Pigment spots — where they come from and which treatment makes sense when

How pigment gets into the skin

The melanocytes sit in the lowest layer of the epidermis. They produce melanin, the brown pigment that protects us from UV radiation, and distribute it to the surrounding skin cells. Normally this happens evenly. A pigment spot forms when individual melanocytes permanently produce more than their neighbours, or when melanin remains in one place instead of being shed with skin renewal. The trigger determines which type of spot you are dealing with.

The four most common types

• Lentigines (age or sun spots) — sharply defined, light to dark brown spots in places that have seen sun over the years: face, backs of the hands, décolleté, forearms. They remain in winter too. The cause is the sum of a lifetime's UV exposure, which is why they increase from the fourth decade of life onwards.
• Freckles (ephelides) — small, usually light-brown dots in fair skin types, genetically determined. They darken in the sun and fade in winter. Many people consider them part of their face; those who wish to soften them can do so with light, but they return with sun exposure.
• Melasma (chloasma) — widespread, poorly defined brownish discolouration, typically on the forehead, cheeks and upper lip, predominantly in women. Triggers are hormones (pregnancy, the pill) combined with sun. Melasma is treacherous: it often sits deeper, reacts sensitively to heat and light, and can become darker after a treatment that is too aggressive.
• Post-inflammatory hyperpigmentation (PIH) — spots that remain once an inflammation has healed: after acne, insect bites, injuries or an overly harsh cosmetic treatment. They occur more frequently in darker skin types and often fade on their own over months.

The causes behind them

Almost always, several factors act together. UV radiation is the most important: it stimulates the melanocytes directly and is involved in each of the four types. Hormones make the pigment cells more light-sensitive, which is why melasma often develops during pregnancy or with hormonal contraception. Inflammation leaves behind melanin that the skin does not clear away cleanly. Predisposition determines skin type and tendency. And finally, age plays a role: skin renewal slows down, melanin lingers longer, the protective mechanisms become less precise. Heat too — sauna, cooking over the stove, hot summers — can intensify melasma, even without direct sun.

When a spot needs medical clarification

Before treatment is even discussed, it must be clear that a spot is benign. That is a dermatological task, and we treat exclusively assessed, benign spots. The ABCDE rule helps you stay alert at home:

• A — Asymmetry: The spot is unevenly shaped.
• B — Border: The edge is blurred, frayed or jagged.
• C — Colour: Several shades within one spot, from light brown to black, reddish or bluish.
• D — Diameter: larger than about five millimetres and growing.
• E — Evolution: the spot has changed, itches, bleeds or has become raised.

If any of these points apply, please have the spot assessed first at a dermatology practice. A light device is not a diagnostic instrument, and a suspicious spot that has been treated is harder to assess later. If you go for regular skin cancer screening, simply bring the findings with you.

Which treatment for which spot

BBL HERO, the broadband light, is the first choice for lentigines and freckles. The light is absorbed by the melanin, the spot darkens for a few days and flakes off finely. One to three sessions are usually enough; local treatment of individual spots starts at €120 per session, the whole face costs €440. Everything else on BBL HERO in Wiesbaden.

MOXI, the gentle fractional laser, renews the uppermost layer of skin and takes diffuse, superficial pigmentation with it. It is the treatment of choice when the skin as a whole looks blotchy and uneven, and it is used cautiously and at low doses for melasma, because it works without intense heat. For pronounced sun damage we combine both; more on this under BBL or MOXI?.

Medical peels with fruit acids or trichloroacetic acid accelerate skin renewal and are a good option for PIH and superficial melasma, often as a series. Details: Medical peel.

Active-ingredient skincare is indispensable for melasma and a sensible companion for all other types: azelaic acid, vitamin C, niacinamide, tranexamic acid or retinoids slow melanin production and accompany every light treatment. What suits your skin is something we discuss in the preliminary consultation.

Sun protection is not an add-on but the foundation. Without daily sun protection factor 50, every pigment treatment reaches its limit.

Hands, décolleté and forearms

Pigment spots are not confined to the face, and the hands in particular often reveal the years of sun more clearly. The back of the hand has thin skin and little subcutaneous tissue; the spots lie superficially and generally respond well to broadband light — pigment treatment of the hands costs €240 per session, Forever Young for the hands €270. The décolleté is more sensitive: the skin is thin, heals more slowly and reacts to excessive energy with pigment shifts, which is why we work there with lower settings and more sessions. On the forearms and legs the skin is thicker, the spots sit deeper and skin renewal is slower; here it takes patience and consistent sun protection, because arms and legs are rarely covered in summer.

How a light treatment works

After the preliminary consultation, you come to the appointment without make-up and without a tan. The skin is cleansed, you receive protective goggles, and the cooled handpiece is applied spot by spot or zone by zone. Each pulse of light feels like a brief, warm snap; for full-area treatment, the face takes about 15 to 20 minutes. Immediately afterwards the skin is slightly reddened and the spots look darker than before. In the following days they contract, turn almost black and flake off finely between day five and ten — please do not scratch. Underneath lies more even skin. Whether a second session is needed, we assess after about four weeks.

What does not help

Lightening creams from the internet with undeclared ingredients, often high-dose hydroquinone or mercury, can damage the skin permanently. Home remedies such as lemon juice irritate and trigger new pigmentation through that irritation. Mechanically rubbing or peeling off flakes after a treatment prolongs the redness and can leave PIH behind. And a tanning bed “to even things out” is the opposite of helpful: it evens nothing out, it adds pigment.

Applying sun protection correctly

“But I do use sunscreen,” we often hear — and still see new spots. The difference lies in the application. An SPF 50 only protects if it is applied in sufficient quantity: about a teaspoon for face and neck, and daily, even in winter and under overcast skies, because UVA radiation penetrates clouds and window glass. After two to three hours outdoors, it must be reapplied. For melasma, a tinted mineral filter with iron oxides is additionally advisable, because it also blocks visible light, which stimulates the pigment cells. A wide-brimmed hat does more in the midday sun than any cream. Anyone who establishes this routine has created the most important precondition for a treatment to last.

Preventing recurrence

Treated spots generally do not return in the same place. New ones can form if the cause continues to act. That is why every treatment includes a plan for afterwards: SPF 50 on the face every day of the year, a hat in the midday sun, and for melasma additional protection from heat and coordination of hormone therapy with your gynaecologist. A refresh of the light treatment once or twice a year keeps the complexion even. Guidance for the first weeks after the session can be found in the aftercare after BBL and MOXI, and all options for Wiesbaden bundled on Pigment spot removal in Wiesbaden.

Frequently asked questions