SUN SPOTS

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Skin discolouration

Briefly

Sun spots are actually a discolouration of the skin, occurring as grey, brown or black flat spots. They vary in size and they usually occur on the face, hands and chest, i.e. on sun exposed areas. Contrary to freckles that become darker during the summer and fade in winter, sun spots do not fade without treatment. In most cases they are harmless but they should be examined by a dermatologist if there is a change of their colour or size. If they cause cosmetic concerns they can be treated with the use of lightening agents, Lasers and other effective treatments. Prevention is the best treatment method.

Symptoms

Sun spots seem to “prefer” more fair complexions than darker skin types.

They are flat, oval areas showing increased level of pigmentation. They are usually brown, black or grey.

They appear on areas of the skin that have been extensively exposed to the sun for many years, such as the hands and feet, the face, shoulders and upper part of the body.

Their size varies – from small spots like freckles to larger ones, reaching 1 cm, while many times they occur in groups and they are more profound.

When to see a doctor

You may not like the way they look, but age spots are usually harmless and don’t require medical care. However, your doctor should evaluate spots that are dark or have changed in appearance, because these changes can be signs of melanoma, a serious form of skin cancer.

It’s best to visit your dermatologist, especially if a spot or lesion:

Is darkly pigmented

Is rapidly increasing in size

Has an irregular border

Has an unusual combination of colours

Is accompanied by itching, redness, tenderness or bleeding

Causes

Sun spots are caused primarily by years of exposure to ultraviolet (UV) light from the sun. The use of commercial tanning lamps and tanning beds (solarium) can also contribute to the development of age spots. The pigment in the upper layer of skin (epidermis) that gives your skin its normal colour is called melanin. UV light accelerates the production of melanin, creating a tan that helps protect deeper layers of skin from UV rays.

On areas of the skin that have years of frequent and prolonged sun exposure, age spots appear due to over secretion of melanin. Apart from sun exposure, genetic predisposition may also be an aggravating factor

Risk factors

Although anyone can develop age spots, you may be more likely to develop the condition if you:

Have light-coloured or fair skin

Have a history of frequent or intense sun exposure or sunburn 

Pre-appointment preparation

When you visit your dermatologist you should be prepared to answer the following questions:

  • 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 sun or UV radiation?
  • Do you regularly protect your skin from UV radiation?
  • What kind of sun protection do you use?

Questions you may want to ask your doctor?

  • What suspicious changes in my skin should I look for?
  • If the spots are sun spots, what can I do to improve their appearance?
  • What is the expected result?

Tests and Diagnosis

For the diagnosis of sun spots the following may be necessary:

Visual examination: The doctor may diagnose the age spots through the careful examination of your skin.

Biopsy: If there’s any doubt whether something is an age spot or not, your doctor may do other tests, such as a skin biopsy. 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 anaesthetic.

Other similar conditions

Other conditions that can look similar to age spots and that your doctor may need to rule out include the following:

  • Moles. Although they often appear as small, dark brown spots, moles (nevi) vary in colour and size. They can be raised or flat and can develop almost anywhere on your body.
  • Seborrheic keratoses. These tan, brown or black growths have a wart-like or waxy, pasted-on appearance.
  • Lentigo maligna. A type of skin cancer known as lentigo maligna melanoma can develop in areas of long-term sun exposure. Lentigo maligna starts as tan, brown or black lesions that slowly darken and enlarge. They tend to have an irregular border and uneven colouring, and they may be slightly raised.

Treatments and medication

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 must penetrate this layer of skin.

For the treatment of sun spots the following methods are available:

  • 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. 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 several 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 also necessary after laser or intense pulsed light therapy.
  • 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 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. This procedure consists of sanding down 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. Temporary redness and scab formation can result from this treatment.
  • 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 irritation is likely, and there’s a slight risk of discoloration.

Home treatments

Many fade creams and lotions for lightening sun spots are available in certain stores and pharmacies. 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 lightening product, choose one that contains hydroquinone, glycolic acid or kojic acid. It should also be noted that some products, especially those that contain hydroquinone, may cause skin irritation.

Prevention

To avoid sun spots, you can follow the tips provided below to limit the time of sun exposure:

Avoid the sun between 10 a.m. and 3 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 a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor, and tightly woven clothing that covers your arms and legs. You might also consider wearing clothing designed to provide sun protection.

About the author:

Christofer Tzermias

A top specialist in LASER and Invasive Dermatology in England (Oxford/London) and North America (New York/San Diego) and a leading pioneer in the implementation of sophisticated LASER in Greece, Dr Christofer Tzermias is also the founder of the first and most well-equipped inpatient departments of LASER Dermatology in the Athens Medical Center, Marousi, the St. Lucas Clinic of Panorama of Thessaloniki and the Balkan Clinic in Thessaloniki. He was the Director of Invasive and LASER Dermatology at the Athens Medical Center for 18 years, from 1996 to 2014 and is a writer and editor of numerous papers and publications for international and Greek scientific journals, as well as, international foreign language books. Dr Tzermias regularly participates in international and Greek conferences, as well as, giving speeches and lectures at university clinics in Greece and abroad. He accepts appointments at his state-of-the-art clinics on Vas. Sophia 49 – Athens, and 71 Kifissias Avenue in Marousi.

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