Brown Spots Defined
Solar lentigo (plural lentigines) is the medical term for brown spots, sometimes called liver spots, or age spots. They occur most often on skin which has had the greatest exposure to sun: the face, neck, hands, arms, shoulders and upper back. Age spots are usually flat, and colored brown, black, or gray. They are common after age 40, but can occur in younger people. Some may have an appearance similar to a more serious medical condition. Brown spots are harmless, but the spots may raise concerns about cancer, thanks to public education. People have been conditioned to examine their skin, and to report the appearance of new lesions, aware of the potential for new growths to be pre-cancerous or frank cancer. Lesions which appear spontaneously, change shape, or grow rapidly should be checked by a doctor for irregular borders and varied pigments within the same lesion.
Causes of Brown Spots
Brown spots are caused primarily by years of exposure to ultraviolet (UV) light from the sun. Commercial tanning lamps and tanning beds also damage the skin. Melanin is the pigment in the upper layer of skin (epidermis), which gives skin its normal color. UV light speeds up the production of melanin, causing a tan, which protects the deeper layers of skin from UV light. Brown spots on the Skin are formed when the melanin “clumps” or is, in some areas, in particularly high concentration. Just getting older can also speed up production of melanin, even without sun exposure. There may be some genetic influence, with some people more susceptible than others to forming spots. Fair-skinned people are more prone to forming age spots than are people with naturally darker skin. There is also increased risk with a history of exceptionally intense and frequent sun exposure.
Signs and Symptoms of Brown Spots
Solar lentigines may resemble moles (nevi), which are raised or flat, and are not limited to sun-exposed parts of the body. Seborrheic keratoses, which are nonmalignant, are small, tan, brown or black, with a “pasted on” appearance. There’s a broad range of normal size, from 1 millimeter to more than 2.5 centimeters. Lentigo maligna is a type of skin cancer, a melanoma, which can develop in areas of long-term sun exposure. It starts as tan to brown to black, that darkens and enlarges. They have irregular borders and are multipigmented within the same lesion. Pigmented actinic keratoses are premalignant.
Solar lentigines are:
- Macular – a flat, demarcated area of increased skin pigmentation which is neither raised nor depressed.
- Usually brown, black, or gray.
- Found on skin that has had the most sun exposure over years, usually on the backs of hands, tops of feet, face, shoulders and upper back.
- Variable in size, from 1 millimeter to 3 centimeters across.
- Prone to group together, making them appear more prominent.
- Sometimes similar in appearance to malignant or nonmalignant lesions.
- More likely to occur in white or Asian people, especially in persons with a tendency to freckle.
Melasma and ephelides are two types of nonmalignant, macular, hyperpigmented lesions which can be mistaken for age spots. Melasma is a progressive, nonscaling, hyperpigmentation of sun-exposed skin, especially on the face and forearms. The formation of melasma is often associated with pregnancy, oral contraceptives and some anticonvulsants. It may appear spontaneously with no identifiable cause or association to known co-existing factors. It occurs in women nine times for frequently than in men, and more often in skin types common to Asia, the Middle East and South America. It is of no consequence to health, but may be distressing cosmetically. The face is the most common site of melasma, usually in the center of the face; less often it occurs around the mouth and jaw. The patches are usually bilateral. There are three types of melasma: epidermal, dermal, and mixed.
Epidermal melasma is usually light brown, and enhances under Wood lamp examination. Dermal melasma is grayish and does not enhance with Wood lamp examination. Mixed lesions are dark brown with variable response to Wood lamp. Ephelides is the medical name for freckles, usually 1-2 millimeters, sharply defined, on the face, neck, chest and arms.
