Diseases & Conditions

Age spots (liver spots)

Age spots — also called liver spots and solar lentigines — are flat, gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.

True age spots are harmless and don't need treatment, but they can look like cancerous growths. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed. However, preventing age spots — by avoiding the sun and using sunscreen — may be the easiest way to maintain your skin's youthful appearance and to avoid these dark skin spots.

Ultraviolet (UV) light accelerates the production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin — produced to protect the deeper layers of your skin — creates the darker color of a tan. Age spots develop when the extra melanin becomes "clumped" or is produced in higher concentrations than normal.

Most often, it takes years of sun exposure for these dark spots to occur — they typically develop very slowly over time. Using commercial tanning lamps and tanning beds can eventually result in the same changes.

In addition to sun exposure, simply growing older can cause the extra production of melanin and subsequent age spots. Genetics also plays a role in how susceptible you are to the development of age spots.

If you're unhappy with the appearance of age spots, treatments are available to lighten or remove them. Since the pigment is located at the base of the epidermis — the topmost layer of skin — any treatments meant to lighten the age spots will need to penetrate through this layer of skin.

Age spot treatments include:

• Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid may gradually fade the spots over several months. Sun protection is strongly advised if you use medication treatments.
• Laser therapy. Laser therapy destroys the extra melanocytes that create the dark pigment without damaging the skin's surface. Treatments with a laser typically require several sessions. After treatment, age spots fade gradually over several weeks or months. Laser therapy has few side effects, but it can be expensive.
• Freezing (cryotherapy). This procedure involves applying liquid nitrogen or another freezing agent to the age spots to destroy the extra pigment. As the area heals, the skin appears lighter. Freezing is typically used on a single or small grouping of age spots. Though effective, this procedure poses a slight risk of permanent scarring or discoloration.
• Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. This procedure removes the skin surface, and a new layer of skin grows in its place. Redness and temporary scab formation can result from this age spot treatment.
• Chemical peel. Superficial and medium-depth chemical peels can fade age spots. With superficial chemical peels, several treatments are necessary before you notice any results. A chemical peel involves applying an acid, which burns the outer layer of your skin, to the age spots. As your skin peels, new skin forms to take its place. Sun protection is strongly advised following this treatment.

Because age spot treatments are considered cosmetic, your insurance may not pay for it. In addition, any of the procedures can have side effects, so discuss them in advance with your doctor. Make sure your dermatologist is specially trained and experienced in the technique you're considering.

Many fade creams and lotions are available in department stores, in drugstores and on the Internet to lighten age spots and other skin discoloration. These may be good options depending on the darkness of the age spot and how often you apply the cream. Successful treatment needs to penetrate through the base of the epidermis — the topmost layer of skin — where the extra pigment is located. This means regular use over several weeks or months may be necessary before any noticeable results occur.

If you do opt for an over-the-counter (nonprescription) fade cream, choose one that contains hydroquinone, deoxyarbutin, glycolic acid or kojic acid. Note that some products, especially those that contain hydroquinone, may cause skin irritation after prolonged use.