Age Spots

Age spots are harmless, hyperpigmented spots that develop due to excessive sun exposure. They are also known as liver spots, sunspots, and solar lentigines (lentigo for one spot). Age spots typically appear later in life, commonly after the age of 50. They can develop in any area exposed to sunlight for a long time, but the most common areas to develop age spots are the face and the hands.

Age spots are flat, uniformly colored, hyperpigmented spots with defined edges. They can vary in size, shape, and color. Age spots appear in different shades of brown, gray, tan, or black. The size of an age spot ranges from that of a small freckle to half an inch across. Sometimes age spots can group together, making them more noticeable. In addition to the face and back of the hands, age spots frequently appear on the neck, shoulders, upper back, and top of the feet.
Be careful at self-diagnosis, though. Age spots can be mistaken for other skin conditions. For example, if the hyperpigmented patches on your skin are slightly raised to the touch, they are most probably seborrheic keratosis, not age spots. Seborrheic keratosis is another harmless skin condition that looks very similar to age spots. A dermatologist can examine the age spots and clinically diagnose them.

Overproduction of the natural skin pigment, melanin, causes age spots. High melanin production can be due to long-term exposure to sunlight. Moreover, exposure to ultraviolet (UV) rays through tanning beds can lead to the development of premature age spots. When you get exposed to sunlight or UV rays, your skin cells start producing extra skin pigment. These pigment molecules accumulate inside the skin cell and try to protect the nucleus from the harmful rays (Figure 1). The nucleus is the place where DNA is kept. By protecting the nucleus, melanin reduces the possible DNA damage caused by harmful sun rays, as DNA damage can ultimately lead to the development of skin cancer. In some ways, age spots are a sign that your skin is trying to protect itself from further damage caused by harmful UV rays.

You can take several steps to prevent age spots from developing:

• Wear sun-protective clothing, hats, and sunglasses when you are outside in the sun.
• Try to stay out of the sun as much as possible, especially when it is strongest, between 10:00 AM and 3:00 PM.
• Wear sunscreen with sun protection factor (SPF) 30 or higher every day. Try to find a broad-spectrum sunscreen, which means it protects your skin from both UVA and UVB rays.
• Avoid tanning beds.

Age spots are harmless, and you can leave them without any treatment. But if they bother you for cosmetic reasons, there are multiple treatment options available. It is advised to consult a dermatologist before starting any treatment for age spots.

Topical cream and lotions: Over-the-counter skin lightening lotions and creams can be used to lighten age spots. Most of these products contain hydroquinone or retinol, or a combination of both. Your dermatologist can also prescribe hydroquinone and retinol creams, which are more effective than over-the-counter formulations. However, be aware that long-term use of hydroquinone-containing creams can sometime cause permanent skin lesions called exogenous ochronosis (bluish black discoloration) in some individuals (1). Therefore, consult your doctor before starting an over-the-counter skin lightening product. Always check the ingredients listed in over-the-counter lotions and avoid products with mercury.

Skin resurfacing: Dermatologists use this procedure to remove the upper layer of the skin. Resurfacing can be done using different techniques: laser resurfacing is one method which uses a laser beam, and chemical peel is another method where chemicals are used. When the upper layer of the skin peels off following skin resurfacing, you will notice fading of the age spots.

Dermabrasion & microdermabrasion: These are non-invasive procedures to remove the top layer of your skin in a small area. These techniques are used by a trained dermatologist to sand off and smooth away the age spot. For dermabrasion, a rapidly spinning brush is used to sand down the surface of the skin. For microdermabrasion, a sterile diamond tip head is used to remove the age spot. Microdermabrasion is easier on your skin compared to dermabrasion. Depending on the color of the age spot, the time it takes for the spot to fade will vary. For some age spots you may have to perform these procedures multiple times before the age spot completely fades away.

Cryotherapy: A dermatologist can freeze age spots using a small amount of liquid nitrogen. When your skin heals, the age spot will fade. This method usually works best with a single age spot or a small cluster of spots. Caution is advised, however. This treatment can be painful and may cause irritation, swelling, blisters, or redness in some individuals. There is also a chance that cryotherapy can cause scars or darker patches. Always consult an experienced doctor to make sure this is the best treatment option for your age spots.

Age spots are harmless and can develop with long-term exposure to the sun or UV rays. But with proper preventive measures you can minimize the development of age spots. If you are not sure whether your skin condition is age spots or something else, do not hesitate to contact an experienced dermatologist. The team at Saguaro Dermatology has successfully treated individuals with different skin conditions. Our board-certified dermatologists and our caring and experienced staff are always ready to help you at Saguaro Dermatology, conveniently located at two campuses, Phoenix and Mesa, AZ.

Suggested Resources
Seborrheic keratosis: https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-overview
Skin cancer: https://saguaroderm.com/services/medical-dermatology/skin-cancer-screenings/
Hydroquinone: https://www.webmd.com/drugs/2/drug-1347/hydroquinone-topical/details
Retinol: https://www.healthline.com/health/beauty-skin-care/best-retinol-cream
Laser resurfacing: https://www.asds.net/skin-experts/skin-treatments/laser-resurfacing
Chemical peel: https://saguaroderm.com/services/cosmetic-dermatology/
Dermabrasion: https://my.clevelandclinic.org/health/treatments/8309-dermabrasion
Microdermabrasion: https://saguaroderm.com/services/cosmetic-dermatology/
UVA and UVB rays: https://uihc.org/health-topics/what-difference-between-uva-and-uvb-rays

Articles Cited
1. Qorbani A, Mubasher A, Sarantopoulos GP, Nelson S, Fung MA. Exogenous Ochronosis (EO): Skin lightening cream causing rare caviar-like lesion with banana-like pigments; review of literature and histological comparison with endogenous counterpart. Autops Case Rep. 2020;10(4): e2020197.