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

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)

As we age, the thick collagen layer of the skin (the layer that leather is made from) atrophies or thins out. This is due to normal aging processes where breakdown of collagen and elastin (the proteins that makes skin spring back when stretched) is not balanced with production of new collagen and elastin.

This loss of collagen is accelerated by ultraviolet light damage. Ultraviolet light, which is a form of radiation from the sun, leads to a gradual but relentless destruction of the collagen and elastin in the skin. Thin, tissue paper-like skin occurs mostly on the arms and hands —  two areas that have very high levels of exposure to ultraviolet light over a lifetime. Here in the US, the left arm is usually worse than the right; this is from a lifetime of exposure from the driver’s side window when driving.

The only thing that can be done for thin skin is to minimize damage before it is too late. This is especially important on the forearms and hands. The best way to do this is to wear long sleeves. Long sleeve shirts provide excellent protection from ultraviolet light damage (even plain cotton is an excellent sun barrier, probably better than any sunscreen). When long sleeves are not practical, then applying a broad spectrum sunscreen (that blocks both UVA as well as UVB light) is a good alternative. Sunscreens need to be reapplied every 4 hours to give good protection.

Once thinning of the skin has developed, there is little that can be done to reverse it. Again, wearing long sleeves is helpful because the clothing protects the skin from tears from minor bumps or scrapes.

Dry skin is also more susceptible to damage. Applying a thick moisturizing cream twice a day can help keep your skin protected. Minimizing washing with soap can also help preserve the natural oils on your skin, protecting it from further damage.

Eating a diet high in lean protein and getting adequate calories can also be helpful in maintaining your skin’s strength and in helping it repair quickly when a tear develops.

Lastly, avoid using topical steroids for longer than necessary — topical steroids hasten thinning of the skin and can make the problem worse. Fortunately, thinning of the skin from steroids is reversible and will improve after the steroids are stopped.

Summertime lends itself to showing a lot more skin. There are plenty of opportunities for checking out that mole on your back while you are walking around in spaghetti strap tops. In wintertime, your skin often doesn’t see the light of day, so you might be unaware of a suspicious mole on your back that is fully covered by a heavy sweater.

So now is a good time to do a thorough skin exam. Spending five minutes after your next shower (preferably under a heat lamp) to look yourself over could be one of the most important things you do for your health this winter. Here are four self checks you should be doing:

1. Check your fingernails and toenails.

It’s about time to take off those holiday themed acrylic nails, which will provide  you the opportunity to examine the health of your nails. At home or in the nail salon, look at the cuticle and nail fold. Is it ragged, red, swollen, or tender? If so, it could be a sign of a nail infection. Look at the end of the nails. Are they splitting and flaking like layers of baklava? This can be from the nails drying out, which is often the result from too much hand washing. Try using alcohol hand sanitizers instead of washing. Apply hand cream to your hands and nails after every time you wash. Dark streaks or brown spots in your nails can be a sign of skin cancer. Any colored nail changes should be checked by a physician.

2. Look under your arms and on your neck.

Do you have thick brown skin? Are there little tabs of skin growing, called skin tags? Thickened velvety brown skin can be a condition called acanthosis nigricans. It often results when you have chronic elevated insulin levels. Elevated insulin can be an indicator or obesity and an early sign of developing diabetes. Similarly, skin tags can grow as a result of elevated insulin and can also be markers that you are heading towards developing diabetes.

3. Look for Moles.

With your tan faded, now is a great time to check out your skin for lingering damage from summer and for potentially dangerous skin cancers. Use a full length mirror and a hand mirror and stand in good light. Check yourself from head to toe. Any new or changing mole, any non-healing or crusted area, or any mole that is larger than 6 mm, has an irregular border, has more than one color, or has color that is asymmetric, should be examined by a physician.

4. Check your legs.

Flaky, dry skin means you are stripping too much natural oil off your skin and not replenishing it often enough. If skin becomes dry enough, an itchy red rash can develop called asteatotic eczema. It is your body’s way of telling you not only that are you too dry, but also your skin is no longer adequately protecting you and your immune system has to kick in to help out. It is a cry for help from your skin. Use only non-soap cleansers like Dove. Apply a thick moisturizer after every shower to slightly damp skin. Sometimes, especially in winter, it is not necessary to shower everyday or certainly not necessary to soap up your legs everyday. Give your skin a chance to replenish its own oils and keep you protected from the cold, dry onslaught of winter.

Photo: Laszlo Ilyes

A sunburn is an actual radiation burn of your skin. The ultraviolet light from the sun damaged the DNA of your skin cells, triggering these cells to die (which is a good thing since you don’t want mutated cells hanging around, causing trouble). The dead cells trigger release of pro-inflammatory signals called cytokines that lead to redness, swelling, and pain. The dead cells will slough off in a few days leading to peeling and often uncomfortable itching.

Here are seven ways to treat a sunburn if you get home and see a bright red you in the mirror:

• Take anti-inflammatory medications such as ibuprophen (Advil, Motrin), naproxen (Aleve) or aspirin. These stop inflammation and reduce the amount of redness and pain. It is important to take them early as they can help block the release of interleukins, the skin’s main sunburn cytokine.
• Apply cool compresses and cool moisturizers. Try Eucerin Calming Cream. Put it in the refrigerator for a few hours before applying to your burn.

• Avoid hot showers. Instead, take a luke warm bath with Aveeno Collodial Oatmeal. The oatmeal is both a soothing anti-inflammatory and a moisturizer, which are the two things your skin needs most.
• Avoid any additional sun exposure. The best way is to cover up with clothing; applying a sunscreen to a sunburn can worsen the inflammation and itching.
• If you have blisters, resist the urge to pop them. They form a protectant seal on your skin; if they tear, the sensitive underlayers of skin will be exposed. You won’t like it. Don’t peel off the dead skin either; rather let it slough off on its own in the shower.
• If you have extensive burns or blistering, see your physician. He or she can prescribe topical steroids to help minimize the inflammation.
• Avoid numbing sprays such as benzocaine. Although they can feel great when applied, they are notorious for causing allergic contact dermatitis. If you think a sunburn is bad, try adding an incredibly itchy, allergic contact dermatitis on top of a sunburn. As one of my patients put it: “Its like being tied down on a hill of fire ants.”

Post written by Jeffrey Benabio, MD. You might also like:

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Photo credit: Keith Lewis