Sun spots, or "liver spots,” are very common, harmless and flat tan to brown spots on sun-exposed skin of the scalp, face, neck, chest, back, shoulders, arms and back of hands. Known by their scientific name, solar lentigenes, they are caused by UV rays in sunlight. UV exposure causes skin to produce more pigment (melanin) by melanocytes (pigment producing cells). They are most common in older adults, people with extremely fair skin, people who have spent a lot of time in the sun, and those genetically predisposed to getting sun spots. Patients with inherited conditions like xeroderma pigmentosum and a type of albinism can develop sun spots in childhood.
Solar lentigines can last a lifetime, and are indicative of sun damage on one's skin. Treatment is not necessary but can help, and is usually sought for cosmetic reasons. It is important to protect skin from further damage and to be vigilant about any changes and growths, as they can be due to progression to lentigo maligna melanoma, a type of melanoma that develops in severely sun damaged skin.
Cosmetic treatment options include combination of these options:
Sunscreen: The most important treatment for solar lentigines is protection of skin from further damage. The physical sunscreens offer superior protection than chemical sunscreens.
Bleaching agents: There are many cream formulations available or custom compounded by special compounding pharmacies with active ingredients like hydroquinone, kojic acid, azelaic acid, tranexamic acid that can reduce the production of melanin pigment by pigment producing cells in the skin called melanocytes, or by reducing the spread of pigment from melanocytes to the skin cells called keratinocytes, hence bleaching the excessive pigment from skin.
Retinols: Over the counter or prescription grade retinols help shed and replace the damaged skin.
Cryotherapy: light spray of liquid nitrogen can be used for targeted treatment of sun spots. Care must be taken in individuals with darker skin types as this treatment can cause permanent loss of pigment in the treated areas, visible as white spots.
Laser treatment: Certain lasers like Q-switched ruby lasers or intense pulse light lasers can target the pigment melanin in skin and help lighten the sun spots. Other lasers like fractional CO2 lasers can be used to improve appearance of sun spots and textural changes in skin caused by excessive sun damage.
Even with aggressive and successful treatment, sun spots can return with sun and UV exposure. It is best to talk to your dermatologist for treatment plan best suited for your skin type and condition, and to follow up regularly to ensure improvement. Not all treatment plans work for all skin types, but there are options that may work better for you.