Age Spot

Q: I have lots of age spots on my face, some larger than others. What can I do to remove them? I now use sunscreen but it is too late to help this problem.

A: Age spots develop due to a variety of reasons, including years of unprotected exposure to the sun. While these marks are usually considered harmless, it's important to ensure they're not masquerading as a potentially harmful condition known as actinic keratosis, or a cancerous growth such as lentigo maligna melanoma. Needless to say, your skin should be evaluated by a dermatologist or family doctor who is trained and skilled in the diagnosis and management of skin conditions. Once you have confirmation that the age spots are truly benign and require no further treatment, techniques such as cryotherapy, chemical peels, pigment-removing lasers and intense pulsed light have proven to be very effective "spot" removers.

Liver spots, sun spots and age spots

Many people refer to the brown and dark patches located on the face, tops of the hands, upper back, shoulders, and arms as liver spots, age spots or sun spots. No matter what they're called, these pigmented spots are officially known as lentigines.

While older age and genetics play a role in the changes to these patchy spots, the most common cause is an overproduction of melanin (brown pigment) in the top layer of the skin due to the harmful effects of ultraviolet (UV) radiation from the sun or from tanning lamps. This can result in an accumulation of freckles and/or sun spots known as solar lentigines.

Since your age spots are most likely due to this type of exposure, let's discuss photoaging. This term is used to describe skin changes that have most likely occurred as a result of persistent and unprotected exposure to the sun. These skin changes might include the following:

• Fine and coarse wrinkles
• Patches of brown or black areas (solar lentigos) or uneven skin tone due to changes in pigmentation
• Yellow discoloration to the skin
• Loss of elasticity, resulting in a sagging appearance, which is more common in older adults
• Increased amount of freckles
• Telangiectasias, an increased dilation and number of small blood vessels that can be seen just under the skin (this appears most frequently on cheeks and nose)
• Large facial pores, especially on the nose
• Benign changes such as melasma and seborrheic keratoses
• Precancerous skin changes—actinic keratosis (small and rough textured reddish/brown areas located on sun-exposed areas of the skin) and actinic cheilitis (which usually, but not always, appears as white scaly patches on the lower lips)
• Cancerous skin changes—basal cell carcinoma, squamous cell carcinoma or melanoma

The melanocytes (cells that produce the melanin) may also "short-circuit" and stop the production of melanin, leading to patchy areas of white spots on sun-exposed skin areas.

As you can tell, there's more to age spots than meets the eye. The damage leading up to its obvious appearance may have occurred silently and gradually over the course of many years.

Erasing the damage

Sun spots have the potential to grow and become a cosmetic concern, especially if located on your face or hands. If this occurs and concerns you, speak with your physician and ask for a recommendation to visit a physician skilled in cosmetic and aesthetic medicine. Options for sun spot removal include the following (note that many are not covered by medical insurance, as they're considered cosmetic procedures):

• Laser therapy—Uses pigment-removing devices such as Q-switched or pulsed-dye lasers and may require multiple treatments.
• Intense pulsed light (IPL) treatments are good for freckles and brown discoloration and may require multiple treatments.
• Dermabrasion—A type of "sanding" of the top layer of skin to treat sun damage and may require multiple treatments.
• Microdermabrasion—Removes some of the top layer of skin to stimulate new growth and may require multiple treatments.
• Chemical peels—May temporarily "burn" the outer layer of skin leading it to peel, resulting in a gradual disappearance of the sun spots.
• Cryotherapy—Often utilizes liquid nitrogen to freeze and destroy the tissues in the pigmented area, leading to a gradual re-growth of new and lighter skin.
• Retinoid cream medications derived from vitamin A—Can improve skin color by causing the spot to gradually fade over two to three months. If using this product, a broad-spectrum sunscreen with an SPF of 15 or above, as well as sun hats and protective clothing, is strongly advised. (Note that retinoid creams are not safe for use during pregnancy.)
• Fading creams that contain hydroquinone (prescription or non-prescription)—May provide temporary lightning of the sun spot. Be careful, as this acts like a bleach and can also affect non-hyperpigmented areas of the skin. Studies are also conflicted on hydroquinone's safety.
• Over the counter agents containing kojic acid, vitamin C, soy and licorice extract—May provide some fading benefits.

Tips to prevent recurring age spots

Many people feel a sense of relief after the sun spots fade or disappear. However, the risk factors that produced the spots still exist and should be minimized. Otherwise, new or recently erased spots will reappear. One or more of the following approaches should be considered for spot prevention:

• Sun safety—Avoid or limit direct sun exposure, especially when sunlight is most intense between the hours of 10 a.m. and 3 p.m.
• Sunblock—Use proper sunscreens that are considered broad spectrum and protect against both UVA and UVB radiation. UVA penetrates deeper into the skin and causes the majority of photoaging, while UVB is the major cause of sunburn. Use at least an SPF of 15 (30 for fair-skinned individuals) and apply 15 to 30 minutes before going outside.
• Sun-protective film—Apply this film to your car and home windows. This filters UVA radiation from the sun (UVB does not penetrate windows as easily), thus decreasing its potential to photo-age the skin.
• Sun protective clothing (Sun Precautions, Coolibar, EcoStinger, and others)—Specially designed clothing can block a large percentage of UV radiation from penetrating the material and reaching the skin. Also, use broad-rimmed hats to protect the scalp and forehead. It is also important to wear wrap-around sunglasses with 100 percent UV protection to protect your eyes, lids and skin in and around that region.

True age spots are benign. However, they do signal that skin damage has already occurred, and those affected areas should be examined yearly to ensure they are free and clear of any pre-cancerous or cancerous skin changes.