Lentigines are commonly called liver or age spots even though they are not associated with liver disease and they are not directly related to age.   They often first appear on the tops of the shoulders in teenagers after a severe sunburn.  They are most often found on sun exposed areas on the face, arms, and legs.  I prefer to call them “sun spots” or “senior freckles.”  They are more common in fair skinned people but the tendency to get them seems to run in families, even in some who have a more olive complexion.  

Although they are sun related lentigines have NO tendency whatsoever to turn in to skin cancer.  They may be safely left alone if desired.  

Some people with large, dark, or very conspicuous lentigines desire treatment.  Solar lentigines  in fair skinned people often respond to  treatment with liquid nitrogen (see discussion of liquid nitrogen above under seborrheic keratoses).  The treated areas peel off in a few weeks. It’s sometimes best to do a test area first and it is usually better to treat lentigines with LN during the fall or winter.   Liquid nitrogen can sometimes leave  hypopigmentation (a white spot) which can be permanent.  

Prescription topical vitamin A derivatives known as retinoids are often used to treat  lentigines.  Examples include Retin-A®, Renova® cream, Differin®, Tazorac®..  Tretinoin, the generic of Retin-A®, is much less expensive than the brand name (especially if purchased through an international pharmacy) and equally effective.  Nightly application can reduce and occasionally eliminate lentigines of the face, hands, or forearms in 6 to 8 weeks.  Some patients with sensitive skin  find retinoids irritating.  Retinol is a less irritating but also less effective alternative to Retin-A® (which chemically is retinoic acid) and is found in some very popular OTC products promoted to lighten lentigines.  

Occasionally topical prescription products containing azelaic acid (Azelex®, Finacea®) are used to treat lentigines.  They may not be covered by many insurance carriers. OTC alpha hydroxy acid (AHA) preparations (usually containing glycolic acid) are less effective than retinoids but easier to use.

Traditional bleaching creams containing hydroquinone (2% is OTC, 4% is Rx) used alone are seldom of benefit but seem to be more effective when used with either a vitamin A derivative or an AHA. .  

Solage® is a prescription topical agent that combines an alternative bleaching agent (Mequinol®) and 0.01% tretinoin.  It comes with a wand applicator which makes its use more efficient.  It is expensive and not usually covered by insurance.

For those who do not have prescription coverage for these agents and have to pay out of pocket for them, we have worked extensively with an international pharmacy to help patients purchase these products at a significant discount.  

We also offer treatment of lentigines with a laser-like device known as the Lumenis One® IPL or intense pulse light.  Besides treatment of facial lentigines, IPL can be very effective for lentigines of the hands, forearms and chest, where topical treatments are less effective and poorly tolerated.  More information about the Lumenis One® IPL device is available.    


IMPORTANT NOTE:  Lentigines that have been lightened or even apparently eliminated by any of the above treatments reliably recur with re-exposure to sunlight unless very special precautions are taken. This entails very consistent use of the very best available sunscreens.  We will provide you with up to date information about what we consider the very best sunscreens.  It makes absolutely no sense to invest time, energy, and expense treating lentigines unless there is a firm commitment to using a very good sunscreen every single day between April and October (in Michigan) or any time you travel south.  



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