How to get rid of age spots, sun spots, liver spots

Question:  I have a dark brown oval-shaped spot on my forehead and a cluster of them on my upper chest. I’ve heard them called age spots, sun spots and liver spots. What are they and how can I get rid of them?

Answer: These spots are medically called solar lentigines because they resemble the shape and color of a lentil bean and are flat (not elevated or depressed).  It’s a discolored oval spot. Usually, they are caused by sun exposure and the incidence is age-related (hence the term “age spots”) because the older you get, the more you’ve been exposed to the sun, the more likely they are to become visible. They closely resemble freckles, but are usually larger and darker than freckles (remember the lentil?) Freckles are usually genetically determined whereas, unfortunately, solar lentigines are often a mark of photo (sun)-damage.

It’s important to remember that this type of hyper-pigmentation can be a mark of malignant melanoma or other type of skin cancer such as a basal cell carcinoma or a squamous cell carcinoma and they may be accompanied by other chronic  degenerative changes in the skin caused by sun damage.  Early lesions of lentigo maligna (melanoma in situ) may be light to medium brown and mimic solar lentigines.  Lentigo maligna, benign solar lentigo and pigmented actinic keratosis all occur on sun-damaged skin and multiple lesions of different types in the same area are common.Always see a dermatologic practitioner when a brown spot appears or changes, as a biopsy may be appropriate (remember the ABC’s of spots?)

That said, we have many means of removing them and normalizing the discoloration, depending on where they are located and how many you have there:

Cryotherapy:  Melanocytes (pigmented skin cells that cause the darkened spot) are very sensitive to cold temperatures and can actually be destroyed at -4°C to -7°C, therefore we effectively use liquid nitrogen cryotherapy  applied to a singular spot for 5-10 seconds. The brown spot will turn white and crusty and new skin will emerge underneath in about a month. For one simple spot that is not on your face, cryotherapy is a great and inexpensive option.

Chemical peels: Medium depth chemical peels such as Trichloroacetic acid (TCA), for example, have been studied and had a fair response, but we use them cautiously because of irritation and redness. A chemical peel can be a good choice for a larger area  or cluster of spots such as on the upper chest, but may need to be repeated to achieve desired results because you are only removing the outer-most layers of the skin each time.

Laser therapy: Of all the lasers available, some are more pigment-specific and attract the discoloration and act on it better than others. I have found Argon, Q-switched ruby and Er:Yag lasers are all effective on solar lentigines. We also use Intense pulsed light idepending on skin type, location and other variables.  I also love  fractionated laser technology for solar lentigines such as the Fraxel DUAL 1550/1927 or the Deka DOT Laser.  I usually use fractionated lasers to treat the whole face, arms, legs or chest because it works so well for larger clusters of spots, although it is the most expensive option. Complications such as post-inflammatory pigment  alterations (discoloration) can occur afterwards, so sun protection after laser is a must.

Topical treatments:  The use of topical prescription retinoid preparations definitely takes longer, but they are an effective and certainly less expensive alternative to laser therapies for both a large cluster of spots or one spot, no matter where it is located. In studies comparing 0.1% tretinoin versus placebo, after the initial 10 months of treatment, there was an 83% improvement versus 29% in the placebo group and the upper extremities responded as did the face. After an additional 6 months of treatment, the lesions that had resolved during initial treatment did not recur during the 6 month follow-up period and patients continued to Improve. The major side effect: redness and irritation. Bleaching creams containing 4-5% hydroquinone used over a period of several months will lighten solar lentigines but possibly only temporarily. We have found that a combination of the tretinoin and 4% hydroquinone plus a corticosteroid may be even more effective for your specific spots than the individual components alone, although tretinoin alone does work beautifully on Asian skin.

No matter what your age, if you never want to see solar lentigines pop up on your skin, always use sunscreen labelled “broad spectrum”  that blocks both UVA and UVB rays.

Have you successfully gotten rid of age-spots and solar lentigines? Share what worked best for you!