Discoloration / Melasma / Sun Spots

Pigmentation or blemishes are dark marks or spots that result from injury to the skin.  They are often unsightly and difficult to cover with makeup. Pigmentation or blemishes can take many forms. Also known as post-inflammatory hyperpigmentation, pigmentation can occur after acne, burns, rashes, or eczema; as age spots; as familial pigmentation on the cheeks; under eye circles; and as melasma.

Age spots are unsightly blemishes that arise on the face, neck, chest and arms as people age. Also called lentigines or liver spots, they are sharply defined, rounded, brown or black, flat patches of skin that may appear alone or in clusters.

Some people have a hereditary predisposition to age spots. They may develop at an early age, especially after a sunburn, but they usually occur after age 50. Age spots are not cancerous, nor do they lead to cancer. However, on skin exposed to the sun, they may be accompanied by precancerous scaly, red-pink spots that come and go called actinic keratoses. Actinic keratoses have a higher risk for the development of skin cancer. Studies show that pigmentation and age spots make people appear even older than the presence of wrinkles.

Melasma, also called cholasma or mask of pregnancy, is a common skin problem most often seen in women. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin and above their upper lip. It can less-commonly appear on other sun-exposed parts of the body, such as the forearms and neck. It is much more common in women and much more common in skin of color. It can, however, present in men.

Common melasma triggers include:

  • Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes, the skin cells that produce pigment. Melasma often presents or worsens in summer because of the increase in UV light exposure. Melasma often recurs because even a small dose of sun can make melasma come back after it is treated.
  • Hormones: Pregnant women often get melasma. Birth control pills and hormone replacement medicine may also trigger melasma.
  • Cosmetics: Skin care products that irritate the skin may worsen melasma.


Melasma is not curable.  It is a condition that dermatologists can often control and improve greatly, but not cure. Melasma requires constant maintenance, including proper sun protection and brightening regimens.

The most important treatment for all causes of hyperpigmentation, blemishes, age spots, and melasma is a daily sunscreen that protects against UVA and UVB with an SPF of 30 or higher. Dr. Holcomb prefers physical blockers which include zinc oxide and titanium dioxide.

Dr. Holcomb selects medical grade skincare and prescriptions tailored to each patient. We offer many safe and effective treatments for pigmentation.

Treating pigmentation requires a partnership between the patient and Dr. Holcomb and a dedication to sun protection and safe sun practices. A series of treatments is necessary for clearance, and maintenance treatment periodically is recommended. Strict sun protection and habitual skincare is critical to controlling melasma.

We offer a variety of options for fading and eliminating brown spots and uneven pigmentation. The following treatments provide additional benefits to improve the appearance and texture of your skin, such as softening wrinkles and tightening the skin, removing redness and broken blood vessels, hair removal, skin cancer and pre skin cancer treatments, and helping treat acne and rosacea.

Medical grade topical treatments are critical to prevent and treat brown discoloration. Effective and well-studied ingredients used at Pure Dermatology include: retinoids (prescription strength vitamin A) and retinol, Vitamin C, Lytera, various alpha, beta, and poly hydroxy acids and exfoliants. Pure Dermatology carries distinguished product lines such as SkinMedica, Revision, Avene, Glytone and Obagi in addition to other products.

Geneo Oxygen facial gently bubbles away damaged skin cells. It is also used to prime the skin for other treatments. This treatment has no downtime.

Chemical peels are medical grade and help fade discoloration from blemishes, age spots, melasma and other causes of excess pigmentation. Chemical peels reveal clearer, younger-looking skin. These treatments have minimal downtime.

Enlighten Laser is the treatment of choice for age spots. It also gently tightens and refreshes the skin. The Enlighten Laser is a favorite as there is minimal to no downtime or healing time. This laser takes about 20 minutes and it is a minimal discomfort treatment. It does not require numbing medication.

Microneedling softens the appearance of pigmentation while also improving pore size, wrinkles, and blemishes. It does not completely erase pigmentation, but is very low risk while also treating other concerns. Microneedling has minimal downtime.

Laser treatments for melasma must be considered with caution and care. While many lasers immediately improve melasma, it is the long term implications that matter. We select treatments very carefully with each patient to minimize the likelihood of worsening.