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What is the effective treatment for dark spots or solar lentigo removal?
As you hit your forties, you may find some dark patches sprouting on your skin, especially the face and backs of your hands. These dark spots on the skin are a result of hyperpigmentation and this happens when some areas of the skin produce more melanin than usual. Some of the common types of skin pigmentation include freckles, solar lentigines, and melasma.
In cases where dark patches develop over the age of 40, they can be solar lentigines, also called "aged spots" or "liver spots", which are often associated with aging [1]. Although these dark spots are usually a harmless problem, the condition can affect self-confidence and dampen your mood. So what are the types of pigmentation treatment available?
What is solar lentigo?
Solar lentigo is a skin pigmentation disorder caused by excess melanin produced when exposed to the sun. Melanin is the pigment that gives your skin, hair and eyes their distinctive colour. Your body produces more melanin when you're in the sun, which protects you from harmful ultraviolet (UV) rays. Despite its ability to act as a natural sunscreen, melanin does not provide enough protection, especially if your skin is damaged by sunburn or becomes darker. Excessive sun exposure or UV radiation can cause pigmented cells called melanocytes in the skin to multiply. Prolonged exposure over the years can cause the spots to grow larger and darker over time.
Lentigo spots can sometimes take many years to develop. But more often than not, these spots make their presence felt very suddenly. Depending on a range of contributing factors, solar lentigo can also appear on several parts of the body. The good news is that solar lentigo is a harmless skin condition. The lentigines also don’t cause any inconvenience or discomfort because they do not itch or pain. But since these spots have a very unattractive look and feel about them, most people prefer to get them removed. Solar lentigo is a common skin concern that typically affects adults over the age of 40. It also frequently appears in individuals with fair skin, those who spend a lot of time in the sun, and people with a history of severe sunburns.
What does solar lentigo look like?
Solar lentigo spots vary in shape. They are usually round, oval, or irregular-shaped flat spots that appear as well-defined dark patches that contrast with the surrounding skin. They can be as small as a few millimetres in diameter up to larger spots that can measure a few centimetres in diameter. You can identify them by the tan, dark brown, or black coloured spots with a slightly scaly appearance.
What is the difference between freckles and solar lentigo?
Due to the shape and appearance of the spots, solar lentigo is mistaken for several other skin conditions. When solar lentigo manifests as a cluster of spots, it is most commonly confused with freckles. However, these two are entirely different types of skin pigmentations.
While both solar lentigo and freckles are the outcome of a physical and chemical process involving sun light and melanocytes, they differ in several ways. The major difference is that while freckles also develop due to sun exposure, they tend to fade away in the absence of the stimulus. So, people with freckles usually find that the spots lighten when there is less sun exposure. But with solar lentigo, the dark patches remain uniformly dark and remain unaffected by the passing of seasons.
Freckles are in genetically predisposed individuals and tend to occur earlier. Solar lentigines can appear in anyone. In terms of size, freckle spots are quite small – no more than 10 mm in diameter, whereas solar lentigo dark patches can be as large as a few centimetres in width. Freckles have poor definition and congeal into larger clusters. On the other hand, solar lentigo spots are quite well-defined and can be present alone or in clusters.
How to treat solar lentigo?
Solar lentigo is basically a cosmetic issue that can be treated effectively in several ways – with energy-based devices like lasers and RF microneedling, chemical peels, topical and oral medications.
#1 Laser Treatments
In recent years, lasers have proven to be a very effective and safe mode of treatment for solar lentigines and several other skin pigmentation concerns such as melasma, freckles, and Hori’s Nevus[2].Solar lentigines can be treated with several different types of lasers, each one emitting specific wavelength which are absorbed by melanin. Melanin is a chromophore that will transform the energy it absorbs from the laser wave into heat that will destroy the pigment in the skin[3]. A combination of lasers such as Long-Pulsed ND: YAG Laser, Q-Switched nanosecond and picosecond Nd: YAG Laser, Picosecond Alexandrite Laser, Yellow Laser, and many others, can be customised to handle individual customers’ skin concerns. Each of these lasers has a specific and different wavelength or pulse duration which can target the different depths of the skin, and selectively remove the excess pigment without damaging the surrounding skin[5].
Combination laser treatments have been clinically proven to be more effective in enhancing the overall appearance of the skin and give long-lasting results. Aside from reducing the dark patches, they help to eliminate fine lines and wrinkles, reduce pore size and inflammation. Moreover, combination treatments also boost healthier and stronger collagen formation, which further improves the overall skin tone and texture.
