Age spots (liver spots)

Overview

Age spots are small, flat dark areas on the skin. They vary in size and usually appear on areas exposed to the sun, such as the face, hands, shoulders and arms. Age spots are also called sunspots, liver spots and solar lentigines.

Age spots are very common in adults older than 50, but younger people can get them if they spend time in the sun.

Age spots can look like cancerous growths. True age spots don't need treatment, but they are a sign the skin has received a lot of sun exposure and are an attempt by your skin to protect itself from more sun damage. For cosmetic reasons, they can be lightened or removed.

You can help prevent age spots by regularly using sunscreen and avoiding the sun.

Symptoms

Age spots may affect people of all skin types, but they're more common in adults with light skin. Unlike freckles, which are common in children and fade with no sun exposure, age spots don't fade.

Age spots:

• Are flat, oval areas of increased pigmentation
• Are usually tan to dark brown
• Occur on skin that has had the most sun exposure over the years, such as the backs of hands, tops of feet, face, shoulders and upper back
• Range from freckle size to about 1/2 inch (13 millimeters) across
• Can group together, making them more noticeable

When to see a doctor

Age spots don't require medical care. Have your doctor look at spots that are black or have changed in appearance. These changes can be signs of melanoma, a serious form of skin cancer.

It's best to have any new skin changes evaluated by a doctor, especially if a spot:

• Is black
• Is increasing in size
• Has an irregular border
• Has an unusual combination of colors
• Is bleeding

Causes

Age spots are caused by overactive pigment cells. Ultraviolet (UV) light speeds up the production of melanin, a natural pigment that gives skin its color. On skin that has had years of sun exposure, age spots appear when melanin becomes clumped or is produced in high concentrations.

Use of commercial tanning lamps and beds also can cause age spots.

Risk factors

You might be more likely to develop age spots if you:

• Have light skin
• Have a history of frequent or intense sun exposure or sunburn

Prevention

To help avoid age spots and new spots after treatment, follow these tips for limiting your sun exposure:

• Avoid the sun between 10 a.m. and 2 p.m. Because the sun's rays are most intense during this time, try to schedule outdoor activities for other times of the day.
• Use sunscreen. Fifteen to 30 minutes before going outdoors, apply a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring.

• Cover up. For protection from the sun, wear tightly woven clothing that covers your arms and legs and a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor.

  Consider wearing clothing designed to provide sun protection. Look for clothes labeled with an ultraviolet protection factor (UPF) of 40 to 50 to get the best protection.

Diagnosis

Diagnosing age spots might include:

• Visual inspection. Your doctor can usually diagnose age spots by looking at your skin. It's important to distinguish age spots from other skin disorders because the treatments differ and using the wrong procedure may delay other needed therapy.
• Skin biopsy. Your doctor might do other tests, such as removing a small sample of skin for examination in a lab (skin biopsy). This can help distinguish an age spot from other conditions, such as lentigo maligna, a type of skin cancer. A skin biopsy is usually done in a doctor's office, using a local anesthetic.

Treatment

If you want your age spots to be less noticeable, treatments are available to lighten or remove them. Because the pigment is located at the base of the epidermis — the topmost layer of skin — any treatments meant to lighten the age spots must penetrate this layer of skin.

Age spot treatments include:

• Medications. Applying prescription bleaching creams (hydroquinone) alone or with retinoids (tretinoin) and a mild steroid might gradually fade the spots over several months. The treatments might cause temporary itching, redness, burning or dryness.
• Laser and intense pulsed light. Some laser and intense pulsed light therapies destroy melanin-producing cells (melanocytes) without damaging the skin's surface. These approaches typically require two to three sessions. Wounding (ablative) lasers remove the top layer of skin (epidermis).
• Freezing (cryotherapy). This procedure treats the spot by using a cotton-tipped swab to apply liquid nitrogen for five seconds or less. This destroys the extra pigment. As the area heals, the skin appears lighter. Spray freezing may be used on a small grouping of spots. The treatment may temporarily irritate the skin and poses a slight risk of permanent scarring or discoloration.
• Dermabrasion. Dermabrasion sands down the surface layer of skin with a rapidly rotating brush. New skin grows in its place. You may need to undergo the procedure more than once. Possible side effects include temporary redness, scabbing and swelling. It may take several months for pinkness to fade.
• Microdermabrasion. Microdermabrasion is a less aggressive approach than dermabrasion. It leaves mild skin blemishes with a smoother appearance. You'll need a series of procedures over months to get modest, temporary results. You may notice a slight redness or stinging sensation on the treated areas. If you have rosacea or tiny red veins on your face, this technique could make the condition worse.
• Chemical peel. This method involves applying a chemical solution to the skin to remove the top layers. New, smoother skin forms to take its place. Possible side effects include scarring, infection, and lightening or darkening of skin color. Redness lasts up to several weeks. You might need several treatments before you notice any results.

The age spot therapies that remove skin are usually done in a doctor's office and don't require hospitalization. The length of each procedure and the time it takes to see results varies from weeks to months.

After treatment, when outdoors you'll need to use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 and wear protective clothing.

Because age spot treatments are considered cosmetic, they typically aren't covered by insurance. And because the procedures can have side effects, discuss your options carefully with a doctor who specializes in skin conditions (dermatologist). Also, make sure your dermatologist is specially trained and experienced in the technique you're considering.

Self care

Many nonprescription fade creams and lotions for lightening age spots are available for sale. These may improve the appearance of age spots, depending on how dark the spots are and how often you apply the cream. You might need to use such a product regularly for several weeks or months before you notice results.

If you want to try an over-the-counter fade cream, choose one that contains hydroquinone, glycolic acid or kojic acid. Some products, especially those that contain hydroquinone, may cause skin irritation.

You could also apply makeup to help make age spots less noticeable.

Preparing for your appointment

You're likely to start by seeing your primary care doctor, who may then refer you to a dermatologist.

Your doctor is likely to ask you a number of questions, such as:

• When did you first notice the spots on your skin?
• Did the spots appear gradually or quickly?
• Have you noticed any other changes in the appearance of your skin?
• Is the condition itchy, tender or otherwise bothersome?
• Have you experienced frequent or severe sunburns?
• How often are you exposed to the sun or UV radiation?
• Do you regularly protect your skin from UV radiation?
• What kind of sun protection do you use?
• Do you have a family history of age spots or skin cancer?
• What medications do you take?

Questions you may want to ask your doctor include:

• What suspicious changes in my skin should I look for?
• If the spots are age spots, what can I do to improve the appearance of my skin?
• Do treatments make them go away completely, or do they just lighten the age spots?
• Could these spots turn into skin cancer?