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Sunspots, Treatments And Prevention

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Sunspots, Treatments And Prevention
July 04
12:37 2016

Article Highlights

  • A combination of genetic propensity and environmental factors (primarily sun exposure) causes the pigment producing cells of the skin (melanocytes) to increase in number and distribute their pigment (melanin) unevenly
  • Repetitive exposure to the sun continues to stimulate certain melanocytes to grow in number and increase their irregular pigment disposition
  • Topical treatments either act to reduce melanin synthesis by blocking one or more steps in the melanin synthesis cascade or the topical agent increases the rate of breakdown of the melanin, or increases skin cell turnover so that the pigment is lost quicker as the skin cells are sloughed off

Summer is finally here and with it we get to enjoy what we have been yearning for most all winter – long, warm and carefree days spent luxuriating in the sun. But as summer turns to fall and the years go on, you may notice that these glorious moments of this season have left unexpected imprints on your skin – lasting kisses from the sun that are most unwelcome.

What Are Sunspots?
Dr. David Zloty, a dermatologist in Vancouver and president of the Canadian Dermatology Association (CDA), said that the term sunspot can include many skin entities, such as melasma, freckles, benign lichenoid keratoses (lesions on the skin), seborrheic keratoses (skin growths), actinic keratoses (scaly or crusty growths) and lentigos (small brown spots on the skin). However, solar lentigos (liver spots) are the most common change that people refer to as sunspots.

“Why they [sunspots] occur is not fully known,” noted Dr. Zloty. “A combination of genetic propensity and environmental factors (primarily sun exposure) causes the pigment producing cells of the skin (melanocytes) to increase in number and distribute their pigment (melanin) unevenly.”

Repetitive exposure to the sun continues to stimulate certain melanocytes to grow in number and increase their irregular pigment disposition, continued Dr. Zloty. Sunspots generally occur after years of sun exposure; and fair skinned, blue-eyed and red-haired people are usually most susceptible.

Dr. Zloty mentioned that the age sunspots appear varies, and this will depend on factors such as an individual’s hair, eye and skin colour, degree of sun exposure and use of sunscreens and tanning beds.

“In my practice, I have had fair skinned, sun sensitive patients with sunspots and they are only in their late 20s. However, in most patients, they start to appear in the late 30s and are most common in the 50s.”

Additionally, according to the Fitzpatrick skin type classification test, which on a scale of one to five helps identify your risk of photoaging based on your skin type and reaction when in the sun, people with fairer skin who usually burn and never tan (Type I) or usually burn and then tan (Type II) are most susceptible to sunspots and photoaging.

Sunspots, Treatments And Prevention

Sunspots, Treatments And Prevention

Sunspot Treatments: Creams
Topical creams with vitamin A derivatives, such as retinoids like Steiva-A®, Retin-A® and Tazorac®, as well as hydroquinone, kojic acid, niacinamide, vitamin C, ferulic acid, soy proteins and azaleic acid help treat sunspots.

“The topical treatments either act to reduce melanin synthesis by blocking one or more steps in the melanin synthesis cascade or the topical agent increases the rate of breakdown of the melanin, or increases skin cell turnover so that the pigment is lost quicker as the skin cells are sloughed off,” explained Dr. Zloty.

He also maintained that the creams are, for the most part, only partially effective and should be used for several months to see maximal benefits and need to be continued over the long term. Side effects of these creams are minimal, but may include irritation, redness, scaling, in rare cases – allergic reactions and in very rare instances can actually make the spots darker.

Sunspot Treatments: Peels and Lasers
Various chemical peels, along with laser and light devices (intense pulsed light) can be quite effective in treating sunspots, especially for treating larger areas on the body, such as the entire face, chest, back of the hands and forearms, stated Dr. Zloty.

“These devices work by destroying the pigment producing cells or by causing breakdown of the melanin pigment, or by removing the top layer of the skin and then allowing a new skin layer to form,” clarified Dr. Zloty. “In many cases, more than one treatment will be required to achieve the best result, and maintenance treatments once or twice a year are generally recommended.”

He noted that patients should expect some discomfort during treatment, mild to moderate redness and swelling post-treatment.

“With the more aggressive laser treatments, some skin loss should be expected with a “peeling sunburn look,” followed by complete healing in a week. Rarely the devices can cause lighter or darker areas to appear after treatment. Very rarely scarring can occur.”

Physician-directed use of liquid nitrogen or electrodessication can also be helpful for treating isolated sunspots, added Dr. Zloty. These can cause mild swelling, blistering and less commonly, can leave the treated area lighter than the surrounding skin and in rare cases, can cause scarring.

“Patients with very mild sunspots may do well with only one of the topical creams,” maintained Dr. Zloty. “Patients with more pronounced changes will require a combination approach of using the topicals together with a number of treatments with peels or light, or laser devices. This would then be followed by the maintenance use of the creams as well as one or two additional peel/laser/light treatments per year.”

New topical agents and laser, and light devices are being developed at an ever increasing rate to treat sunspots and other photoaging changes, expanded Dr. Zloty. Even though no treatments currently exist that work equally well for all patients, this may occur in the future, summed up Dr. Zloty.

Sunspot Prevention: The Most Effective Method
The easiest way to prevent sunspots is through the regular and liberal use of a SPF 60, broad-spectrum sunscreen that blocks both UVA and UVB rays, emphasized Dr. Zloty. There is also evidence to suggest that regular sunscreen use can lead to a decreased number of sunspots.

“All of the treatments above pale in comparison to the importance of regular use of a sunscreen,” he asserted. “Patients should really not embark on a treatment plan unless diligent sunscreen use is part of the treatment plan.”


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