Solar lentigines is the medical term for age spots, sometimes called liver spots. They occur most often on skin which has had the greatest exposure to sun: the face, neck, hands, arms, shoulders and upper back. Age spots are usually flat, and colored brown, black, or gray. They are common after age 40, but can occur in younger people. Some may have an appearance similar to a more serious medical condition.
Age spots are harmless, but the spots may raise concerns about cancer. Lesions which appear spontaneously, change shape, or grow rapidly should be checked for irregular borders and varied pigments within the same lesion.
How To Lighten Age Spots
For cosmetic reasons, age spots can be lightened with skin bleaching agents or can be removed surgically. The best management of age spots is to prevent them by using sunscreen and avoiding direct sun on skin as much as possible. Choose natural sunscreens that do not contain parabens or petrochemicals.
Age spots are caused primarily by years of exposure to ultraviolet (UV) light from the sun. Commercial tanning lamps and beds also damage the skin. Melanin is the pigment in the upper layer of skin (epidermis), which gives skin its normal color. UV light speeds up the production of melanin, causing a tan, which protects the deeper layers of skin from UV light.
Age spots are formed when the melanin "clumps" or is, in some areas, in particularly high concentration. Just getting older can also speed up production of melanin, even without sun exposure. There may be some genetic effect, with some people more susceptible than others to forming age spots. Fair-skinned people are more prone to forming age spots than are people with a naturally darker skin. There is also increased risk with a history of exceptionally intense and frequent sun exposure. (1,2)
Signs And Symptoms
Solar lentigines are:
- macular - a flat, demarcated area of increased skin pigmentation which is neither raised nor depressed.
- usually brown, black, or gray.
- found on skin that has had the most sun exposure over years, usually on the backs of hands, tops of feet, face, shoulders and upper back.
- variable in size, from 1 millimeter to 3 centimeters across.
- prone to group together, making them more prominent.
- sometimes similar in appearance to malignant or nonmalignant lesions.
- more likely to occur in white or Asian people, especially in persons with a tendency to freckle.
Melasma and ephelides are two types of nonmalignant, macular, hyperpigmented lesions which can be mistaken for age spots. Melasma is a progressive, nonscaling hyperpigmentation of sun-exposed skin, especially on the face and forearms.
The formation of melasma is often associated with pregnancy, oral contraceptives and some anticonvulsants. It may appear spontaneously with no identifiable cause or association to known co-existing factors. It occurs in women nine times more frequently than in men, and more often in skin types common to Asia, the Middle East and South America. It is of no consequence to health, but may be distressing cosmetically.
The face is the most common site of melasma, usually in the center of the face; less often it occurs around the mouth and jaw. The patches are usually bilateral. There are three types of melasma: epidermal, dermal, and mixed. Epidermal melasma is usually light brown, and enhances under a Wood's lamp examination. Dermal melasma is grayish and does not enhance with a Wood's lamp examination. Mixed lesions are dark brown with variable response to Wood's lamp. Ephelides are the medical name for freckles, usually 1-2 millimeters, sharply defined, on the face, neck, chest and arms. (2)
Solar lentigines may resemble moles (nevi), which are raised or flat, and are not limited to sun-exposed parts of the body. Seborrheic keratoses, which are nonmalignant, are small, tan, brown or black, with a "pasted on" appearance. There's a broad range of normal size, from 1 millimeter to more than 2.5 centimeters. Lentigo maligna is a type of skin cancer, a melanoma, which can develop in areas of long-term sun exposure. It starts as tan to brown to black, that darkens and enlarges. They have irregular borders and are multipigmented within the same lesion. Pigmented actinic keratoses are premalignant. (2,4)
New skin lesions should always be evaluated by a board-certified dermatologist. The following characteristics are concerning:
- dark pigmentation
- rapid growth
- irregular borders
- multiple colors within the same lesion
- tenderness or bleeding
- itchy, reddened skin
- poor healing
Any lesion which is atypical or suggestive of melanoma should be biopsied, through all layers of the skin. Seborrheic dermatoses and pigmented actinic keratoses cannot always be distinguished by visualization alone. If there is uncertainty about a diagnosis, biopsy should be performed. (1,2,4)
Some systemic disorders show first as multiple lentigines: Peutz-Jeghers syndrome, LEOPARD syndrome, and Lamb syndrome.
- It is advised that direct sunlight should be avoided between 10 a.m. and 4 p.m., when the sun's rays are most intense. Outdoor activities should be scheduled either before 10 a.m. or after 4 p.m.
- Sunscreen, which protects from both UVA and UBV rays, with a sun-protection factor of at least 15, should be applied 15-30 minutes before sun exposure, then be reapplied every 2 hours. It should be reapplied more often when swimming or perspiring. It should not contain potentially harmful ingredients such as parabens or petrochemicals. For more information, see our free report, "The Poisons You Put On Your Face Everyday."
- Cover up. Use a broad-brimmed hat which provides more protection than a baseball cap or visor. Wear tightly woven clothing, covering the arms and legs. Clothing designed to provide sun protection is useful. An ultraviolet protection factor (UPF) of 40-50, in the clothing, is the best protection. The fabric can lose the protection by stretching , getting wet, or with repeated washing. (2)
TreatmentsAlthough age spots are of no threat to health, they can be of cosmetic concern. There are treatments available to lighten or remove them. Pigmentation is in the deepest part of the epidermis, the top layer of skin. Any treatments meant to lighten the spots must penetrate to the deepest part of the epidermis. The treatments are seen as cosmetic, so usually insurance will not apply. Care should be taken to select a physician trained and experienced in the various treatments under consideration.
- Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid may gradually lighten age spots over the course of months. Natural sunscreen with a SPF of 30 (without parabens) is strongly advised when medication treatment is used. It may result in reddening, burning, dryness or itching.
- Laser therapy. Laser therapy destroys melanocytes, the pigment-producing cells, without damaging the skin's surface. Multiple sessions are usually required. After treatment, the age spots fade gradually, over weeks or months. There are few side effects, but there may be slight discoloration of the skin.
- Cryotherapy (freezing). Liquid nitrogen or another freezing agent is used to destroy excessive pigment. It's usually used on a single age spot or small groupings of spots. It can irritate the skin and there is a slight risk of permanent scarring or discoloration.
- Dermabrasion. This treatment consists of planing the surface of the skin using a rapidly rotating brush; new skin replaces the old. There may be temporary redness and scab formation.
- Chemical peel. This treatment method involves applying acid to the skin, burning the outer layer of the skin. As the skin peels, new skin forms. Usually several treatments are needed to see any results. Sun protection is strongly advised after treatment with chemical peels. There is temporary irritation and there is a slight risk of discoloration.
Lifestyle And Home Remedies
Fading creams and lotions are available over-the-counter at department and drug stores, as well as on the internet. They may improve the appearance of the age spots over the course of months. Results depend somewhat on how darkly pigmented the age spots are and how often the cream or lotion is applied. The product used can contain hydroquinone, deoxyarbutin, glycolic acid or kojic acid, which may cause skin irritation. (4,2)
A natural option for radiant skin is this combination of pure botanical ingredients that feed your skin what it needs to stay beautiful. Click here to learn more. An ingredient to be avoided in over-the-counter skin lighteners is mercury. It has been banned in skin lightening products manufactured in Europe and Africa, but is still used in one out of four products manufactured in Asia and sold in the U.S. The World Health Organization (WHO) warns consumers to avoid mercury because it causes kidney damage and lowers the skin's ability to avoid bacterial and fungal infections.
Mercury ingestion or absorption through the skin can also cause anxiety, depression and even psychosis. It can also cause peripheral neuropathy - damage to nerves, usually in the hands and feet. It changes sensation and may cause stinging and burning pain, markedly lowering quality of life. It responds poorly to treatment. (3)
Your Questions About Age Spots Answered
Is there a pill I can take to get rid of the spots? There are no oral medications for preventing or fading age spots. All treatments are topical, on the surface of the skin.
Do birth control pills have an effect on age spots? Oral contraceptives have no effect on age spots. They can cause melasma, a hyperpigmentation of areas on the face, which can be mistaken for age spots.
After treatment, will age spots reappear? After lesions are removed or faded by the various treatments addressed in this article, the same spots will not regrow. There remains, however, the damaged skin changes from years ago that led to the formation of the age spots which were treated. New age spots can occur.
Will antibiotics get rid of the age spots? There is no association between antibiotics and age spots, neither causing nor curing the spots.
I'm a smoker. What effect does that have on age spots? Smoking affects every cell in the body in negative ways. It damages the body's ability to self-repair damaged cells and contribute to age spots.
How long should I give over-the-counter bleaching agents the opportunity to work before I see a doctor? It can take months to see any improvement when using home remedies. A board-certified dermatologist can assist in prescription and laser treatments.
I know that damage occurred from the deep tans and sun exposure I got when I was much younger. Isn't it too late to do any good by protecting my skin from sun? Damage can occur at any age, and sun exposure continues to increase your risk of forming new age spots and other skin problems, including the risk of skin cancers.
What can I use to prevent age spots while I'm still using a tanning bed? There is nothing to do or use that can lessen skin damage while continuing exposure to the light bulbs in tanning beds.
I thought I was supposed to get as much sun exposure as I can to supply my body with vitamin D. What about that? Sun exposure is a good source of vitamin D, but do it in moderation and don't burn yourself. Vitamin D is also found in many foods, and healthful, food-based vitamin D is superior to solar vitamin D.
I had some new spots appear recently that look like age spots. Can I treat them with home remedies? New lesions should be examined by a physician before starting treatment. Make your skin beautiful again – click here to learn more.
Article Written By Sheila M. Krishna M.D., FAAD
Dr. Krishna is a board certified dermatologist. She received her undergraduate degree at the Massachusetts Institute of Technology where she double majored in biology and foreign languages and graduated with Phi Beta Kappa honors. She is fluent in both English and Spanish. Dr. Krishna received her medical degree at the David Geffen School of Medicine at the University of California, Los Angeles, where she was a member of the Alpha Omega Alpha Medical Honor Society. She completed her dermatology residency at the Virginia Commonwealth University in Richmond, Virginia, and she served as Chief Resident in the Department of Dermatology. She completed an additional research year at UCLA with Dr. Lloyd Miller, where she gained expertise in research methods and protocol design and execution. Dr. Krishna is a Fellow of both the American Academy of Dermatology (AAD) and the American Society for Mohs Surgery (ASMS). Dr. Krishna practices in San Diego, California where she treats adults and children for skin conditions. Dr. Krishna was selected as a Top Doctor by her peers in San Diego in 2017. Website - https://www.sheilakrishnamd.com/
More information for the public Consumers Guide: https://consumersguides.com/skin_lightener_reviews Mayo Clinic: https://www.mayoclinic.com/health/age-spots/DS00912
References 1. National Institutes of health: https://nlm.nih.gov/medlineplus/ency/article001141.htm 2. American Academy of Family Physicians: https://www.aafp.org/afp/2009/0115p109.html 3. World Health Organization: https://www.who.int/ipcs/assessment/public_health/mercury/en/index.html 4. Mayo Clinic: https://www.mayoclinic/health/age-spots/DS00912