Solar lentigines (age spots)

Lentigo means resembling a small lentil. True to their name, age spots are usually flat and tan, brown or blackish in colour. They may have a round or oval shape and uneven edges but they are usually well-defined.

Solar lentigos are a sign of photodamage; that is, they are caused when the skin makes more melanin pigment to protect itself against chronic or long-term sun exposure. They, therefore, occur in sites such as hands, lower legs, feet, upper back, neck and the face which are often exposed to the sunlight.

Here's a quick look at the symptoms of age spots:

• Painless spots that are otherwise harmless (caution: experts advise that you get them check anyway, to make sure they are just age spots and not cancerous moles)
• Increased pigmentation that can be oval or round, and tan, brown or black in colour
• Range from freckle size to about half an inch
• Appear on sun-exposed areas
• Have similar texture to the rest of the skin
• Age spots do not go away even if the person reduces their exposure to the sun

The primary cause of solar lentigines is exposure to UV radiation and how it reacts with the skin. Our body makes a pigment called melanin that protects our skin from the sun's UV rays. When someone spends a lot of time in the sun, the production of melanin in their skin increases, sometimes resulting in this hyperpigmentation.

This could happen:

• After indoor tanning 
• Due to sun damage
• Due to sunburn 
• If you are receiving phototherapy

To reduce your chances of developing age spots, reducing sun exposure is the key. The following steps can be followed to do the same:

• Covering up the skin is the most effective way to prevent sun exposure. Wear clothes that cover up the arms and legs. You could also wear a hat.
• Avoid going outdoors between 10 am and 2 pm as the rays of the sun are extremely intense during this time.
• If it is absolutely necessary for you to go out, wear a sunscreen (ideally SPF 50+ broad-spectrum sunscreen). Apply generous amounts 15 to 30 minutes before going out.

A diagnosis of age spots is typically made through physical examination and on the basis of their characteristic appearance.

Even though solar lentigines (lentigo for singular) are harmless, the doctor might recommend a biopsy to rule out skin cancer (melanoma) as a routine procedure. During this test, the doctor will numb the affected area of skin and then remove a small piece of the spot. The tissue will go to a lab to be checked for cancer and other skin conditions and disorders.

Age spots may be left alone as they are not harmful. However, some people may want them to be less noticeable or removed for various reasons. For them, the treatment options available are as follows:

• Freezing/cryotherapy: This technique involves using liquid nitrogen. A swab dipped in nitrogen is applied to the age spot for 5 seconds or less. This will destroy the excess pigment and the skin will appear lighter as it heals.
• Dermabrasion: This is an exfoliating technique which involves a rapidly rotating brush. This sands down the epidermis (top layer) so that new skin emerges in place of old.
• Microdermabrasion: This procedure is slightly more aggressive than dermabrasion. It addresses mild skin blemishes, to give skin a smoother appearance. 
• Laser: Typically requiring two to three sessions, laser or intense pulsed light destroys melanocytes without damaging the epidermis.
• Chemical peel: As the name suggests, a chemical solution or mask is applied to the skin. This results in the removal of the top layer, so smoother skin can emerge from underneath to take its place.
• Medication: These include both oral medication like retinoids, vitamin C as well as applying prescription creams such as hydroquinone.

Keep in mind that each of these treatments has some side-effect, chief among them, increased sensitivity to sunlight. Talk to your doctor before getting any treatments for age spots.

Also, visit a doctor if your age spots change in size, become painful or itchy, bleed or get an irregular outline.