Age Spots

Sunspots, or “liver spots,” are very common, harmless, flat tan/brown spots on sun-exposed skin on the scalp, face, neck, chest, back, shoulders, arms and back of hands. Known by their scientific name, solar lentigines, these spots are caused by UV rays in sunlight. UV exposure causes skin to produce more pigment (melanin) by melanocytes (pigment producing cells). Sunspots are most common in older adults, people with extremely fair skin, people who have spent a lot of time in the sun, and those genetically predisposed to getting sunspots. Patients with inherited conditions like xeroderma pigmentosum and a type of albinism can develop sunspots in childhood.

Solar lentigines can last a lifetime and are indicative of sun damage on one’s skin. Treatment is not medically necessary but can help with cosmetic appearance if desired. It is important to protect skin from further damage and to be vigilant about any changes and growths as changes can be indicative of progression from a sunspot to a lentigo malignant melanoma, a type of melanoma that develops in severely sun damaged skin. 

Cosmetic treatment options include combination of the following options:

• Sunscreen: The most important treatment for solar lentigines is protection of skin from further damage. Physical sunscreens offer superior protection than chemical sunscreens.
• Bleaching agents: There are many cream formulations available or custom compounded by special compounding pharmacies with active ingredients like hydroquinone, kojic acid, azelaic acid, and tranexamic acid. These bleaching creams work by reducing the production of melanin by melanocytes or by reducing the spread of pigment from melanocytes to the skin cells called keratinocytes.
• Retinols: Over the counter or prescription grade retinols can help shed and replace the sun-damaged skin.
• Cryotherapy: A light spray of liquid nitrogen can be used for targeted treatment of sunspots. Care must be taken in individuals with darker skin types as this treatment can cause permanent loss of pigment in the treated areas.
• Laser treatment: Lasers such as Q-switched ruby lasers or intense pulse light (IPL) lasers can target the melanin in skin and help lighten the sunspots. Other lasers like fractional CO2 lasers can be used to improve appearance of sunspots and textural changes in skin caused by excessive sun damage.

Even with aggressive and successful treatment, sunspots can return with sun and UV exposure. It is best to talk to your dermatologist for treatment plan best suited for your skin type and condition and to follow up regularly to ensure improvement.