#2 RadioFrequency (RF) Microneedling
This minimally invasive RF microneedling treatment creates microchannels in your skin and then delivers radiofrequency waves through the microneedles. The advantage of this procedure is that energy penetrates the papillary dermis – an important layer of the skin located just below the basement membrane to stimulate new healthy collagen production. It is important to treat this layer as it helps to enhance the skin’s elasticity, reduce pigmentation, strengthen the skin barrier, and maximize the effects of collagen production.
A weak skin basement membrane allows melanin pigment to penetrate much deeper into the skin, making it more difficult to clear pigmentation. By remodelling and strengthening the skin basement membrane, it can stop the melanin pigment from going deeper into the dermis and makes your dark patches easier to treat. In addition, this treatment can also minimize the recurrence of abnormal blood vessels, gives stability to the epidermis, and reforms the vessel structure in the dermis. All this together, helps in the regenerative processes of facial skin tissue.
#3 Topical Medicated Creams
In mild and superficial cases of solar lentigo, your doctor can prescribe medical formulations for topical application. Topical creams like hydroquinone and tretinoin are found suitable for lightening up superficial pigmentation. Hydroquinone inhibits the production of melanin by decreasing the formation of melanin in the skin, and thus reducing the number of pigments, lightening your dark patches. Hydroquinone must be prescribed by a doctor, and the treatment must be monitored carefully because its continued use has been linked with exogenous ochronosis which is a persistent blue-black pigmentation.
A topical retinoid derived from Vitamin A, tretinoin is commonly prescribed for treating skin conditions such as acne and discolouration. Tretinoin increases the epidermal turnover which leads to faster skin cell growth. It also helps enhance the skin’s texture, treat facial wrinkles and reduce hyperpigmentation.
Although most topical medications are safe, it is always advisable to consult a doctor for the appropriate prescription. In case topical medications are not effective for your hyperpigmentation, there are other treatment options available for treating solar lentigo.
#4 Chemical Peels
Medical-grade chemical peels accelerate the rate of skin shedding through exfoliation. Hydroxy acids such as AHA, BHA or PHA, are used to exfoliate and peel the skin surface. Chemical peels minimise the appearance of superficial age spots by eliminating unwanted melanin along with the skin’s top layer. The treatment must be carefully prescribed and monitored, as chemical peels are not suitable for all skin type.
Broadly, there are many types of chemical peels, and the difference lies in the skin depth the acid penetrates. Medium to deep peels work comparatively deeper into your skin and are generally not suitable for Asian skin, as it can result in a lot of side effects like hypopigmentation or hyperpigmentation, scarring, or infection. While chemical peels work as a stand-alone treatment, achieving a multi-pronged approach can yield optimal results.
#5 Intensed Pulsed Light (IPL)
This non-surgical modality utilises a broadband light source to generate energy capable of reducing skin pigmentation concerns like sunspots and age spots. The treatment involves targeting the problematic skin pigmentation with intense pulsed light so that they absorb the energy, disintegrate into smaller particles, and rise to the epidermis also known as an IPL facial. Thereafter, the body’s lymphatic processes remove the wastes gradually over the ensuing months. The heat generated by the IPL device during the treatment also promotes collagen production, that is a crucial factor in the healing process for removing the dark spots. In addition to helping treat pigmentation, IPL also helps normalise pore size and improve skin tone. Although optimal results are seen in the treatment of mild or superficial pigmentation, IPL, in combination with other modalities, can help to remove solar lentigo more effectively.
How to prevent solar lentigo?
Since UV radiation is the main cause of solar lentigo, avoiding sustained exposure to harsh sunlight is one of the ways to prevent solar lentigo. As a rule, apply a good sunblock before you venture outdoors during the daytime. Ensure that your sunscreen has a minimum sun protection factor of at least SPF30. To the extent possible, you could also try to use sun-shielding accessories like a hat, cap or a UV protection umbrella when you go out in the sun.
The Key Takeaway
As you approach your forties, solar lentigo may become more common. However, you can certainly reduce or prevent these troublesome spots on your skin. While lasers do offer effective treatment for these spots, combination treatments can deliver more effective results, and faster too.
These treatments are especially appropriate for treating stubborn age spots from the skin surface. When availing treatment for your solar lentigo at a clinic, consulting an aesthetics physician experienced in treating pigmentation can help further improve the results.