Symptoms
Age spots are round, flat, oval to irregularly shaped pigment spots on the skin with a yellow-brown, light or dark brown to black color. The size is in the millimeter to deep centimeter range. Age spots occur mainly on the face, back of the hands, forearms, décolleté, shoulders and back. They occur singly or in groups. They are observed mainly in older people and from the age of 40.
Causes
Age spots are caused by local hyperpigmentation of the skin. The main trigger for the skin change is cumulative damage from UV-B radiation. That is, the ultraviolet radiation of sunlight with a wavelength between 290 to 320 nm. Age spots therefore appear mainly on sun-exposed areas of the skin on the body. Risk factors include:
- Age
- Light skin type
- Sunburn, sun exposure, solarium visits.
- Hereditary factors
Diagnosis
Diagnosis is made in medical treatment based on visual inspection and with dermoscopy. Other benign and malignant skin lesions must be excluded. A skin sample may be taken (biopsy) for this purpose. Red flags that require a doctor’s visit:
- Dark spots
- Change in size
- Irregular border
- Unusual colors
- Itching, redness and bleeding
Non-drug treatment
True age spots are harmless and are not precancerous. Treatment is not necessary from a medical point of view. However, the spots may be considered aesthetically disturbing. Non-medicinal methods can be performed in medical therapy or in aesthetic centers:
- Laser therapy: layer-by-layer peeling of the skin.
- Cryotherapy: cold treatment, usually with liquid nitrogen.
- Dermabrasion: abrasion of the top layers of the skin.
Age spots can also be covered with makeup.
Drug treatment
Medicinal treatment uses drugs, medical devices and many cosmetics. Chemical peeling agents (peels):
- This group includes alpha hydroxy acids (AHAs) such as lactic acid, malic acid, citric acid, and glycolic acid. They are carboxylic acids that carry a hydroxyl group at the alpha position. Possible adverse effects are skin irritation and redness.
Retinoids:
- Retinoids such as tretinoin and adapalene stimulate the mitotic activity of the epidermis and thin the stratum corneum. This leads to skin bleaching.
Hydroquinone:
- The diphenol hydroquinone inhibits the oxidation of tyrosine to DOPA in melanocytes. The duration of treatment should be kept short. Hydroquinone is controversial because it has shown mutagenic and clastogenic properties in cell cultures and in animal studies.
Other active ingredients:
- Azelaic acid, mequinol
Prevention
For prevention, the skin should be protected from excessive sun exposure with behavioral recommendations and with sunscreens. Sunscreens (UV filters) are also effective when spots are already present.