There are so many kinds of spots on the face

As we age, spots on our faces gradually appear, and even become more and more numerous. They may be darker or lighter, larger or smaller. Little do people know that the so-called "spots", a seemingly simple term, actually covers a wide variety of skin changes - there are so many types of spots. They may be signs of aging, or they may be a sign of health, and sometimes they may even be a genetic mark.

Today, we are going to uncover the diversity of facial spots and explore their causes, types, and the impact they have on our lives.

1. There may be several types of spots on the face

What we call pigmentation is actually an imprecise folk term. Medically, it refers to a large category of skin problems with darker pigmentation.

When spots appear on the face, they may be: post-inflammatory pigmentation, melasma, solar lentigo, seborrheic keratosis, freckles, malar nevus, etc.

Each of these spots has its own characteristics, and the causes and treatments vary from disease to disease. We have summarized their basic characteristics in the table below.

Table 1. Facial spots may be of these types

Pigmentation Type

reason

Features

Post-inflammatory hyperpigmentation

Inflammation interferes with melanocytes

Before the spots appeared, there were other skin problems, such as acne and eczema

chloasma

Caused by pregnancy, medication, etc., melanocytes are overactive

More common in women, patches of pigmentation with irregular borders, difficult to treat

Solar sunspots

Caused by sun exposure, commonly known as sunburn

Many small spots, symmetrical, start to appear around age 30

Seborrheic keratosis

Commonly known as age spots, they are closely related to skin aging and are the hyperplasia of the local epidermis.

Grows into a small, sticky mass that is slightly raised

freckle

It is caused by an increase in melanocytes and is related to race, genetics, etc.

There are many small spots, mostly on the nose and face, symmetrical on both sides, which get worse after sun exposure

Brown-blue nevus on the zygomatic region

Active melanocytes cause

Mainly on the cheekbones, basically symmetrical on both sides, the brown-blue spots merge into a small piece

Although there are many types of pigmentation, which affect appearance and disturb daily life and social interaction, fortunately, these problems are usually benign. If you want individualized evaluation and treatment, you should see a regular doctor, who will ask about your condition, check the details of the pigmentation, and then make targeted analysis and treatment.

Below, we will discuss these types of spots one by one in the following text for your initial reference.

2. Post-inflammatory hyperpigmentation

The name sounds strange and academic, but it actually refers to the very common pigmentation.

The reason for this kind of spots is that skin inflammation interferes with melanocytes and melanin, causing an increase in melanin or excessive deposition, which manifests as darkening of the inflamed skin areas and remaining spots.

Figure 1. Post-inflammatory pigmentation (Source: https://zh.nutrisynergy.com.hk/)

Many inflammations can cause this kind of spots, the most common of which are acne (pimples), eczema, and skin trauma. After acne, we call it black acne marks. If you like to squeeze acne and do not use standardized medication, it is easy to leave behind temporary acne sequelae such as black acne marks. Similarly, if the skin is abraded and bleeds or breaks, it is easy to have post-inflammatory pigmentation that lasts for several months after the wound heals.

It’s also a fact that people with darker skin are more likely to have post-inflammatory hyperpigmentation than people with lighter skin.

Fortunately, this type of pigmentation generally does not last a lifetime. Most of them will last for a few months to a few years, and will gradually fade away and return to normal.

In order to prevent the condition from persisting or getting worse, you should pay attention to sun protection, correct the underlying cause, and eliminate aggravating factors (such as frequent skin damage) on a daily basis. Since this type of pigmentation can slowly improve on its own, it is not necessary to use medication or other treatments. If treatment is required, it should be carried out under the guidance of a doctor and expectations should be adjusted (because the effect is slow and there may be side effects).

3. Melasma

Melasma is a type of pigmentation that is difficult to treat and is also chronic. This type of pigmentation tends to grow in patches of yellow-brown color with irregular borders, usually on or around the cheekbones, and is relatively symmetrical on both sides.

Figure 2. Melasma (Source: https://skindoc.com.au/)

The cause of chloasma is that melanocytes are overactive and excessive melanin is deposited in the epidermis and dermis of the skin.

This is more common in women, while men are usually spared. As for the cause, it may be related to factors such as sun exposure, pregnancy, oral contraceptives, etc. Melasma during pregnancy or breastfeeding is actually quite common, but fortunately, this type of melasma has the hope of being cured without treatment, that is, after giving birth, it will gradually fade naturally within 1 or 2 years.

If it is melasma, pay special attention to 2 points:

Try to strictly protect yourself from the sun, such as avoiding the sun, using physical shields to block the sun, and applying sunscreen, because sun exposure can easily aggravate the condition;

2) Try to seek medical treatment in a standardized manner, find a reliable institution and doctor for standardized treatment, and do not take medication on your own, because melasma is difficult to treat, has a long cycle, and a high recurrence rate, and requires frequent follow-up visits.

4. Solar sunspots

Whether it is solar lentigo in medicine or solar lentigo, they both refer to the common sun spots we often talk about.

As the name suggests, these are spots caused by sun exposure, which is closely related to ultraviolet radiation. They usually begin to appear around the age of 30. The mechanism of sun spots is that acute or chronic ultraviolet radiation causes the proliferation of local melanocytes in the skin and significantly increases the deposition of melanin.

