elcome to Skin Sense, a monthly column dedicated to bringing you clear, up-to-date, no-nonsense advice about taking care of your skin -- keeping it healthy and looking great. The column is written by Rachel Herschenfeld, M.D., who is a frequent guest for live online discussions on skin care.

Fall is in full swing, but for many of us, something still lingers from summer vacation, and it isn't always pretty. This is the time of year I see many patients who are seeing spots -- brown spots on their skin Even with diligent use of sunscreen, many people get enough UV exposure to produce visible changes in the skin. Fortunately, there are several ways to safely fade those marks and restore a healthier, fresher-looking appearance to the skin. Depending on the extent of your spots and how quickly you want to get rid of them, I recommend three types of treatment: topical creams, peels and light lasers.

If you only have a few spots, over-the-counter products may do the trick. Hydroquinone and glycolic or alpha-hydroxy acids are very effective ingredients found in many products, including Black Opal Advanced Dual Complex Fade Gel ($10-$12), which contains 2 percent hyrodquinone as well as glycolic acid. Alpha Hydroxy Extra Strength AHA Oil Free Formula and Aqua Glycolic Face Cream (both sell at pharmacies for $10 to $20) and M.D. Forte Facial Cream and Lotion ($40-$60) are also effective products. Creams and gels such as Pevonia Lightening gel ($30-$40) that contain arbutin, kojic acid or azeleic acid work well, too.

When spots don't fade after a few months of over-the-counter treatment, prescription products that contain some of these same ingredients in higher concentrations may help. I almost always prescribe a cream containing 4 percent hydroquinone, which is the main ingredient in brands such as TriLuma, EpiquinMicro, Lustra, and Claripel.. Although the FDA recently called for a review of the use of hydroquinone, citing evidence of increased tumor risk in lab animals fed large doses of this compound, there have been no reports of topical hydroquinone causing any tumors in humans, and it is still considered safe by most dermatologists (including me!). For eliminating brown spots, retinoids (including RetinA, Differin and Tazorac or Avage) are also at the top of my list, as is Finacea, which contains azeleic acid that also safely fades dark spots on the skin. For maximum effect, I frequently recommend a combination of products to be used for at least two months.

When creams don't work, or simply to speed things along, it's time to move on to peels. Glycolic acid, salicylic acid, lactic acid, and trichloracetic acid (TCA) can all be used to increase fading of dark spots. Glycolic peels come in all different strengths, but the percentage of the glycolic acid is not always a reliable indicator of the strength of the peel. For best results, I recommend four to six monthly peels ($150-$250 per treatment) done either under the supervision of a dermatologist or by the dermatologist.

For dramatic, relatively quick results, laser or IPL treatments are excellent. The Aura or Vbeam laser can target individual spots on the face or hands. IPL, or intense pulsed light, can be used over the entire face, neck, chest and hands to fade brown spots and to improve the overall appearance of sun-damaged skin. Be prepared for temporary redness, scabbing or peeling after light treatments (though this can usually be covered with makeup). Several sessions are necessary to produce optimal results in most cases, and I usually combine these treatments with topical creams and peels.

Last but not least, one of the most important things you can do to prevent spots is to use a broad spectrum, high SPF sunscreen as well (LaRoche Posay Anthelios XL or Neutrogena UltraSheer SPF 55) and since some of these creams, peels and laser used to fade the spots make the skin more sensitive to sunlight, the dark spots can come back without adequate protection.

There are a lot of options out there, and if you're confused about the best one for you, talk to your dermatologist about designing a regimen that fits your skin's profile.