Concerned about unusual new marks on your body? While any worrying additions to your skin including marks or lumps that change in appearance, size or texture should be investigated by your GP, if you notice small dark spots similar to freckles, this could be caused by skin damage known as sunspots.
Dr Louise Wiseman explains why we get sunspots on the skin including symptoms, treatments and prevention, plus cancer warning signs to look out for:
What are sunspots?
Sunspots, medically known as solar lentigines, are flat pale brown spots that can appear on the skin wherever there has been long term sun exposure. Sunspots are also sometimes known as liver spots - because of their colour, not because they have anything to do with the liver. Sunspots tend to range from freckle size to half an inch or so and there may be many in one area.
What causes sunspots?
Cumulative exposure to ultraviolet light causes sunspots that look like splotches of darker skin. They are part of photo-ageing or skin damage caused by the sun. The skin naturally becomes thinner and loses elasticity with age and any hyper-pigmentation can accentuate the aged appearance.
How do sunspots differ from a tan?
As part of natural sun protection, the epidermis or top layer of skin thickens in response to ultraviolet light and produces melanin or a tan. With repeated sun damage this melanin tends to clump and not distribute evenly. A tan will fade away from the sun after a few days, whereas sunspots become permanent marks on the skin. The more sun an area of skin receives, the more vulnerable it is to sunspots, sun damage and skin cancer.
Sunspots can appear anywhere that is regularly exposed to light but high risk areas include:
Top and sides of the head
Tops of the ears
Back, arms and legs
Who gets sunspots?
Anyone can get sunspots, but they tend to first appear in early adulthood and are more prevalent after the age of 40. More than 90 per cent of Caucasians have at least one sunspot. Most people describe them as appearing overnight having not noticed them before.
⚠️ Any worrying changes to your skin including marks or lumps that alter in appearance, size or texture, changes to an existing spot or something that does not heal should be investigated by your GP.
How do sunspots differ from a freckles?
Genetically some skin types are more prone to freckles than others. Some people have freckles all their lives, while others only develop them in adulthood. If sun protection is used, freckles tend to fade whereas with sunspots this is not usually the case. If a few sunspots develop in one area they can also coalesce to form an irregularly pigmented area much larger than a freckle.
Sometimes pigmentation can occur on areas that have simply been inflamed rather than exposed to the sun. For this reason, it is a good idea not to irritate spots and acne by picking at them. This kind of pigmentation may be darker or more red than pale brown sunspots.
How do sunspots differ from melasma?
Melasma, also known as the ‘mask of pregnancy’ or ‘chloasma’, is when brown or grey areas of flat pigmentation develop on the face, and is often triggered by hormonal changes such as the contraceptive pill, pregnancy and thyroid changes, or medication. There can be a hereditary component and it is more common in women and those who tan easily. Melasma tends to increase in summer thanks to sun exposure and then fade in winter, unlike sunspots which once present are visible all year around. Melasma uniquely tends to have symmetry around the face affecting the upper lip, chin, cheeks and forehead.
Sunspots and skin cancer risk
Spots or lesions on the skin are described by doctors as macular (flat) or papular (raised). Sunspot are macular so tend to be flat and pale brown and can take any shape.
• Skin cancer
A type of melanoma called ‘lentigo maligna’ starts as a brown patch that persists over a long time. It tends to be larger than sunspots but is more common in older people with lots of sunspots. Unlike a sunspot it slowly enlarges and may develop darker areas within it. It is a type of melanoma that if caught early can be cured. If left, it will become more of a hard lump and can bleed or crust and can spread to lymph nodes and become very serious.
Actinic keratoses are another lesion that is more common in older people after sun exposure. Unlike sunspots these are not always flat and can be:
A thickened plaque or lumpy
White or yellow, scaly, warty or horny surface
Skin coloured, red or pigmented
May be tender
In some patients these can go on to a type of skin cancer called squamous cell carcinoma so should be treated by various means including topical creams such as 5 FU, surgical removal or freezing.
Other macular pale brown spots include Café au lait spots which are a type of birthmark. Unlike sunspots that develop in later life, these are present from birth or childhood. Other birthmarks may be different colours – reddish, purple, blue and do not look similar to sunspots and again will have been present from birth or early childhood.
Age spots are themselves nothing to worry about, but sometimes other spots can look similar. You might need a doctor to distinguish the difference for you.
⚠️ If you have a large number of pigmented spots, sensitive skin, a family history of skin cancer or you are simply worried, make an appointment with your GP or visit a dermatologist.
How to treat sunspots
Medically prescribed or interventional treatment for sunspots works by disrupting melanin or pigment formation.
Some over-the-counter treatments may be effective but they tend to have a lower concentration of active ingredient than prescription treatments. The positive side to this is that a weaker formulation will often be better tolerated and have less side-effects.
How to prevent sunspots
To lower your risk of sunspots try the following tips:
✔️ Apply sunscreen
Prevention is better than cure, and a sunscreen used regularly will reduce the chance of sunspots developing. Remember to protect the hands, chest and face while outside even if it is overcast, such as when gardening or exercising.
✔️ Use broad spectrum protection
Ideally apply SPF 50 sun protection 15 minutes before sun exposure. The SPF number only applies to the UVB blocking, a UVA rating of 4 or 5 stars is also needed. An easy way to remember is UVA for ageing, UVB for burning as that is the effect of the different wavelengths. Put A and B protection together and you have ‘broad spectrum protection’.
