women. Hormonal changes during pregnancy and certain hormone-containing medications can trigger the onset of melasma or make existing spots prominent.

Freckles

Freckles are small brown pigment spots seen on the skin, associated with genetic predisposition. They can be encountered more frequently, especially in fair-skinned and light-eyed individuals with blonde or red hair. They can darken and become more prominent in spring and summer months when sunlight increases. They are most commonly seen on the face, shoulders, back, and upper parts of the hands exposed to the sun.

How is Laser Spot Treatment Performed?

Laser beams target the pigment in the skin, helping it shatter or be cleared away by the skin over time. With treatment, the goal is to reduce pigment density and achieve a more balanced, bright, and homogeneous skin tone appearance.

How Many Sessions is Laser Spot Treatment Applied?

In laser spot treatment, the number of sessions is determined according to characteristics such as the spread of the spot on the skin, pigment density, type, and depth. In darker spots settled in the lower layers of the skin, multiple sessions may be required to achieve the desired lightening. Particularly in birthmarks, the fact that the pigment or vascular structure lies deeper can cause the treatment process to extend. After sessions are completed, the skin's response is evaluated, and additional applications can be planned if needed.

What Happens After Laser Spot Treatment?

The light energy sent during laser application reaches the lower layers of the skin, acting on the targeted pigment structures. Slight redness, sensitivity, or temporary swelling may be seen in the application area after the procedure. These effects mostly decrease spontaneously in a short time. After laser spot treatment, it is usually not necessary to pause daily life, and the person can continue routine activities. At the doctor's check-up about one week after application, the healing status of the skin is evaluated and the next session is planned if needed.

What is the Scientific Mechanism of Action of Technologies Used in Spot Treatment?

A large portion of contemporary methods used in treating skin spots target melanin pigments in the skin. Specifically, laser technologies penetrate spots through the mechanism of selective photothermolysis. This allows light energy at a specific wavelength to be absorbed only by melanin pigments, shattering melanin without harming surrounding tissues.

Other methods used in spot treatment, such as chemical peels or enzyme peeling treatments, accelerate renewal processes in the epidermal layer of the skin. This reduces pigment accumulation on the skin. Applications such as Dermapen or mesotherapy create controlled, micro-sized damage on the skin surface layer. In this way, triggering the skin's collagen production and eliminating tone inequalities on the skin becomes possible.

What Points Should Be Considered During the Spot Treatment Process?

Sun Protection – Regardless of which treatment method is applied, the skin must be protected against the sun in every season using broad-spectrum sunscreens with a value of at least 50 SPF. If protecting the skin against the sun is neglected, spots can recur in a short time.

Season Selection – Skin becomes sensitive and peels after laser spot treatments or chemical peeling procedures. Therefore, it is more appropriate to apply these treatments in autumn and winter months when sun rays reach the earth at oblique angles.

Expert Control – Since spot treatments create sensitivity on the skin, they must be applied under clinical conditions by a specialist physician. Acids applied in environments such as hairdressers or beauty salons can burn the skin and cause permanent damage.

How is Spot Treatment Planned According to Skin Type?

Skin type is important in terms of parameters to be selected in laser and light-based treatments and potential side effects. Since the risk of post-inflammatory hyperpigmentation may be higher in darker skin types, treatment planning may need to be done more carefully.

What Are the Advantages of Combined Treatments in Skin Spots?

Applying multiple spot treatments in combination instead of a single treatment method can increase the effectiveness of the treatment. To give an example, laser treatments and mesotherapy applications or chemical peeling and Dermapen applications can be combined together according to the patient's needs.

All these combinations both ensure the reduction of pigments in the skin and activate the skin's self-renewal mechanism. In this way, it becomes possible to achieve much faster and permanent results.

What is the Role of Home Care Products in Spot Treatment?

One of the most important factors supporting the success of clinical procedures in skin spot treatment is proper care practices to be applied at home. Usually, individuals undergoing skin spot treatment are advised to use products containing:

• Vitamin C with antioxidant effect
• Niacinamide with pigment-suppressing effect
• Retinol that accelerates cell renewal
• Ingredients such as Arbutin and Kojic acid that show spot-lightening effects. Using these products both accelerates the spot treatment process and ensures longer-lasting treatment results.

When Are Spot Treatment Results Seen?

Results in skin spot treatments differ depending on the methods used in treatment. In laser skin spot treatments, visible results begin to be seen within two to four weeks. Lightening is observed in the spots.

In chemical peeling and mesotherapy applications, results begin to appear after a few sessions. A timeframe of two to three months is required to see the definitive final results.