Age Spots

What to Do
When the Damage Is Done

She was a striking woman of a certain age. She was fit and trim, and she had obviously cared for her complexion. You admired her style, her carriage, her makeup. Getting older wouldn't be so bad if you could look that good, you thought. Then suddenly, you noticed her hands. They were covered with brown blotches. Ugh.

These days, you might find yourself glancing worriedly at your own hands. Only a few so far--but there they are. Age spots. Liver spots. Solar lentigos. But it doesn't matter what you call them: They add unnecessary years to your
appearance, and they're one reason your hands can give away your age. But nowadays, you can do a whole lot more about age spots than simply count them as they come.

Sort Your Spots

First, you need to decipher what's an age spot and what's not. There are several types of these unsightly blotches, but one cause is common to all of them, doctors say, and that's sun damage. You may have exposed unprotected skin to ultraviolet rays, whether from a tanning booth, a sunlamp or years of going without sunscreen. In response, your skin has tried to protect itself by producing an overabundance of melanin--the pigmented cells in your skin--in uneven patches.

What's the difference between age spots and freckles? Freckles appear when you're young, they're more numerous in the summer and they tend to fade with age, says Nicholas Lowe, M.D., clinical professor of dermatology at the University of California, Los Angeles, UCLA School of Medicine. Age spots get worse--and they don't go away.

If you've ever gone in the sun while pregnant, you may have developed the "mask of pregnancy"--a light to dark patch on the skin. This is not an age spot. Properly called melasma, these blotches most often occur on the face and might go away on their own.

Chemical Causes

Certain substances that come in contact with your skin may cause age spots, says Karen Burke, M.D., Ph.D., a dermatologist in private practice in New York City. Chemicals called psoralens are present in foods such as parsley, limes and parsnips. When you handle these foods and then go out in the sun, your skin may be more sensitive and burn more easily where the psoralens touched it. When the little blisters from the burns have healed, age spots may appear in their places.

Antibiotics such as tetracycline (Achromycin), some diuretics (water pills) and antipsychotic medicines such as chlorpromazine (Thorazine) will also cause your skin to produce age spots when it is not protected from the sun, Dr. Burke says.

And if your favorite fragrance or lotion contains musk or bergamot oil, which are common perfume ingredients, it may give you more than a lovely scent. When perfumes or lotions containing these ingredients are applied to sun-exposed areas, they can produce age spots, says Dr. Burke.

An Ounce of Prevention

The most important thing you can do to stop new age spots from forming is to wear sunscreen--all the time. And an ounce is just about what it takes, dermatologists say.

Apply it daily. "Start using an SPF 15 or higher sunscreen on a daily basis," says John E. Wolf, Jr., M.D., professor and chairman of the dermatology department at Baylor College of Medicine in Houston. What's SPF? It stands for sun protection factor. SPF 15, for example, means you can stay out in the sun 15 times longer before burning than you could without the sunscreen.

"Apply it to the backs of your hands and to your face first thing in the morning, before you put on any moisturizer or makeup," says Dr. Wolf. "When you wash your hands, don't forget to reapply your sunscreen. If you see the beginnings of age spots or melasma, switch to a higher SPF sunscreen than the one you are currently using."

And remember that if you're not prepared to use sunscreen every day, year-round, there's really no point in treating your age spots, Dr. Lowe says. Without daily sunscreen, "in a number of months your skin will be back in the same shape," he says.

Wash up. Wash your hands thoroughly after handling foods that contain psoralens and reapply sunscreen before going outdoors again, says Dr. Burke.

Save your scents for the shadows. Apply your perfume or lotion to areas of your skin that will not be exposed to sun, Dr. Burke suggests.

Spot Removers

The most important thing you can do about age spots is to first make sure they're not precancerous lesions, says Dr. Wolf. "If a brown spot pops up out of the blue, or an old one suddenly changes shape, becomes raised or bleeds, have a dermatologist look at it to be certain it's not an early melanoma," he says. The number of cases of melanoma, a potentially fatal form of skin cancer, is increasing more rapidly than any other type of cancer. (For more information on melanoma, see Skin Cancer, chapter 54.)

If you have just a few age spots that are not too dark, you can try an over-the-counter remedy. But for a persistent crop of age spots, your dermatologist has several very effective treatments.

Bleach them away. Head for the hair care aisle at your drugstore for nonprescription help. It takes time, but a hair bleaching product that's about 12 percent hydrogen peroxide may help fade away smaller age spots. Dr. Burke suggests dabbing on the peroxide with a cotton swab. Test the peroxide on a very small age spot once every three days for a week, and then gradually adjust the frequency to accommodate your individual level of tolerance. Do not use peroxide on large areas of skin without seeing your doctor. If you develop a burn of any sort, see your doctor immediately.

Try a fade cream. We're not kidding. You heard those ads for "Porcelana, the Fade Cream" when you were a kid. It's still around--and it just may work. Porcelana and other creams, including Esotérica and Palmer's Skin Success fade creams, contain hydroquinone, which interferes with your skin's production of melanin. Dr. Burke says these products work slowly, however. Prescription-strength hydroquinone preparations might work faster.

Seek a stronger solution. Melanex and Eldoquin, creams that contain prescription-strength hydroquinone, can help wipe out bigger, more stubborn age spots. Tretinoin (Retin-A), which comes in cream or gel, is another potential age spot eraser, although it's normally used against acne and wrinkles. Retin-A gradually returns skin to its normal state, making age spots fade. It can be used with hydroquinone at your doctor's discretion, Dr. Burke says.

Consider peeling or freezing. Your dermatologist may try trichloroacetic acid, which is often used for chemical peels and is quite effective on age spots. It would be a good choice for just a few spots that aren't too dark, says Dr. Wolf. Another alternative is freezing the spots with liquid nitrogen. With these treatments, which must be done in a doctor's office, there is some risk that the chemicals will do their job too well, leaving de-pigmented white spots where the age spots have been removed, he says.

Learn about lasers. Wielded by a highly skilled physician, a laser is the high-tech solution to age spots, says Dr. Lowe. It's also the priciest. "The great thing about laser treatment for this problem is that in the hands of an expert, you don't run the risk of having white spots where the dark spots had been," he says. Ask your dermatologist whether laser treatment is available. Does it hurt? Only for an instant. And the pain is similar to a rubber band snapped against your skin, Dr. Lowe says.

Remember that with all these treatments, it is essential to keep using sunscreen. Otherwise, new age spots are sure to form.