Age spots, liver spots, or brown spots usually first appear on the face and are the result of genetic susceptibility as well as sun exposure. Contrary to common belief, they have nothing to do with age or the liver although patients may get more as they get older. In addition to the face, these spots often can occur on the chest, arms and any sun-exposed areas.
Brown spots or age spots1 do not respond to creams. However, they can safely and effectively be removed by a variety of laser treatments. The most effective treatment for brown spots on the face is the use of Q-switched lasers such as the Q-switched Alexandrite laser or the Q switched Nd-YAG laser. Often, one treatment is enough to eradicate brown spots safely and effectively anywhere on the body. Rarely a second touch up treatment will be necessary. Freckles on the face, chest, and back can also be effectively treated with the Q-switched Alexandrite of Nd:YAG lasers.
Intense pulsed light sources (IPL)2 or photofacials can also be used in the treatment of brown spots3 or age spots. However, treatment with this modality often requires at least three to five sessions. This modality is not as effective as lasers.
Fractional Resurfacing with the Fraxel laser is also an effective treatment for brown spots for those individuals who additionally seek improvement in fine and moderate wrinkles, texture, pores, acne scars, and other skin imperfections.
Research shows that there are, in fact, two distinct types of aging. Aging caused by the genes we inherit is called intrinsic (internal) aging. The other type of aging is known as extrinsic (external) aging and is caused by environmental factors, such as exposure to the sun’s rays.
Intrinsic aging, also known as the natural aging process, is a continuous process that normally begins in our mid-20s. Within the skin, collagen production slows, and elastin, the substance that enables the skin to snap back into place, has a bit less spring. Dead skin cells do not shed as quickly and turnover of new skin cells may decrease slightly. While these changes usually begin in our 20s, the signs of intrinsic aging are typically not visible for decades. The signs of intrinsic aging are:
Genes control how quickly the normal aging process unfolds. Some notice those first gray hairs in their 20s; others do not see graying until their 40s. People with Werner’s syndrome, a rare inherited condition that rapidly accelerates the normal aging process, usually appear elderly in their 30s. Their hair can gray and thin considerably in their teens. Cataracts may appear in their 20s. The average life expectancy for people with Werner’s syndrome is 46 years of age.
A number of extrinsic, or external, factors often act together with the normal aging process to prematurely age our skin. Most premature aging is caused by sun exposure. Other external factors that prematurely age our skin are repetitive facial expressions, gravity, sleeping positions, and smoking.
The sun. Without protection from the sun’s rays, just a few minutes of exposure each day over the years can cause noticeable changes to the skin. Freckles, age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, a blotchy complexion, actinic keratoses (thick wart-like, rough, reddish patches of skin), and skin cancer can all be traced to sun exposure.
“Photoaging” is the term dermatologists use to describe this type of aging caused by exposure to the sun’s rays. The amount of photoaging that develops depends on 1) a person’s skin color and 2) their history of long-term or intense sun exposure. People with fair skin who have a history of sun exposure develop more signs of photoaging than those with dark skin. In the darkest skin, the signs of photoaging are usually limited to fine wrinkles and a mottled complexion.
Photoaging occurs over a period of years. With repeated exposure to the sun, the skin loses the ability to repair itself, and the damage accumulates. Scientific studies have shown that repeated ultraviolet (UV) exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks our elastin. Sun-weakened skin ceases to spring back much earlier than skin protected from UV rays. Skin also becomes loose, wrinkled, and leathery much earlier with unprotected exposure to sunlight.
Sun Spots4, or brown spots, like their name implies, is a condition developed by overexposure to the sun. The darkened patches of skin can appear in a variety of shades depending on a patient’s skin type, age and amount of exposure. Also called actinic keratoses, liver spots or age spots can be mildly treated with strong topical medicine made with hydroquinone that works to bleach the spots and even out skin tone.
Lasers have been proven to most effectively treat sun spots. Unfortunately, they cannot be completely erased, but laser treatment can stimulate new melanin production that will exfoliate the out layers of the skin, bringing sun spots to the surface where the skin can naturally shed the old skin.
The lasers that Dr. Rokhsar uses to treat brown spots in NY and Long Island include:
Q-Switched Alexandrite Laser – When the laser is shone on an area of skin, the irregular pigment absorbs the laser light. During absorption, the pigment is broken down and then shed by the body’s natural process.
Q-Switched Ruby Laser – Uses a wavelength with a similar technique to absorb the melanin. The laser is highly selective in targeting the pigmented cells that cause a discolored appearance. Fading has been clinically proven and tested as a safe and effective procedure for removing sun spots.