✔️ Wear a hat
Wear a large brimmed sunhat and suitable SPF clothing for sensitive skins or people with many moles.
✔️ Protect your eyes
Wraparound sunglasses can protect the delicate eye and cheek area.
✔️ Don't forget to reapply
Reapply sunscreen regularly and after water exposure.
✔️ Be mindful of sun exposure
Avoid the brightest times of the day during warmer weather.
Home remedies for sunspots
Various home remedies may be effective for reducing the appearance of sunspots, but consult your doctor for speak to a dermatologist before tying anything new on your skin:
• Grape seed extract: this has been demonstrated to be helpful in treating melasma, but more studies are needed on sunspots.
• Orchid extract: in one study orchid extract was found to be equivalent to vitamin C, which is considered to be very effective against skin pigmentation.
• Aloe vera: the aloe plant contains aloin which has been found to alter melanin distribution.
• Green tea and black tea: both contain polyphenols that are natural antioxidants. However, supplements have potential to cause liver damage. Topical application to the face may be effective but more studies are needed.
• Coffeeberry: following one successful study Coffeeberry was found to help prevent cellular damage, but more research is needed.
• Liquorice extract: studies suggest liquorice extract reduces UVB induced pigmentation.
• Milk: research has shown that lactic acid found in milk may help lighten skin pigmentation, including sunspots.
• Bakuchiol: this has been found to be similar in action to retinol in terms of anti-ageing, including reducing pigmentation, but has less side-effects than retinol.
• Apple cider vinegar: ACV was found to help lighten sunspots when applied regularly, according to a 2009 review, but more studies are needed.
Over-the-counter treatments for sunspots
Some ageing and pigmentation is caused by free radicals that form in the skin due to atmospheric pollutants, ultraviolet light, stress, smoking and the rigours of everyday life. Theoretically antioxidants, including vitamins A and C, could ‘mop up’ these free radicals and could prevent daily deterioration and reduce pigmentation.
The following vitamins and ingredients can potentially help fade sunspots:
Retinol is a vitamin A derivative. It interrupts melanin production and is less irritating with less redness and discomfort than tretinoin (doctor prescribed).
Vitamin C has been proven to be effective against skin pigmentation and to reduce ultraviolet induced skin injury. Vitamin C denatures so it is often stored in dark glass bottles or kept at cold temperatures, so the active form still works when the product is used on skin.
Vitamin B3 (Niacinamide) is a well-tolerated product ingredient recommended for reducing hyperpigmentation, blotchiness, fine lines and wrinkles. It also improves skin elasticity and reduces sallowness.
Hydroxyacids (glycolic, lactic, salicylic) reduce discolouration and are at safe levels in over-the-counter preparations. Always use sunblock at the same time, as these can induce photosensitivity. Never use over 10 per cent concentration in home preparations (as advised by the USA cosmetic ingredient review panel) to avoid sensitivity.
Prescription treatments for sunspots
The following treatments can potentially help fade sunspots, but will need to be prescribed by your doctor:
Hydroquinone can be purchased over the counter in creams at 2 per cent concentration. Doctors can prescribe up to 4 per cent twice a day. There is an unregulated market for illegal hydroquinone for skin bleaching with severe side-effects if correct products are not used carefully under medical supervision. It is always better to discuss with your doctor. There is concern of possible carcinogenic effects in animals but not enough evidence in humans, but this does trigger some people to experiment more with natural remedies.
Prescribed by a doctor, Tretinoin (brand names Retin-A, Retin-A micro, Renova, Avita) is sometimes combined with other preparations to treat sunspots. Turnover of skin cells is said to be improved and melanocyte activity suppressed, but it can take months to fade age spots. Side-effects include redness, irritation, dryness and burning although tolerance develops. Most practitioners start with a lower percentage strength and increase gradually. High SPF is essential as this potentiates skin photo sensitivity. There are severe potential side-effects and tretinoin is not advised in pregnancy or breastfeeding or when trying to conceive.
This gel is licensed for acne, but some consultants carefully use it in an unlicensed way for photoaging.
Azelaic acid inhibits tyrosinase – an enzyme needed to produce melanin, but it can also irritate the skin. It may be wise to apply infrequently initially to check tolerance.
Interventional treatments for sunspots
The following interventional treatments carried out by skincare specialists can potentially help treat sunspots:
Laser and peels: Laser and peels should only be considered when performed by an experienced medical clinician. There is a risk of scarring or irritation and worsening of any pigmentation if given by inexperienced practitioners.
Cryotherapy: Cryotherapy is a freezing technique using liquid nitrogen to remove sunspots, carried out by a dermatologist. Proceed with caution as lesions may recur.
Microdermabrasion: Microdermabrasion is a treatment that exfoliates your skin on a professional level, by removing the top layer of skin including the sunspot.
Microneedling: Microneedling uses tiny needles to help trigger stimulation of natural collagen production so is used as an anti-aging treatment and has been seen to reduce sunspots.
When to worry about sunspots
Sunspots are harmless but if a pale brown spot seems to be enlarging, areas of darker pigmentation occur, or the skin surface changes make an appointment to see your doctor. Itching, bleeding or pain in a long term existing lesion should always be reported. If in any doubt whatsoever always get it checked out.
Last updated: 15-03-2021
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