Lentigo Senilis: Age Spots

Lentigines seniles (colloquially called age spots; synonyms: Age pigmentation; lentigines seniles; lentigines, lentigines solaris; senile lentigo; solar lentigo; age spot, liver spot; ICD-10: L81.4 – Other melanin hyperpigmentation) are pigmentary disorders of the skin. They are light to dark brown, usually sharply demarcated spot(s) in chronically light-exposed skin areas. Therefore, the term solar lentigo best describes age spots. Solar lentigo may present as:

  • Seborrheic keratosis (verruca seborrhoica; age wart) of the reticular acanthotic type.
  • Melanocytic nevus of the junctional type.
  • Lentigo maligna (synonyms: Melanoma in situ, melanotic precancerosis, melanosis circumscripta praeblastomatosa Dubreuilh, Dubreuilh’s disease or Dubreuilh’s disease) – intraepidermal (located in the epidermis) neoplastic proliferation of atypical melanocytes.

Age of manifestation (first age of onset of disease): middle age (40-60 years) and older age (> 60 years).

Sex ratio: men and women are equally affected. Approximately 90% of 60-year-olds have one or more lentigines senilis (central European population).

Symptoms – complaints

Age spots are usually lentil to penny-sized, light to dark brown, usually sharply demarcated spot(s). However, they can also grow up to several centimeters in size. Localization: Age spots are usually found on sun-exposed areas of the skin, i.e. on the face, the back of the hands and the extensor sides of the forearms. In women, the décolleté and lower legs are often affected. People with lighter skin are more likely to have age spots.

Differential diagnoses

  • Seborrheic keratosis (verruca seborrhoica; senile wart).
  • Ephelides (freckles)
  • Lentigo maligna (see above).

Pathogenesis (disease development) – etiology (causes)

Aging leads to the decrease of melanocytes. These are melanin-laden cells responsible for skin color. Melanocyte stimulation is equally dependent on UV radiation and stress. Both lead to the release of the hormone ACTH, which stimulates the melanocyte-stimulating hormone (MSH) and thus stimulates pigment formation. Age spots can thus be triggered by both exogenous – UV light – and endogenous influences (stress).

Diagnostics

Age spots are detected by eye diagnosis. Dermoscopically (by reflected-light microscopy), a regular pigment network with pigmented portions of varying intensity is seen.

Therapy

General measures

  • Cosmetic coverage with make-up
  • Avoidance of UV radiation

Other therapeutic measures include:

  • Therapy trial with 5% hydroquinone ointment – inhibits the enzyme tyrosinase responsible for melanic information and synthesis.
  • Dermabrasion (skin abrasion) or superficial curettage with sharp curette.
  • To mitigate age spots, a mechanical exfoliation product (peeling) can be used.
  • Cryotherapy (cold therapy) or cryosurgery (cryopeeling): this involves freezing the spot with the help of liquid nitrogen. A crust is formed, which falls off after a few days. New skin is then found underneath. As a rule, no scars are formed.
  • Laser therapy: age spots can be easily removed by laser without pain or scarring. For this purpose, various types of lasers can be used, such as the surgical CO2 lasers or erbium Yag lasers.Likewise, the lasers can be used for vascular and pigmentary changes in the skin. These include the argon laser, the krypton ion laser, the Nd:Yag laser or the pulsed ruby laser.
  • In any case, a consistent sun protection must be carried out after the treatment!

Note: The age-changed skin can be a precursor to skin cancer!