Topical drug treatments for age spots

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A bit of sun may give skin a youthful glow but, over time, too much can leave it looking old.

Photoaging (skin damage caused by the sun) not only contributes to fine lines, wrinkles and leathery-looking skin, but also can cause uneven skin darkening that gives rise to age spots, or solar lentigines (len-TIH-gen-eez) - also called liver spots because of their brownish colour.

These are areas where pigment (melanin) has clumped together, forming dark splotches.

They're most common on sun-exposed areas such as the backs of the hands and parts of the face. Solar lentigines occur occasionally in early adulthood, but mainly after age 40. More than 90% of white people over age 50 have at least one.

The upper layer of the skin (the epidermis) protects itself from the sun's ultraviolet rays by thickening and producing more melanin, the pigment responsible for tanning.

Age spots arise when melanin clumps together after years of sun damage, in much the same way that a callus develops in response to repeated contact and pressure.

Solar lentigines (a single one is called a lentigo) are most common on sun-exposed areas of the body, including the backs of the hands and parts of the face, back, arms, legs, feet and shoulders.

Even without years of sun exposure, some kinds of skin form the small brown spots that we call freckles.

Age spots differ in that they do not typically fade when protected from sunlight and they are often larger in size. Several can mass together and form more noticeable mottled patches.

Age spots are harmless, but they can be unattractive and give skin an older appearance. At one time, the only remedy was to cover them up with cosmetics.

Now, there are therapies that help reverse the signs of photoaging at the physiological level.

One approach is physical removal - by laser surgery, cryosurgery (freezing), microdermabrasion, or chemical peel.

Physical removal can be very effective, but it can be expensive and sometimes has harsh side effects, such as pain and reddening of the skin.

Many women prefer to start with something gentler - topical medications that help fade age spots over time.

Sunscreen first

The first line of defense against age spots is a sunscreen with a sun protection factor (SPF) rating of 30 or higher.

According to Dr. Mollie MacCormack, a dermatologist at Lahey Clinic in Burlington, Mass., the best sunscreens contain one of the following active ingredients: zinc oxide or titanium dioxide in a concentration of 9% or higher, ecamsule (Mexoryl), or helioplex (a proprietary formulation that includes both avobenzone and oxybenzone).

These kinds of sunscreens, she says, "will give you long-lasting protection against UVA and UVB light," the ranges of ultraviolet radiation wavelengths that damage skin. "Regular use of such broad-spectrum sunscreens will vastly increase the response to any prescription medication for photoaged skin."

Mostly by prescription

The topical drugs used in the treatment of age spots work mainly by interrupting melanin formation. Prescription topicals generally do the best job because they have active ingredients in higher concentrations than over-the-counter products.

One downside is that people with sensitive skin may not tolerate them as well.

The most commonly used agents include the following:

Hydroquinone

Many dermatologists consider hydroquinone the best choice for treating age spots. As a prescription drug, it's available in a 4% cream, which is usually applied twice daily. (Over-the-counter preparations may contain up to 2% hydroquinone.)

You can expect to see results in four to six weeks, with the greatest improvement after four to six months. The most common side effect is irritation or reddening of the skin.

Hydroquinone may soon be harder to come by. In August 2006, the FDA proposed a ban on all over-the-counter sales of hydroquinone-based cosmetics because studies turned up evidence that the drug may cause cancer when it is fed to rats and mice.

This is very different from how it is used in humans, and so far, there are no studies showing any increased risk to humans when the drug is used topically. As we went to press, the FDA was still responding to challenges from critics who oppose the ban.

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