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Liver spots and freckles, birthmarks and pigment defects, psoriasis and rash. We find some to be sexy, others to be ugly, some are harmless, others are dangerous.
Brown skin spots: development and symptoms
Brown spots on the skin form as speckles, larger areas of color or spots. Sometimes they appear individually, then again in groups, sometimes they rise, sometimes the skin remains smooth. Such spots appear everywhere on the skin, on the ears as well as on the face, on the scalp and on the genitals.
The dye melanin usually plays a crucial role. This is responsible for dark tones. If the organism produces too much melanin in one area of the skin, brown tones develop. Melanin is mainly formed by sunlight, which is why the freckles are rightly called that, because the more we expose ourselves to the sun, the more they form.
In addition to the sun, metabolism, genetic makeup, age and hormones also play a role in the formation of dark spots, for example when women get such spots on their faces during pregnancy. Skin diseases such as neurodermatitis also leave brown spots. We should always keep an eye on brown spots because it could be early stage skin cancer.
However, the spots also result from bleeding in the legs as a result of venous insufficiency, through a changed metabolism in the case of liver disease, with inherited diseases and diseases in the cardiopulmonary system.
When to the doctor?
In cancer, cells grow out of control. This also applies to skin cancer. So if a mole or birthmark changes, caution is advised. Even if new dark spots suddenly appear and enlarge, you should consult a doctor.
warning sign are when the dark areas change their shape and color, when existing stains fibrillate, that is, they grow into the surrounding tissue, the surface ignites, a smooth surface becomes a knot, the skin itches or blisters.
Other symptoms indicate basic diseases such as venous insufficiency. These include: varicose veins, swollen legs, pain in the joints, fatigue and fever.
The family doctor carries out the first examination. If a disease is suspected, he will forward it to specialists, especially a dermatologist. He takes a tissue sample and the laboratory then determines whether it is skin cancer. If venous weakness is possible, a vein specialist (phlebologist) is required.
Skin diseases
Dark spots can indicate skin disorders. This includes neurodermatitis, psoriasis or nodule. Neurofibromatosis, an inherited disease, is rare. Systemic diseases affect the entire body and sometimes also affect the skin.
A very rare disease is genetic. This Peutz-Jeghers syndrome shows up with dark brown spots on the lips and the oral mucosa. Tumors often form in the internal organs.
Bleeding and metabolic disorders
Not all dark skin discolourations are due to melanin. Bleeding can also be the cause. There are many blood vessels in the dermis that supply the top layer of skin. If these blood vessels are damaged, for example by blows or blows, blood flows into the epidermis.
Such bruises appear red to blue when they are fresh. If the bruise fades away, on the other hand, it looks yellowish-brownish. Iron stains the blood red, but it changes color in the skin and turns brown.
Vein weakness also leads to brown spots. The skin tissue becomes inflamed and the blood seeps into the epidermis. The brownish spots, especially on the lower legs, herald inflammation.
The Pupura pigmentosa progressiva is a chronic disease of the skin and is expressed in punctiform bleeding in the skin tissue. Brown-orange colored spots form on the lower legs.
Metabolic disorders lead to extensive discoloration of the skin. The liver and kidney can no longer break down various substances and these are stored in the tissue.
Addison's disease is a disease of the adrenal cortex. The skin and mucous membranes turn brown.
Freckles
Freckles are small and numerous. The speckles appear in yellow to reddish brown, sometimes all over the body, but especially in places that are particularly exposed to the sun: face, upper arms and shoulders. They fade in winter or even disappear completely to reappear in summer.
The trigger is an increased formation of melanin in response to the UV rays of the sun, which is why people with fair skin have a lot of freckles.
Age spots
Age spots are paler than freckles and light to dark brown. They are small and often lie on the face, neck, back of the hands and forearms.
The cause is both an altered metabolism in old age and intense sun exposure. Age spots themselves are harmless, but sufferers should have the spots examined regularly as they can develop into skin cancer.
Melasmas
Melasms are colored areas in yellow-brown, which are particularly evident in women. The cause is probably the female hormones. The areas change color especially during pregnancy, and when women use hormonal contraception or use hormone replacement products. The sun intensifies the coloring.
Melasmas are harmless, but because they mainly appear on the cheeks, mouth, forehead and temples, those affected usually find them unaesthetic.
Moles
These pigment disorders are usually lens-sized, which is why they are called lentigines - lenticular skin spots. They are sometimes innate, but can also be formed by sunlight.
Skin cancer can develop from liver spots, so people with many of these discolorations should be examined regularly. Liver spots on the hands, arms, face, shoulders and back are particularly common. They are often flat and limited, but can also rise.