Figure 3. Solar sunspots (Source: https://clinicadelriohortega.es/)

It is manifested by the appearance of 1-3 cm (or smaller, a few millimeters) spot-like pigmentation in areas with much sun exposure, ranging in color from light brown to dark brown, with a large number of spots and symmetry. The most common areas are the zygomatic area and surrounding areas, cheeks, arms, back of hands, etc.

In order to prevent sun spots, you should pay attention to taking sun protection measures on a daily basis, especially for people with fair skin and light complexion. These people may start to develop sun spots in their 20s.

The treatment of sun spots mainly involves some operational methods, such as acid scrubbing, photons (intense pulsed light), etc. It is recommended to carry out targeted treatment after a doctor's evaluation and diagnosis.

5. Seborrheic keratosis

Some people may not have heard of seborrheic keratosis, but everyone must have heard of age spots. The two are related by their scientific name and nickname.

The reason why they are called age spots is that this problem is closely related to age - the older you are, the more likely you are to have age spots. Data shows that the incidence rate of age spots is close to 100% among people over 60 years old.

However, the nickname of age spots is not very accurate, because it is not exclusive to the elderly. Some young people in their twenties and thirties may also have this problem, which is not surprising.

If brown or brown sticky spots appear on exposed skin, slightly raised from the skin, feel hard, or look scaly, then you should consider the possibility of age spots. The number of spots varies, some may be only one, and some may have multiple.

Figure 4. Seborrheic keratosis (Source: https://www.verywellhealth.com/)

Don't worry, age spots are definitely benign lesions, they grow very slowly and will not turn malignant in the future.

If you feel that it has no impact on your appearance, you may not even need treatment. If you need treatment, you can see a doctor and choose destructive treatments such as liquid nitrogen freezing and laser burning.

6. Freckles

Freckles are another type of pigmentation that can first appear in childhood rather than in older age.

It also likes to grow on areas of the skin that are easily exposed to the sun, especially the nose, the area around the nose, the cheeks, and sometimes the back of the hands and the body. Specifically, it is a small spot, about 2 to 4 mm in size, with a relatively uniform color, usually brown or tan, and there are more of them.

Figure 5. Freckles (Source: https://ozmedica.com.au/)

Another characteristic of freckles is that their number, size and depth of pigmentation tend to increase in summer (if you do not pay attention to sun protection), and become smaller, lighter and less in winter.

Freckles, like other spots, will not become malignant and are always benign because they are just an increase in melanin and do not contain abnormal diseased cells.

In terms of treatment, the most basic thing is to pay attention to sun protection. Other measures are not necessary, it depends on personal choice. If you are willing to treat, you can consult a doctor for evaluation and then choose drug treatment or phototherapy.

7. Brown-blue nevus on the zygomatic region

Brown-blue nevus on the zygomatic region is more common in women and can easily be mistaken for sun spots, freckles or chloasma.

In fact, it is a separate disease with its own characteristics. In terms of etiology, it is composed of many active melanocytes, which produce excessive melanin, showing up as gray-brown or dark brown spots, sometimes a little bluish, that is, brown-blue.

Figure 6. Brown-blue nevus on the zygomatic region (Source: https://www.altmeyers.org/)

The most common area is the cheekbones, which are the protruding skin areas under the eyes. There are usually many 1-5 mm spots (10 to 20 on average) that merge into a small patch that is basically symmetrical. If you touch these spots, there is usually no bulge.

It is a benign lesion and is difficult to treat. Relatively effective measures are specific laser treatments, such as Q-switched lasers, picosecond lasers, and ultra-picosecond lasers. Many other measures to remove pigmentation have not been very effective, such as medical acid peels, topical azelaic acid, topical hydroquinone, and photorejuvenation (intense pulsed light therapy).

summary

In summary, we know that there are actually many so-called "spots" on the face. The most common ones are those mentioned above - post-inflammatory pigmentation, melasma, solar lentigo (sun spots), seborrheic keratosis (age spots), freckles and malar nevus. They may appear due to age, health signs or genetic factors, mainly affecting the appearance, but fortunately they are benign. However, it should be noted that some very individual spots may be malignant manifestations, such as basal cell carcinoma and malignant melanoma. Due to space limitations, we will not discuss them today. If you find that spots appear on your face in the short term and they are constantly changing and worsening, it is best to see a doctor for evaluation in a timely manner.

References

[1] What to know about hyperpigmentation. https://www.medicalnewstoday.com/articles/323808

[2] Thawabteh AM, Jibreen A, Karaman D, et al. Skin pigmentation types, causes and treatment-a review. Molecules. 2023; 28(12): 4839.

[3] Plensdorf S, Livieratos M, Dada N. Pigmentation disorders: diagnosis and management. Am Fam Physician. 2017; 96(12): 797-804.

[4] UpToDate. Melasma. https://www.uptodate.com/contents/en/melasma-epidemiology-pathogenesis-clinical-presentation-and-diagnosis

Author: Tang Jiaoqing, MD, attending physician of dermatology

Reviewer: Feng Jun, deputy chief physician of the Dermatology Department of Sinopharm Tongmei General Hospital

The article is produced by Science Popularization China-Creation Cultivation Program. Please indicate the source when reprinting.