The Dermatology Blog

Ever notice brown spots on your skin after a rash or an injury? Brown spots on your skin are often blamed on the sun, but any damage to your skin can result in skin spots.

Skin color is caused by pigment-producing cells called melanocytes. Anything that excites these cells will cause them to release brown pigment into your skin. Sun causes them to release pigment, but so can an infection, a  rash, and even acne.

When you have an infection, injury or a rash,  inflammation develops to protect your skin from harm and to repair damage. This inflammation is apparent as redness, scaling, swelling, pus, pain, or even itching.  Inflammation triggers the melanocytes to make brown pigment which is dispersed and sinks into the deep layers of your skin.

Long after the inflammation is gone, the pigment remains and the brown spots stay visible. People with darker skin tones release more pigment when their skin is inflamed, which leads to more noticeable brown skin spots.

Brown spots such as these are called post-inflammatory hyperpigmentation because they appear after inflammation resolves. Unfortunately, once that pigment is deposited in the skin, it is very slow to fade. Over-the-counter bleaching creams such as hydroquinone 2% can lighten brown skin when used for weeks to months. More potent prescription creams such as Tri-Luma® can remove brown spots, but are expensive and generally are not covered by health insurance.

It is much easier to prevent than to remove brown skin spots:

• Minimize inflammation as quickly as possible by treating the underlying problem
• Avoid sun which could make the spots even darker
• Be patient — some brown spots can last for years and treating them excessively can lead to inflammation making the problem worse.

Photo: Pat Hensen

Self or sunless tanners are lotions that create a fake tan. Most use dihydroxyacetone (DHA) which reacts with protein in your skin, turning it brown (it’s the same chemical reaction that turns bread brown when it’s toasted!) The higher the concentration of the DHA, the darker your skin. Color from DHA develops in hours.

Some self tanners use erythrulose to create color. It’s similar to DHA, but works more slowly, taking up to two days to develop. Erythrulose creates a lighter color than DHA, but when combined with DHA, it gives a redder tan.

Unfortunately, many variables affect sunless tanners and you can just as easily develop an I’ve-got-hepatitis-glow as  a sexy Salma Hayek shimmer. Ask at the cosmetic counter which product matches your skin and apply sparingly — you can always apply more later.

Any irregularities in your skin’s dryness will lead to a streaky tan, so exfoliate before applying. Areas where your skin is thick will darken more than areas that are thin, so apply less in the thick spots like elbows and knees. Put  Vaseline on your fingernails before using your self tanner, otherwise your nails will turn brown giving that not-so-attractive fake smokers-nail look.

Many people prefer tanning wipes to lotions because the wipes apply evenly and you can adjust the color easily by increasing or decreasing the number of applications.

Remember, self tanners do not protect you — they actually oxidize your skin when exposed to sun or UV light (that’s why they’re called ‘fake’ tans, they are not a real tan, remember?). Avoid sun and tanning booths once you have self tanned. Avoid people if your self tan turns you bright orange.

A bruise is blood that has leaked into your skin. The blood is red, but it appears blue when seen though the skin layers. Bruises can be frustrating, especially for women who always get them on their legs the day they wear their new INC empire-waist jersey dresses.

Bruises are a normal response to injury. Who among us has not walked into the corner of the bed or miscalculated the exact location of the coffee table when crossing the room? Most of the time bruising does not indicate any underlying diseases, except for clumsiness.

Women bruise more easily than men, especially on their thighs, calves and buttocks. This easy bruising is because women have exposed blood vessels and thinner skin as compared to men, so even unnoticed injuries to their legs leave noticeable bruises.

Usually bruising is a minor, lifelong problem. However, if bruising develops rapidly or is getting progressively worse, then investigation is needed. Also, bruising that is associated with taking medications like aspirin, plavix or coumadin should be discussed with a physician. Bruises that appear on the face, back, or abdomen are not typical and should also be evaluated by a physician. Also, if bruising is accompanied by bleeding such as heavy periods, recurrent nose bleeds, bleeding from the gums, or blood in your urine or stool, then you should see a doctor.

There is little you can do to prevent bruises. When bruising is the result of taking certain medications such as ibuprofen, fish oil or ginkgo, then stopping these can lessen bruising. Also, wearing long sleeves and long pants can be the difference in whether a bruise develops or not after a minor injury.

After an injury, try to minimize the amount of blood that leaks out to minimize the bruise. Sit down and apply pressure to the injured spot for 10-15 minutes. You can also use ice, but only for 15-20 minutes (longer than 20 minutes can cause worsening of the bruise). Apply ice with a wash cloth or other layer between it and your skin. Avoid hot showers or hot baths for 24 hours after the injury as the heat can restart bleeding into the skin.

Vitamin K and bromelain (found in pineapples) might be helpful in resolving bruises more quickly. Look for them in topical products or in oral supplements that can be taken for a few days after a bruise develops. And look out for the coffee table.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Christy Gordon (flickr)

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