Nd:YAG Laser – Another Q-switched laser that is known for its efficacy in removing sun spots. After the laser has been placed over the discolored skin and treatment is complete, the pigment will develop a white color and leave behind a small scab. After the skin continues its natural healing process and the scabs fall off, a slight red discoloration will remain but slowly fade and new skin with matching pigmentation to the rest of the undamaged face will take its place.
Uneven pigmentation can result from the damaging effects of too much sun exposure. The skin increases the production of melanin, which creates a darker tone, which is why skin looks a darker brown shade from sun tanning. Melanin protects the deeper layers of the skin from sun damage, the darker the skin appears, the more protection it has against the sun.
The sun can also cause a permanent stretching or dilation of small blood vessels, which creates an uneven, reddish appearance.
Solar lentigines, more commonly known as age or liver spots, are flat spots of increased pigmentation that can appear as tan, brown, black or even gray. Spots usually appear in areas that are most exposed to the sun such as the face, hands, arms, and upper back.
Size varies depending on the level of sun exposure. This is typically found on older adults but can occur in younger people that spend an excessive amount of time in the sun.
Solar elastosis occurs when ultraviolet rays from the sun break down the skin’s connective tissue, collagen and elastin fibers within the dermis. The weakening of the skin’s dermis causes the skin to lose flexibility, leaving vertical creases deep wrinkles and loose sagging skin.
Solar keratoses also referred to as actinic, appear as rough, scaly raised patches found along the face, ears, lower arms, and hands. They range in color from pink, dark pink, light brown, or brown on fair-skinned people from overexposure of the sun. Although any skin damage will increase the chance of skin cancer, solar keratoses if left untreated can progress to a type of skin cancer known as squamous cell carcinoma.
Labial lentigo is a dark brown lesion that appears usually as a single spot on the lower lip after repeated sun exposure, however, it can appear anywhere along the lip’s surface.
Melasma occurs from a combination of overexposure to the sun and an increase in the female hormones, estrogen, and progesterone and typically appear on the cheeks, forehead, nose, and chin. Women with a darker skin complexion or those who take oral contraceptives, hormone therapy, or are pregnant are most susceptible to melasma.
Poikiloderma appears as irregular reddish-brown pigmentation characteristically underneath the chin, down the neck, over the collarbone and chest from too much sun exposure.
Lentigo maligna is a growth that appears most commonly along the face, hands or legs from overexposure to the sun. With increased sun exposure, the dark flat spot that develops will slowly darken and enlarge along the skin and may eventually develop into melanoma, a type of skin cancer that begins on the uppermost skin layer and works its way deeper into the skin’s layers.
After going to the beach all summer and basking in the sun, it is not a surprise to see a couple of sun spots on the skin. Or are they age spots? Contrary to popular belief, age spots are not different than sun spots. In fact, both terms describe common hyperpigmentation of the skin.
Also called liver spots and solar lentigines, these dark pigmented spots occur when the skin produces an excess amount of melanin, the substance that gives the skin its color. These spots have been associated with age because they tend to appear most frequently in older individuals, often emerging after the age of 40.
Age spots are very common, particularly in those with fair skin or who have a history of excessive sun exposure or tanning bed use. Primarily caused by sun exposure (ultraviolet radiation), age spots most often arise on the face, hands and other places that are subjected to UV light on a daily basis.
Although age spots are not dangerous, they may indicate that you are spending too much time in the sun. You may not only be subjecting your skin to premature aging but also may be increasing your risk of developing skin cancer. According to the Skin Cancer Foundation, nearly 5 million people are treated for skin cancer every year in the U.S.
The best way to prevent age spots is to limit sun your exposure:
True age spots are harmless and do not need treatment, but they can look like cancerous growths. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed. However, preventing age spots — by avoiding the sun and using sunscreen — may be the easiest way to maintain your skin’s youthful appearance and to avoid these dark skin spots.
Brown spots or age spots do not respond to creams. They can safely and effectively be removed by a variety of laser treatments. The most effective treatment for brown spots on the face is the use of Q-switched lasers such as the Q-switched Alexandrite laser or the Q switched Nd-YAG laser.
Often, one treatment is enough to eradicate brown spots safely and effectively anywhere on the body. Rarely a second touch up treatment will be necessary. Freckles on the face, chest, and back can also be effectively treated with the Q-switched Alexandrite of Nd:YAG lasers.
Fractional Resurfacing with the Fraxel laser is also an effective treatment for brown spots for those individuals who additionally seek improvement in fine and moderate wrinkles, texture, pores, acne scars, and other skin imperfections.
