Basically, there are four types of dark skin spots. There are freckles, which we call ephelides. There are liver spots, due to sun damage, as you get older. There are seborrheic keratoses, and then there is the type of pigmentation that you get from taking estrogen, or hormones, or being pregnant.
If you think of an ephelides, or a freckle, there is not much you’re going to do about those, because they’re usually multiple and for most women, they can cover those up with makeup. For most guys, they really don’t care about those. If one of the freckles gets larger and does something totally different, it may require a biopsy to make sure it’s only a freckle Then there are seborrheic keratoses, that look a little bit like moles, but they’re slightly scaly. They’re totally harmless, they’re inherited. Most people don’t like them, so they can usually be frozen off. If they’re larger, they have to actually be surgically removed. But they don’t have to have any treatment at all.
The type of pigmentation you see during pregnancy or when taking estrogen or birth control pills can be treated with sunscreen with a high SPF number and also bleaching creams. We use hydroquinone and we also sometimes use a combination of hydroquinone with Retin-A – a brand name called Tri-Luma®. That gets rid of the pigment, but it only does it on a temporary basis. As long as you’re taking the estrogen, it’s going to be a problem, so you have to continue to treat. You need to particularly use a sunscreen on a daily basis, throughout the entire year.