HEALTH TALK: Getting old, are you?

I realize that over the years, I have not been paying too much attention to those in the older age group, at least not directly, so why don’t I make a start with something quite benign, and gradually progress over the weeks and months?

AGE SPOTS, also called LIVER SPOTS (a misnomer) and solar lentigines, are flat, gray, brown or black spots of various sizes which appear on the face, hands or shoulders and arms. What do these areas of your body have in common, to some extent? They are exposed to sunlight. Although more common in adults over 40, they can affect younger people as well.

True age spots are harmless and don’t require treatment, but they can look like cancerous growths. They can be lightened with skin-bleaching products or removed for cosmetic reasons. But prevention – by avoiding the sun, and especially for lighter skin persons, using sunscreen – may be the easiest way to maintain your skin’s youthful appearance and to avoid these dark skin spots.

SIGNS AND SYMPTOMS

Their appearance has already been described. They typically appear in fair-skinned people but can even be seen in darker skinned individuals. As alluded to just a while ago, age spots occur on skin that has had the most exposure to the sun over the years , such as the tops of feet, face, shoulders, backs of hands, and upper back.

Age spots range from freckle-size to more than a centimeter across and can group together, making them more prominent. Often, they are accompanied by other signs of sun exposure, including:

•    Deep wrinkles
•    Dry rough skin
•    Fine red veins on your cheeks, nose and ears
•    Thinner, more translucent-looking skin.

CAUSES

Ultraviolet (UV) light accelerates the production of melanin, the dark pigment in the skin’s epidermis that gives your skin its normal color, especially people of color. The extra melanin – produced to protect the deeper layers of your skin – creates the darker color of a tan. Age spots develop when the extra melanin becomes “clumped” or is produced in higher concentration than normal.

Most often, it takes years of exposure to the sun for the dark spots to occur – usually they develop very slowly over time.  For very light skinned people and Caucasians who crave a tan, using commercial tanning lamps and tanning beds can eventually result in the same changes.

Besides sun exposure, simply growing older can cause the extra production of melanin and subsequent age spots. Genetics also plays a role in one’s susceptibility to develop age spots.

WHEN TO SEEK MEDICAL ASSISTANCE

They may not be esthetically pleasing, but age spots are usually harmless and don’t require medical care. But your doctor should assess spots that are particularly dark or have changed appearance, because these can be signs of melanoma, a serious form of skin cancer.

Evaluation by a doctor of any new skin changes should be done, especially if a spot or lesion:

•    Is darkly pigmented
•    Is rapidly increasing in size
•    Has an irregular border
•    Has an unusual combination of colors

A biopsy (the removal and examination of tissue) may be done on suspicious areas to make sure cancer is not what we’re dealing with.

SCREENING AND DIAGNOSIS

Often, your doctor can make a diagnosis of age spots by inspecting the skin. If there’s any doubt, other tests, such as a biopsy, may be done. Other conditions that can look similar to age spots include:

•    Moles. They often look like small, dark brown spots, but moles (nevi) vary in color and size. They can be flat or raised and can develop almost anywhere on your body – even between your fingers and toes. Unlike age spots, moles can be present at birth, and often become more permanent with age. Moles may also become darker with repeated exposure to the sun, or as a result of hormonal changes in pregnancy.

•    Seborrheic keratoses. These tan, brown or black growths have a wart like or waxy, pasted-on look and range in size from very small to more than 1 inch across. Seborrhoic keratoses don’t become cancerous, but can resemble age spots, moles or skin cancer.

•    Letigo maligna. This is a type of skin cancer known as lentigo maligna melanoma, that can develop in areas of long-term sun exposure. It starts as tan, brown or black lesions that slowly darken and enlarge. They tend to have an irregular border and uneven coloring and may be slightly raised.

TREATMENT

If you don’t like to see your age spots, treatments are available to lighten or remove them. Since the pigment is located at the base of the epidermis – the uppermost layer of skin – treatments to lighten age spots will need to penetrate through this layer of skin.

Age spots treatments include:

•    Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid cream may gradually fade the spots over several months. Over-the-counter fade creams that contain glycolic acid or kojic acid may slightly reduce the appearance of age spots. Sun protection is strongly advised if you use medication treatments.

•    Laser therapy. This destroys the extra melanocytes that create the dark pigments, without damaging the skin’s surface. Several treatment sessions are usually required, after which age spots fade gradually after several weeks or months. There are few side effects, other than expense.

•    Freezing (cryotherapy). Liquid nitrogen or another freezing agent is applied to the age spots to destroy the extra pigment. As the area heals, the skin appears lighter. Freezing is typically used on a single or small grouping of spots. Although an effective procedure, it poses a slight risk of permanent scaring or discoloration.

•    Dermabrasion. This is sanding down (planing) the surface layer of your skin with a rapidly rotating brush. The skin surface is removed, and a new layer of skin grows in its place. This treatment can result in redness and temporary scab formation.

•    Chemical peel. Age spots can gradually fade with a light or medium chemical peel. Several treatments are necessary before any results are noticed. An acid which burns the outer layers of your skin, is applied to the spots. As the skin peels, new skin forms to take its place. Sun protection is strongly advised after this treatment.

Any of these procedures can have side effects, so discuss them in advance with your doctor. If they can be done in your locale (Dominica), your specialist must be specially trained and experienced in the technique you’re considering.

CAN ONE PREVENT AGE SPOTS?

Minimize your exposure to the sun. I know this is pretty near impossible in our climate, but for most of us who live here, age spots are not much of a problem anyway.  If you must be in the sun for long hours, use a sunscreen with a sun protection factor (SPF) of at least 15, a broad-spectrum one which blocks both ultra violet A (UVA) and ultraviolet B (UVB) rays.

•    Avoid the sun during high-intensity hours. The sun’s rays are most damaging between 10 a.m. and 4 p.m.  Keep this in mind when spending time outdoors.

•    Wear protective clothing. Use long-sleeved shirts, long pants, and wide brimmed hats. And remember, certain styles and fabrics are better than others. Tightly woven fibers are better than loosely woven ones, for example

•    Use sunscreen. This may not seem like something most of us in this country of people who are mostly of African origin would think about. But we do have a lot of sun. So apply sunscreen liberally 30 minutes before going outside, so your skin has the time to absorb it. Then reapply according to the directions on the label, usually about every hour.

See you next week.