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Solar Lentigines / Age Spots

Definition :
Also called liver spots and solar lentigines, age spots are flat, gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.

True age spots are harmless and don't need treatment, but they can look like cancerous growths. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed. However, prevention — by avoiding the sun and using sunscreen — may be the easiest way to maintain your skin's youthful appearance and to avoid these dark skin spots.

Causes :
Ultraviolet (UV) light accelerates the production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin — produced to protect the deeper layers of your skin — creates the darker color of a tan. Age spots develop when the extra melanin becomes "clumped" or is produced in higher concentrations than normal.

Most often, it takes years of sun exposure for these dark spots to occur — they typically develop very slowly over time. Using commercial tanning lamps and tanning beds can eventually result in the same changes.

In addition to sun exposure, simply growing older can cause the extra production of melanin and subsequent age spots. Genetics also plays a role in how susceptible you are to the development of age spots.

When to seek medical advice :
You may not like the way they look, but age spots are usually harmless and don't require medical care. However, your doctor should evaluate spots that are dark or have changed appearance because these can be signs of melanoma, a serious form of skin cancer.

It's best to have any new skin changes evaluated by a doctor, especially if a spot or lesion :

  • Is darkly pigmented
  • Is rapidly increasing in size
  • Has an irregular border
  • Has an unusual combination of colors

A biopsy (the removal and examination of tissue) may be done on suspicious lesions to rule out cancer.

Symptoms :
Age spots are flat, oval areas of increased pigmentation — usually brown, black or gray. They typically develop in people with a fair complexion but can be seen even in those with darker skin. Age spots occur on skin that has had the most sun exposure over the years, such as the backs of hands, tops of feet, face, shoulders and upper back.

Age spots range from freckle-size to more than a centimeter

across and can group together, making them more prominent. Often, age spots are accompanied by other signs of sun damage, including :

  • Deep wrinkles
  • Dry, rough skin
  • Fine red veins on your cheeks, nose and ears
  • Thinner, more translucent-looking skin

Diagnosis:
Your doctor can diagnose age spots by inspecting the skin. If there's any doubt, your doctor may do other tests, such as a biopsy. Other conditions that can look similar to age spots include :

  • Moles. Although they often appear as small, dark brown spots, moles (nevi) vary in color and size. They can be raised or flat and can develop almost anywhere on your body — even between your fingers and toes. Unlike age spots, moles can be present at birth. They often become more prominent with age. Moles also may darken with repeated sun exposure or as a result of hormonal changes in pregnancy.
  • Seborrheic keratoses. These tan, brown or black growths have a wart-like or waxy, pasted-on appearance and range in size from very small to more than 1 inch (2.5 centimeters) across. Seborrheic keratoses don't become cancerous, but they can resemble age spots, moles or skin cancer.
  • Lentigo maligna. One type of skin cancer known as lentigo maligna melanoma can develop in areas of long-term sun exposure. Lentigo maligna starts as tan, brown or black lesions that slowly darken and enlarge. They tend to have an irregular border and uneven coloring and may be slightly raised.
Treatment:
If you're unhappy with the appearance of age spots, treatments are available to lighten or remove them. Since the pigment is located at the base of the epidermis — the topmost layer of skin — any treatments meant to lighten the age spots will need to penetrate through this layer of skin.

Age spot treatments include :

  • Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid may gradually fade the spots over several months. Over-the-counter (nonprescription) fade creams that contain glycolic acid or kojic acid may slightly reduce the appearance of the age spots. Sun protection is strongly advised if you use medication treatments.
  • Laser therapy. Laser therapy destroys the extra melanocytes that create the dark pigment without damaging the skin's surface. Treatments with laser typically require several sessions. After treatment, age spots fade gradually over several weeks or months. Laser therapy has few side effects, but it can be expensive.
  • Freezing (cryotherapy). This procedure involves applying liquid nitrogen or another freezing agent to the age spots to destroy the extra pigment. As the area heals, the skin appears lighter. Freezing is typically used on a single or small grouping of age spots. Though effective, this procedure poses a slight risk of permanent scarring or discoloration.
  • Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. This procedure removes the skin surface, and a new layer of skin grows in its place. Redness and temporary scab formation can result from this age spot treatment.
  • Chemical peel. A light or medium chemical peel can gradually fade age spots, but several treatments are necessary before you notice any results. A chemical peel involves applying an acid, which burns the outer layer of your skin, to the age spots. As your skin peels, new skin forms to take its place. Sun protection is strongly advised following this treatment.

Because age spot treatments are considered cosmetic, your insurance may not pay for it.

In addition, any of the procedures can have side effects, so be sure to discuss them in advance with your doctor. Make sure your dermatologist is specially trained and experienced in the technique you're considering.

Prevention:
To help avoid age spots, minimize your sun exposure. If you must be in the sun, use a sunscreen with a sun protection factor (SPF) of at least 15. It should be a broad-spectrum sunscreen, which means it blocks both ultraviolet A (UVA) and ultraviolet B (UVB) rays.

  • Avoid the sun during high-intensity hours. The sun's rays are most damaging from 10 a.m. to 4 p.m. Reduce the time you spend outdoors during these hours.
  • Wear protective clothing. Cover your skin with clothing, such as long-sleeved shirts, long pants and wide-brimmed hats. Also, keep in mind that certain clothing styles and fabrics offer better protection from the sun than do others. For example, tightly woven fabrics are better than loosely woven fabrics.
  • Use sunscreen. Apply sunscreen liberally 30 minutes before going outdoors so that your skin has time to absorb the sunscreen. Then reapply according to the directions on the label — usually about every hour.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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