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What Doctors Don't Tell You

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October 2020 (Vol. 5 Issue 7)

Age spots

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Age spots image

Q) I am 53 years old and have countless age spots covering my face, neck and hands

Q) I am 53 years old and have countless age spots covering my face, neck and hands. Are there any safe, effective ways to get rid of them?-J.K., via e-mail

A) Age spots-also known as liver spots, sun spots and solar lentigines-are flat brown or black lesions caused by an increased number of pigment-producing cells in the skin. They are thought to develop in response to long-term exposure to the sun and other forms of ultraviolet light (such as tanning beds), although just growing older can also cause this skin 'hyperpigmentation' to arise.
Although harmless, age spots can sometimes resemble cancerous growths, so have any suspicious marks checked out by a doctor. True age spots require no treatment, but a variety of options are available for those who wish to be rid of them for cosmetic reasons.

Conventional treatments
- Skin-lightening creams. The topical agents commonly used to treat age spots are hydroquinone, retinoids and azelaic acid. Although effective, most require long-term use and come with a host of unwanted effects, ranging from mild inflammation and peeling to permanent skin dis-coloration. Hydroquinone (a phenol) is the main ingredient to watch out for. As well as causing ochronosis-a permanent, ripple-like, sooty pigmentation-it's also been linked to cancer (J Drugs Dermatol, 2004; 3: 668-73; J Cosmet Dermatol, 2005; 4: 55-9).
- Laser therapy. Pigment-specific lasers have been used to treat age spots. They act by thermally injuring the epidermis (skin surface) to remove the pigmented lesions (Dermatol Nurs, 2004; 16: 401- 16). The frequency-doubled Q-switched Nd:YAG laser appears to be among the most effective, giving the best results with the fewest side-effects in one study (Arch Dermatol, 2000; 136: 841-6). Nevertheless, the side-effects of laser treatment are not insignif-icant, and include skin atrophy, hypertrophic scarring (red, raised lumps on the skin) and, ironically, hyperpigmentation (J Drugs Derma-tol, 2004; 3: 668-73).
- Cryotherapy. As the skin's pigment-producing cells (melano-cytes) are vulnerable to cold, cryotherapy-which uses liquid nitrogen to freeze and destroy skin lesions-can be effective for age spots. However, side-effects to consider include pain, inflamma-tion and permanent lightening of the skin (hypopigmentation) (Dermatol Nurs, 2004; 16: 401-16).
- Chemical peels. Superficial and medium-depth peels using tri-chloracetic acid (TCA), glycolic acid and salicylic acid can successfully fade age spots. They work by dissolving the skin's surface, allowing new, more youthful-looking skin to grow in its place. Although the results are impressive, particularly when used in combination with topical therapy, possible complications include infections, scarring, pore enlargement and spider veins (J Drugs Dermatol, 2004; 3: 668-73).

- Light therapy. Although perhaps slightly less effective than lasers (Ann Plast Surg, 2007; 59: 479-83), intense pulsed light (IPL) may be a safer way of treating age spots. In one study, 23 patients with age spots had "good to excellent results" after just four sessions-with no significant side-effects (J Cutan Med Surg, 2008; 12: 107-13).
- Chinese medicine. In a controlled study of 61 patients with chloasma-a problem similar to age spots-Chinese herbs and acupuncture plus oral supplemen-tation with vitamins C and E, and topical applications of quban (whitening) powder, were signif-icantly more effective than using vitamins and quban powder alone, leading to improvement in 100 per cent of cases (Chin J Integr Med, 2007; 13: 219-23). A qualified practitioner of Chinese medicine should be able to advise you on the treatment that's best for you.
- Glucosamine. Better known for treating arthritis, glucosamine is also promising for fading age spots and other forms of hyperpigmen-tation. In a spilt-face clinical trial, topical 2-per-cent N-acetyl glucos-amine (NAG) reduced facial hyper-pigmentation after eight weeks. The results were even better when NAG was used along with 4-per-cent niacinamide (vitamin B3) (J Cosmet Dermatol, 2007; 6: 20-6). Both ingredients can be found in the Definity range from beauty brand Olay.
- Plant extracts. Other natural ingredients are proving useful as skin-lightening agents. Look for creams that contain arbutin, aloesin, flavonoids (particularly hesperidin), liquorice, proantho-cyanidin-rich grape seed extract and polyphenols (J Investig Dermatol Symp Proc, 2008; 13: 20-4; Phytother Res, 2004; 18: 895-9).
- Vitamin E. Oral vitamin E supplements have improved facial hyperpigmentation in some cases (Pigment Cell Res, 2000; 13 Suppl 8: 170-4). As it also offers protection against future UV-induced skin damage, vitamin E may also help to prevent new age spots from forming (Drug Metab Rev, 2000; 32: 413-20). It may be best to take it with other skin-protective anti-oxidants such as vitamin C and beta-carotene (Skin Pharmacol Appl Skin Physiol, 2002; 15: 307-15).

Preventing age spots

- Avoid the sun between 10am and 4pm, when the sun's rays are particularly damaging
- Wear protective clothing, such as long-sleeved shirts and wide-brimmed hats, whenever you're in the sun
- Use a non-toxic sunscreen, such as those offered by Green People and Weleda.

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