Age spots – which appear on the face, hands, arms, chest, and shoulders – can be diminished with the use of topical creams, as well as procedures including cryotherapy, lasers, and chemical peels.
While age spots can be unsightly for people who have them, the good news is that age spots are benign – meaning non-cancerous.
They can also be prevented to begin with, by implementing sun safety habits such as wearing sunscreen, avoiding tanning beds, and wearing sun-protective clothing.
This article takes a comprehensive look at age spots, including what they are, who gets them, the primary causes, how to determine whether an age spot is benign or cancerous, and ways to prevent them.
Keep in mind that this article is not intended as medical advice. If you’re concerned that your age spot might be a serious risk to your health, talk to your medical provider or a Board Certified Dermatologist to get a professional diagnosis.
Age spots, often referred to as liver spots and sun spots, are small dark marks that are usually tan or brown and darker than the surrounding skin, explained Dr. Paul Yamauchi, Ph.D, who’s in private practice at the Dermatology Institute and Skin Care Center in Santa Monica, California.
The medical term for age spots is “solar lentigines,” and they usually appear on areas of the skin that have gotten a lot of sun exposure such as the face, hands, arms, chest, shoulders, and the lower legs, Dr. Yamauchi noted.
While their size varies, on average, they are about 5mm, but can also be as big as the size of a nickel or a quarter, “or larger.”
Others include seborrheic keratoses, which can present with a range of colors and textures – light brown to dark almost black, smooth and waxy, to rough and raised, said Dr. Jeremy A. Brauer, Clinical Associate Professor at the Ronald O. Perelman Department of Dermatology at New York University.
They usually appear on areas of the body that have received the most sun exposure, agreed Dr. Marguerite Germain, a dermatologist in Mt. Pleasant, South Carolina and member of the Women’s Dermatologic Society.
Age spots are harmless darkened regions of skin, which correlate to increased pigmentation, added Dr. Katrina Riboni, an anesthesiologist who is associated with numerous hospitals; and a specialist who offers beautification treatments, including treatments for age spots, at Shonan Beauty in Southern California.
They are often found on adults over 40, “but can occur earlier in life depending on the amount of sun exposure – the more sun exposure, the more age spots,” said Dr. Germain, adding that age spots are also more common in people with light skin, “but can affect all skin types.”
Age spots usually start to occur as we get older, Dr. Yamauchi added. “If you’ve had a lot of sun exposure, they can appear in your 20s, but usually appear after the age of 40.”
When people use the phrase “age spots” or “liver spots,” they are generally referring to brown spots that are acquired, or first noticed, later in life – in other words, you weren't born with them, Dr. Brauer added.
“However, if younger individuals have had significant sun or UV exposure – think tanning bed – they can develop these spots as well.”
Age spots occur due to sun exposure or other forms of UV rays such as tanning beds, according to Dr. Riboni.
Sun exposure is the most common cause of age spots, regardless if you have light or dark skin, said Dr. Yamauchi.
That’s because the ultraviolet rays cause more production of melanin, which is the pigment that causes the skin to get darker. “That is why they are more common on the face, hands, arms, chest and neck, and shins.”
Dr. Germain agreed that years of prolonged sun exposure can lead to high concentrations of melanin in certain areas, allowing age spots to develop.
“Therefore the more sun, the more melanin in your skin, the greater the likelihood of developing these spots,” Dr. Brauer added.
The sign of an age spot is a brown or tan toned spot on the skin that is the same texture as the surrounding skin and otherwise asymptomatic – meaning no pain or itchiness, said Dr. Deanne Mraz Robinson, Assistant Clinical Professor of Dermatology at Yale New Haven Hospital and Co-Founder of Modern Dermatology of Connecticut and Pure BioDerm.
Age spots appear as flat, oval-shaped dark spots that can range from the size of a small dot to about half an inch in diameter, noted Dr. Germain, adding that they are often found grouped together on areas that have received large amounts of sun exposure.
Age spots are benign, said Dr. Yamauchi, adding that a Board-Certified Dermatologist can visually make the determination. “However, if the diagnosis is uncertain or if a skin cancer is suspected, then a skin biopsy is performed.”
See a Board-Certified Dermatologist for a skin exam, “as precancerous and cancerous spots can look very similar to age spots,” Dr. Germain advised.
“If the spots have increased in size over a short amount of time, are very dark, have an irregular border or are itching or bleeding, they could be something more serious and it is important to have them examined by your dermatologist.”
A Board-Certified Dermatologist can confirm the difference by examining the lesion with a dermatoscope, which uses light and magnification to give see the deeper skin structures, Dr. Robinson further explained.
“If your doctor suspects something else, they may do a skin biopsy, to confirm an age spot from other conditions, such as lentigo maligna, a type of skin cancer.”
Freckles are hereditary, while age spots are lifestyle-induced, according to Dr. Robinson. “Furthermore freckles are not from sun damage, while sun spots are the result of sun damage.”
Freckles and age spots can look similar, however, they differ based on the timing of their appearance, Dr. Riboni noted. “Freckles typically appear earlier in life such as pre-teens, while age spots occur later in life.”
Freckles can occur in childhood and may fade with age, and are more prominent in the summer, but get lighter in the winter due to lower sun exposure, said Dr. Yamauchi, adding that freckles can be hereditary and are more common in people with red hair.
Age spots, however, “occur during adulthood, do not fade, persist for life unless treated, and are caused by sun exposure.”
