Age spots (liver spots)
Age spots — also called liver spots and solar lentigines — are small dark areas on your skin. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun.
Age spots are very common in adults older than 50. But younger people can get them too, especially if they spend a lot of time in the sun.
Age spots can look like cancerous growths. But true age spots are harmless and don't need treatment. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed.
You can help prevent age spots by regularly using sunscreen and avoiding the sun.
Age spots may affect people of all skin types, but they're more common in people with light skin. Age spots:
- Are flat, oval areas of increased pigmentation
- Are usually tan, brown or black
- 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
Age spots range from freckle size to about a 1/2 inch (13 millimeters) across and can group together, making them more noticeable.
When to see a doctor
Age spots are usually harmless and don't require medical care. Have your doctor look at spots that are dark 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 darkly pigmented
- Is rapidly increasing in size
- Has an irregular border
- Has an unusual combination of colors
- Is accompanied by itching, redness, tenderness or bleeding
Age spots are caused by overactive pigment cells. Ultraviolet (UV) light accelerates the production of melanin. On the areas of skin that have had years of frequent and prolonged sun exposure, age spots appear when melanin becomes "clumped" or is produced in high concentrations.
The use of commercial tanning lamps and tanning beds can also contribute to the development of age spots.
Anyone can develop age spots, but you may be more likely to develop the condition if you:
- Have red hair and light skin
- Have a history of frequent or intense sun exposure or sunburn
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 that provides protection from both UVA and UVB light. Use a 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.
Diagnosing age spots may include:
- Visual inspection. Your doctor can usually diagnose age spots by looking at your skin.
Skin biopsy. Your doctor may do other tests, such as a skin biopsy, to help distinguish an age spot from other conditions, such as lentigo maligna, a type of skin cancer.
During a skin biopsy, your doctor takes a small sample of your skin (biopsy) for microscopic analysis. A skin biopsy is usually done in a doctor's office, using a local anesthetic.
If you want your age spots to be less noticeable, 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 must penetrate 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. Use of a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 is strongly advised if you use medication treatments. The treatments may result in temporary itching, redness, burning or dryness.
Laser and intense pulsed light therapy. Laser and intense pulsed light therapies destroy melanin-producing cells (melanocytes) without damaging the skin's surface. Treatments with a laser or intense pulsed light typically require two to three sessions.
After treatment, age spots fade gradually over several weeks or months. Laser therapy has few side effects, but it may result in slight discoloration of the skin. Sun protection is necessary after laser or intense pulsed light therapy.
- Freezing (cryotherapy). This procedure involves using a cotton-tipped swab to apply 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 age spot or a small grouping of age spots. The treatment may temporarily irritate the skin and poses a slight risk of permanent scarring or discoloration.
Dermabrasion and microdermabrasion. Dermabrasion 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. You may need to undergo the procedure more than once. Temporary redness and scab formation can result from this treatment.
Microdermabrasion is a less aggressive approach that leaves mild skin blemishes with a smoother appearance. You'll need a series of procedures over months to get the full effect. If you have rosacea or tiny red veins on your face, this technique could make the condition worse.
- Chemical peel. 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. Several treatments may be necessary before you notice any results. Sun protection is strongly advised following this treatment. Temporary redness is likely, and there's a slight risk of permanent changes in skin color.
Because age spot treatments are considered cosmetic, your insurance may not pay for them. 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.
Lifestyle and home remedies
Many fade creams and lotions for lightening age spots are available in department stores, in drugstores and on the internet. These may improve the appearance of age spots, depending on how dark the spots are and how often you apply the cream. Regular use over several weeks or months may be necessary to produce noticeable results.
If you opt for an over-the-counter (nonprescription) fade cream, choose one that contains hydroquinone, glycolic acid or kojic acid. Note that 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 an appointment
You're likely to start by seeing your primary care doctor. He or she may 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?
Questions for your doctor
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?