It is an alarm signal if the brown spots on the skin change color, start to itch and widen, because these are typical signs of skin cancer. Liver spots form when melanocytes multiply in certain places.
How affected liver spots perceive depends on their size, location and culture. In some societies, small liver spots in women at a distance of approximately two cm from the upper lip and nose are considered sexy, and some women even have such "beauty spots" tattooed extra. Large liver spots on female breasts, in the area of the eyes or in the middle of the forehead, on the other hand, are generally considered to be ugly, as are many liver spots on different skin areas.
Congenital brown spots on the skin: birthmarks
Birthmarks, as the name suggests, are innate. They appear in many facets from brown, reddish to blackish and are of different sizes. They occur individually or in so-called nests, for example as dark brown spots on a yellow-brown surface. They are often flat, but sometimes they are curved and round or even flat. Some of these brown spots are hairy.
Birthmarks are congenital benign growths of the skin. Either the melanocytes or the nevus cells are the trigger. They are benign, but like liver spots, can grow into malignant growths. Birthmarks should therefore be protected from the sun and examined regularly by a dermatologist.
Milk coffee stain
These skin changes do not indicate a specific type or the symptom of a specific disorder, but congenital spots of light brown color. They are of different sizes, but flat and clearly delineated from the surrounding skin. Mostly they are due to the trunk or limbs.
More than six of these spots in one place can indicate neurofibromatosis, a rare inherited disorder in which bright pigment spots form, but also tumors.
Melanoma
Such a dark spot on the skin is anything but harmless. Rather, melanoma, the black skin cancer, refers to a malignant growth that can lead to death. Such a stain can be dark brown, black-blue, reddish or even colorless. Frequent places for skin cancer are the lower legs, shoulders, face and back.
Black skin cancer shows up as a blotch or lump. The flaring edges are typical, since cancer is a cell proliferation and the change in the area.
The pigment-forming cells grow uncontrollably in cancer. People with many liver spots, birthmarks and fair skin are particularly at risk. They cause skin cancer triggers such as frequent sunburn and intense UV radiation. There is also a generally weak immune system and a genetic predisposition.
Skin cancer is not necessarily a death sentence. Recognized early, it is considered the best form of cancer to treat because the tumors that arise can be easily removed from the skin and the cancer does not quickly spread to vital organs. Even in later stages, the ways to cure skin cancer are still good.
Cause of Kaposi's sarcoma
This is also a tumor formation. However, this starts from the vessels. Spots develop into ulcers and the disease manifests itself in reddish rashes. The trigger is not the sun, but among other things the human herpes virus 8. All people with a weak immune system are at risk and the syndrome is one of the typical diseases of AIDS patients.
Inflammation of brown skin spots
Skin inflammation often leaves discolored skin where the rash and infection appeared. Typical diseases that leave a brownish color are neurodermatitis, psoriasis and nodules.
Even if the skin becomes infected because Corynebacteria multiply excessively, brown spots appear where the skin rubs against the skin, i.e. in the pubic area, under the armpits or on the breasts.
Urticaria pigmentosa
With this skin disease, raised spots form in so-called nests and take up larger areas. The affected areas are extremely sensitive and react to stimuli such as pressure or rubbing by swelling and itching. Even more: pressure, cold and warmth can lead to dizziness, diarrhea and loss of consciousness.
With this rare pigment disease, the mast cells multiply uncontrollably. So far, medicine has been puzzled as to why this is so. Young people are affected.
Purpura pigmentosa progressiva
Here are the spots, not pupurn as the name suggests, but mostly red to orange-brown. They spread from the lower legs to the legs, stomach and ame. Small red dots appear on the edges of the spots.
It is a disease in which small vessels ignite and which science has not yet been able to explain.
Peutz-Jeghers syndrome and hemochromatosis
Iron storage disease (hemochromatosis) is a genetic malfunction of the liver. The organ cannot store and break down enough iron here, the metal instead accumulates in the tissue, and that includes the skin.
Those affected suffer from blue-black spots, which are particularly evident on the ear, eyelids, nose, cheeks and hands.
The so-called Peutz-Jeghers syndrome is an inherited disease that initially shows with brown spots on the mouth, lips, oral mucosa and back of the hand. Later, tumors in the internal organs are added.
Cause rheumatic diseases
Articular rheumatism sometimes leads to pigment discoloration on the back of the hand. It is not a question of clearly delimited stains, but of "washed out" lighter and darker areas.
Felty syndrome is a special form. This manifests itself in the recurring smallest bleeding, which lead to yellow-brown spots. There may also be blood red spots that form knots and itchy, or even dark blisters with bleeding. The skin is extremely flammable.