It is recommended that new skin lesions should be seen by a physician, especially with:
- dark pigmentation
- rapid growth
- irregular borders
- multiple colors within the same lesion
- tenderness or bleeding
- itchy, reddened skin
- poor healing
Usually a patient is seen by a family doctor first, who may refer to a cosmetic dermatologist. Any lesion which is atypical or suggestive of melanoma should be biopsied, through all layers of the skin. A biopsy may be an excisional biopsy, which removes the entire lesion, or by punch biopsy for large lesions or those in cosmetically sensitive areas, such as on the face. Seborrheic dermatoses and pigmented actinic keratoses can be distinguished by visualization alone. If there is uncertainty about a diagnosis, biopsy should be performed.
Some systemic disorders show first as multiple lentigines: Peutz-Jeghers syndrome, LEOPARD syndrome, and Lamb syndrome.
Brown Spots Prevention
- Direct sunlight should be avoided between 10 am and 4 pm, when the sun’s rays are most intense. Outdoor activities should be scheduled either before 10 am or after 4 pm.
- Sunscreen which protects from both UVA and UBV rays, with a sun-protection factor of at least 15, should be applied 15-30 minutes before sun exposure. It should be reapplied every 2 hours, or more often when swimming or perspiring. It should contain one or more of these ingredients: avobenzone, cinoxate, ecamsule, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, oxybenzone, sulisobenzone, titanium dioxide, and/or zinc oxide.
- Cover up. Use a broad-brimmed hat which provides more protection than a baseball cap or visor. Wear tightly woven clothing, covering the arms and legs. Clothing designed to provide sun protection is useful. An ultraviolet protection factor (UPF) of 40-50, in the clothing, is the best protection. The fabric can lose the protection, however, by stretching getting wet, or with repeated washing.
Brown Spots Treatments
Although age spots are no threat to health, they can be of cosmetic concern. There are treatments available to lighten or remove them. Pigmentation is in the deepest part of the epidermis, the top layer of skin, therefore any treatments to lighten the spots must penetrate to the deepest part of the epidermis. The treatments are considered cosmetic, so usually insurance will not apply. Care should be taken to select a physician trained and experienced in the various treatments under consideration.
- DermaSweep Michigan exfoliates the skin by using a wand tip that provides vacuum action to gently remove the skin’s uppermost layer. The vacuum action also cleans pores, increases blood flow to the area and eliminates unhealthy skin debris using a HEPA filter. In addition to reducing the appearance of unsightly age spots, The DermaSweep Microdermabrasion system stimulates collagen production, and promotes firming of the epidermis.
- Intense Pulsed Light (IPL) phototherapy targets age spots with an intense light beam that damages melanocytes responsible for brown spots. The skin immediately begins to repair itself. New cells are formed that do not contain heavy amounts of melanin. The skin is left looking smoother, refreshed and toned.
- Cryotherapy (freezing). Liquid nitrogen or another freezing agent is used to destroy excessive pigment. It may be used on a single age spot, or small groupings of spots. It can irritate the skin and there is a slight risk of permanent scarring or discoloration.
- Glycolic acid peels, made from sugar cane, involve applying glycolic acid to the skin, burning the outer layers. As the skin peels, new skin forms. Usually several treatments are needed to see results. Sun protection is strongly advised after treatment with the peels. There is temporary irritation and there is a slight risk of discoloration.
- Hydroquinone, a prescription bleaching agent, with or without a retinoid (tretinoin), and a mild steroid, will fade the spots gradually, over several months. Use of a sunscreen with SPF 30 or greater is strongly advised with this treatment.
More information for the public on Brown Spots
Consumers Guide: http://consumersguides.com/skin_lightener_reviews
Mayo Clinic: http://www.mayoclinic.com/health/age-spots/DS00912
References for this Guide
1. National Institutes of health: http://nlm.nih.gov/medlineplus/ency/article001141.htm
2. American Academy of Family Physicians: http://www.aafp.org/afp/2009/0115p109.html
3. World Health Organization: http://www.who.int/ipcs/assessment/public_health/mercury/en/index.html
4. Mayo Clinic: http://www.mayoclinic/health/age-spots/DS00912