Freckles are usually smaller than sun spots and can be seen in children, Dr. Germain added. “The main differences are the age at which they appear, their location on the body, and their size.”
Interestingly, freckles may actually fade with age, Dr. Brauer said. “Additionally, whereas age spots are often found in areas of the body with significant sun exposures, freckles can occur anywhere on the body, independent of exposure.”
Several options are available to diminish the look of age spots, including topical creams, cryotherapy, lasers, chemical peels and microneedling.
For in-office treatments, “your dermatologist can advise you the cost and how many sessions will be needed,” Dr. Yamauchi said.
As a complement to topical therapies, or as an alternative and more aggressive route – such as in-office laser treatments, ranging from chemical peels to laser and light-based devices – “I tend to treat with a customized blend of therapies for my patients with age spots,” Dr. Robinson said.
With all of these treatments, “avoiding sun exposure following treatment is critical in determining your skin’s results.”
Topical creams that contain a retinoid and hydroquinone are commonly used to treat age spots, said Dr. Yamauchi; and Dr. Robinson said topical therapies can be used as “the first line of attack.”
“A retinol can help to shed the skin cells, while a hydroquinone product will lighten the skin,” Dr. Robinson explained. “I’d encourage patients to skip the drugstore brands and seek out a prescription-strength skin-lightening cream from their dermatologist.”
Hydroquinone is a brightening cream that works by reducing skin pigment, explained Dr. Riboni, who noted that combining hydroquinone with topical retinoids and corticosteroids “can lead to even greater improvement.”
Hydroquinone is typically used at least daily, which leads to gradual improvement over weeks to months.
Kojic acid is another topical medication that can help improve age spots by lightening the skin, Dr. Riboni added, and can be used in addition to or as an alternative to hydroquinone. “Kojic acid is generally thought to be a gentler alternative to hydroquinone.”
The use of prescription hydroquinone and retinoids, or a non-hydroquinone lightening agent and retinol/retinoid, are great options, said Dr. Brauer, who recommends the following products: SkinBetter's AlphaRet® and Melatonik™ as well as SkinMedica's Lytera® 2.0.
According to Dr. Yamauchi, procedures that can help lighten age spots include cryotherapy with liquid nitrogen, the same method used to treat warts and precancerous lesions.
Dr. Robinson further explained that cryotherapy involves the application of liquid nitrogen to the age spots to destroy the extra pigment, and as the area heals, “the skin appears lighter.”
However, Dr. Germain warned that while cryotherapy is a common treatment for age spots, “many times this treatment can lead to pigmentation alteration and permanent scarring.”
While creams can be used to lighten the skin, “they are often not effective long-term solutions,” Dr. Germain said. Therefore, “I think lasers and chemical peels are much more effective treatments for age spots with fewer side effects.”
Dr. Yamauchi and Dr. Robinson agreed that methods like lasers, such as Fraxel® and intense pulsed light, can be effective.
“The laser’s energy penetrates the skin and targets pigment, destroying melanin-producing cells without causing any damage to the skin's surface,” Dr. Robinson explained, adding that typically, there are multiple sessions required.
According to Dr. Brauer, the best treatments, meaning the safest and often with fastest results, are those performed in your doctor's office: specifically, either laser treatment with a nanosecond or picosecond device –such as Candela™ PicoWay, Hologic® PicoSure®, or Cutera® Enlighten®.
Other procedures include chemical peels, which involve applying an acid to the skin, which removes the outer layer of your skin. “As your skin peels, new skin forms to take its place,” Dr. Robinson explained, noting that several treatments are often required.
Microneedling is another method used, according to Dr. Yamauchi and Dr. Robinson.
Microneedling, which utilizes controlled injuries to the first and second layers of the skin to cause the production of more collagen in the second layer, “creates trauma prompting a healing response in the skin to shed the overly pigmented cells,” Dr. Robinson said.
Minimizing exposure to UV rays, and using broad-spectrum SPF of at least 30 days, are the primary ways to reduce the risk for developing age spots, Dr. Robinson advised.
Good sun safety habits are the best way to prevent the development of age spots, said Dr. Germain, who advises the following:
- Wear sunscreen
- Reapply sunscreen
- Wear a hat with a three-inch brim
- Wear sun-protective clothing
- Seek shade whenever possible
- Avoid peak hours of sun exposure
“Have fun in the sun, but be sun-smart,” Dr. Germain added.
Preventing age spots from forming in the first place is a great preventative step. Dr. Brauer recommended the following broad-spectrum sunscreens that can help prevent age spots: ISDIN, EltaMD®, and La Roche Posay Anthelios.
Additionally, “appropriate sun protection with hats…and clothing should be practiced to minimize darkening of existing, and prevention of new, spots,” Dr. Brauer added.
Age spots are usually a clear indication of excessive sun exposure, which also increases the risk of skin cancer, Dr. Germain warned. “Always be sure to see a board-certified dermatologist at least once a year for a full-body skin check.”
Remember: “prevention is key,” Dr. Robinson emphasized. “Wear your SPF every day.”
If you’re seeking treatments for age spots, lasers and intense pulsed light therapy “are great treatment options” by directly targeting and destroying the brown color in age spots, Dr. Riboni added.
“Cryotherapy, microdermabrasion, and chemical peels are other potential treatment options,” Dr. Riboni said. “It is recommended to discuss your concern regarding age spots with a specialist in order to select the appropriate regimen while considering the risks and limitations of each treatment.”
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