Those affected are mostly women after the middle years of life. Other symptoms include swollen lymph nodes and recurrent respiratory infections, abdominal pain, fever, cough with expectoration, and physical weakness.
Brown spots on the skin from medication
Brown skin spots are also caused by various medicines. Medicines for acne, for example, sometimes leave brown spots on the acne scars and where the skin is particularly exposed to the sun. Chloroquine, a malaria remedy, sometimes causes brown spots on the face and fingernails.
Gold salts for rheumatism also sometimes lead to discoloration, as do some neuroleptics and St. John's wort extract. This is because these agents sensitize the skin to light.
Perfume and metals
Some fragrances lead to an increased reaction of the skin to UV light. This is especially true for bergamot oil and tea tree oil. Anyone who rubs himself in with such essences and then sunbaths develops so-called Berloque dermatitis. First, the skin becomes inflamed, and after it heals, brownish patterns remain.
Lead, arsenic, mercury and silver can turn the skin brown on contact.
Brown skin discoloration from plants
Caution is advised with some plants. Giant hogweed causes burns and rashes when touched with the skin in the sunshine. Lily plants and daisies also trigger toxic reactions on the skin in connection with sunlight. That means itchy rash and discoloration.
Diagnosis and treatment
As a layperson, you should never judge brown spots yourself, but leave this to a doctor. If you have moles or a lot of liver spots, you should regularly see a dermatologist who can assess whether risky changes are taking place. It does not matter whether the spots are congenital or acquired.
If there are a particularly large number of large brown spots on the skin, an annual examination is recommended regardless of whether you notice any dramatic developments. Close checks should also be considered if you have skin cancer in your family, and especially if you have already had a skin tumor.
The family doctor only performs the initial assessment. If he sees suspicious spots, he will refer you to a dermatologist. The initiates the further investigations. If skin cancer is suspected, he takes a tissue sample and sends it to the laboratory. He also surgically removes growths that are not yet cancer but are highly likely to develop into them - either with a laser or traditionally with a scalpel.
Such an operation is usually neither difficult nor risky. It usually takes place under local anesthesia and you can leave the practice immediately afterwards. As follow-up care, the usual care for a small cut, i.e. ointment and a plaster, is enough to prevent germs from getting into the opened tissue.
However, if the family doctor suspects a metabolic disorder or systemic disease, he is no longer the appropriate specialist and refers you to an internist who is familiar with internal diseases. If it is a disease of the veins, a so-called phlebologist is required.
Cosmetic corrections
Many people with dark skin spots have no health problem, but find the discoloration to be unaesthetic. Concealers often help to hide the spots. Bleaching creams with certain acids also weaken the color, particularly in the case of age spots, melasmas or Berloque dermatitis.
Dermatologists also remove milk coffee stains or age discoloration if only aesthetic issues matter. They use laser procedures for this, and it is a routine operation.
The health insurance companies do not pay purely cosmetic corrections, but the border can hardly be drawn and ultimately the judgment of the dermatologist counts, who can always say that the spots are removed from cancer screening.
If you are bothered by a large birthmark that is also deep in the middle layers of the skin, you should take the following into account: If the doctor scrapes the upper dark layers and / or removes them with a laser, this does not necessarily mean that the birthmark is gone forever.
The skin grows back, and if there is a congenital pigment disorder, melanin in turn increases. Even after two or three incisions, the old birthmark comes back in a slightly different form.
In the end, only the classic method helps: a deep cut with the scalpel into the lower skin layers, which takes out the entire area that otherwise discolors. However, such an operation leaves a scar and you decide whether the birthmark looks worse than scarring at this part of the body. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
Swell:
- Ashley B. Grossman: Addison's Disease, MSD Manual, (accessed September 8, 2019), MSD
- Thomas Vogt et al .: S1 - Brief guideline - Angiosarcoma of the skin and Kaposi sarcoma, German Cancer Society, German Dermatological Society, (accessed September 8, 2019), AWMF
- Gregory L. Wells: Kaposi's Sarcoma, MSD Manual, (accessed September 8, 2019), MSD
- K. Brockow: Cutaneous mastocytosis (Urticaria pigmentosa), Abeck D., Cremer H. (eds) Common skin diseases in childhood, Steinkopff, (accessed 08.09.2019), doi
- S. Gorbatsch, B. K. Durani: Purpura pigmentosa progressiva, close to dermatology (2017) 33: 8., doi
- National Organization for Rare Disorders (NORD): Peutz Jeghers Syndrome, (accessed September 8, 2019), rarediseases.org