To learn more about the possible treatment alternatives for age spots in NY and Long Island, contact Dr. Rokhsar’s office and book a consultation today.
Although people with medium or dark complexions naturally have more melanin (skin protection) than people with light complexions, they can still experience sun damage. Irregular pigmentation and wrinkles can appear with age and sun exposure.
Age or liver spots usually develop in large numbers, especially soon after repeated sun exposure and develop more often in advancing age. Freckles usually develop earlier in life and appear as red or light brown.
Brown spots on the skin can be caused by a variety of factors including aging, exposure to sunlight, inflammation, skin pigmentation disorders, genetics, medications, and hormonal changes. Seborrheic keratosis is a common noncancerous skin growth that usually appears as brown or black, waxy, scaly, and slightly raised lesions. They appear on the face, neck, chest, or back, and tend to occur more frequently with age. Age spots, also known as liver spots or solar lentigines (lentigo), are caused by overactive pigment cells that produce melanin in high concentrations when exposed to ultraviolet (UV) light over time in genetically susceptible individuals. Age spots can appear anywhere on the body, particularly on areas that are frequently exposed to the sun, such as the hands, face, and arms. Melasma, on the other hand, appears as light or dark brown patches or freckle-like spots on the face, particularly on the cheeks, nose, forehead, and upper lip, often confluent as large patches, and is caused by hormonal changes during pregnancy, menopause, or the use of birth control pills, as well as sun exposure in people where genetically melasma runs in the family.
Inflammation resulting from eczema, psoriasis, injury to the skin, or acne can also lead to the development of dark spots on the skin. This is called post-inflammatory hyperpigmentation (PIH) or post-inflammatory pigment alteration (PIPA) and is more commonly seen in darker skin individuals. Additionally, certain medications, such as chemotherapy drugs and antimalarial medications, some antidepressants as well as some antibiotics (minocycline, doxycycline) can cause hyperpigmentation or dark spots on the skin. Birthmarks and skin cancer can also cause skin discoloration in terms of brown spots or dark spots.
While most brown spots are harmless, changes in size, shape, color, or texture of any skin spot or mole could indicate skin cancer and should be examined by a dermatologist.
Treatment options for brown spots on the skin depends on the specific diagnosis which should be made by a board certified dermatologist as it has implications for choosing the proper treatment. These include topical medications, such as hydroquinone, retinoids, corticosteroids, vitamin C to name a few. There are oral medications such as tranexamic acid that have been shown to be very useful for the treatment of dark spots in melasma. Chemical peels, microdermabrasion, laser therapy, and hydrafacials are other useful treatment modalities. Cryotherapy is a risky treatment for brown spots as it can leave permanent white spots on the skin. The most effective way to prevent brown spots on the skin is to protect the skin from sun exposure by wearing protective clothing, using sunscreen with SPF of 30 or higher, seeking shade during peak sun hours, and avoiding tanning beds.
Age spots (lentigo) typically appear in people who have had years of sun exposure and usually develop after the age of 40, in genetically susceptible people. The excess melanin in the skin becomes clumped together, resulting in flat brown, gray, or black spots that are commonly found on sun-exposed areas such as the face and the backs of the hands. Additionally, the use of commercial tanning lamps and beds can also cause age spots. People with light skin and a history of frequent or intense sun exposure or sunburn may be more likely to develop age spots.
Age spots are also known as liver spots, but they are not related to the liver. They are usually benign and harmless. However, brown spots on the skin may not always be age spots, as they can also be a sign of actinic keratosis, a precancerous lesion that develops when the skin is damaged by ultraviolet (UV) light from the sun or indoor tanning. Actinic keratoses are rough, scaly spots that often appear on the hands, arms, or face, and they are also related to sun exposure. Actinic keratoses must be treated by a board-certified Dermatologist to prevent skin cancer.
While age spots can be a natural part of the aging process, they are often the result of sun exposure. Therefore, it is important to protect the skin from the sun by wearing protective clothing, using sunscreen, and avoiding the sun during peak hours.
Age spots, also known as liver spots or solar lentigines, are small, flat, and dark areas on the skin. They vary in size and usually appear on areas exposed to the sun, such as the face, hands, shoulders, arms, and feet. They are often oval or circular and range in color from light brown to black. Age spots are larger than freckles and do not fade as easily. They are generally flat to the touch and have the same texture as the surrounding skin. Many people are genetically at risk in getting age spots which are more commonly seen in lighter skin people.
While age spots are most commonly found on sun-exposed areas of the skin, they can develop anywhere on the body. Age spots may be accompanied by wrinkling, dryness, thinning of the skin, and rough spots. It’s essential to distinguish age spots from other skin disorders, as the treatments differ. Making the right diagnosis is crucial in coming up with effective treatments as the wrong procedure may delay other needed therapy and may cause further harm. Dermatologists usually diagnose age spots by visually inspecting the skin. In some cases,a skin biopsy may be necessary to rule out an evolving skin cancer such as a melanoma prior to treatment. Dr. Rokhsar is a double board-certified Dermatologist and Dermatologic Surgeon and would be happy to evaluate your skin during a consultation.
Age spots are a natural part of aging in many people and are generally harmless. However, if you are concerned about any skin changes, it is always best to consult with Dr. Rokhsar to rule out any potential health issues. Dr. Rokhsar can come up with an individualized plan for your particular issue which may include topical or oral medications, laser treatments, such as the Alex laser, Fraxel laser resurfacing or treatment with the fractional CO2 laser. Other treatments such as the hydrafacial may be helpful in your particular case. Dr. Rokhsar was the first doctor to conduct a study on the treatment of melasma with Fraxel which led to the FDA approval it for melasma.
Here are some ways to lighten age spots:
To determine which treatment is best for you, consult with Dr. Rokhsar for expert guidance.
Here are some ways to remove age spots:
Prevention is key in avoiding age spots. To avoid age spots and new spots after treatment, limit your sun exposure and use sunscreen when outdoors. The sun’s rays are most intense between 10 a.m. and 2 p.m., so try to schedule outdoor activities for other times of the day.
Dr. Rokhsar’s preferred method for removing age spots on the hands is by specifically targeting each spot with the Alexandrite Q-Switched laser. Dr. Rokhsar is an experienced laser surgeon with over 20 years of practice and has seen phenomenal results with thousands of patients using the Alexandrite Q-Switched laser. Dr. Rokhsar often combines the q switched lasers with the Fraxel laser for even better results in removing age spots on hands.
Protecting the skin on your hands from further sun exposure is key in fading existing age spots and preventing new ones from forming. Limit your sun exposure by avoiding the sun between 10 a.m. and 2 p.m. and wearing protective clothing and sunscreen with at least SPF 30.
One way to treat age spots is through the use of topical creams and lotions. Prescription-strength hydroquinone cream is a common treatment that can help lighten the appearance of age spots. Retinoids and mild steroids can also be used in conjunction with hydroquinone to help fade age spots. Over-the-counter creams containing glycolic acid or alpha hydroxy acids as well topical Vitamin C serums may also help reduce the appearance of age spots.
In addition to topical treatments, there are several procedures that can be done to help remove age spots on the face. Chemical peels and laser therapy are two effective treatments that can help reduce the appearance of age spots. These procedures work by removing the outer layer of skin to promote cell turnover and reveal fresh, new skin underneath. Cryotherapy, which involves freezing the age spot with liquid nitrogen, is an older method which is not recommended by Dr. Rokhsar because of a high incidence of developing permanent white spots.
Dr. Rokhsar’s preferred method for removing age spots on the face is by using a combination of laser procedures. The Alexandrite Q-switched laser is effective for targeting larger, pigmented age spots. Meanwhile, the Fraxel ReStore Dual laser procedure is effective for targeting background hyperpigmentation from sun damage.
Preventing further damage and the development of new age spots is crucial in the management of age spots. This can be achieved by limiting sun exposure, wearing protective clothing and hats, and applying a broad-spectrum sunscreen with an SPF of 30 or higher every day.
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121 East 60th Street, Suite 8AB New York, NY 10022
(212) 285-1110
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References
Dr. Cameron Rokhsar, MD, FAAD, FAACS, is the founder and medical director of the New York Cosmetic, Skin, & Laser Surgery Center. Dr. Rokhsar is a graduate of Harvard College and NYU School of Medicine. Dr. Rokhsar is double board certified in dermatology and micrographic dermatologic surgery, being one of the few select dermatologists in the country who is also fellowship trained in laser surgery. A researcher and innovator, Dr. Rokhsar is the creator of the non-surgical nose job and has been instrumental in the research and development of laser systems such as the Fraxel, CO2, Mirady, Vbeam, Themitight, and Ulthera devices. An Associate Professor of Dermatology at Mount Sinai Hospital in NYC, Dr. Rokhsar actively teaches the cosmetic dermatology clinic to the resident at Mount Sinai. An expert injector of fillers, and a trainer for many companies, patients fly in from around the world to see Dr. Rokhsar in his Garden City and Manhattan offices in New York.
Dr. Rokhsar was chosen by
magazine as a top dermatologist in its Best Doctors 2017, 2018, 2019, 2020, 2021, 2022 and 2023 issues.
