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Image showing sun spots on the forehead

Sunspots, Lentigines, and Pigmentation at Pure Dermatology

Sunspots or age spots are unsightly tan-black splotches that arise on the face, neck, chest, and arms as people age. Also called lentigines or liver spots, they are sharply defined, rounded, brown or black, flat patches of skin that may appear alone or in clusters.

Other types of pigmentation include post-inflammatory hyper-pigmentation, familial pigmentation on the cheeks, under eye circles, and melasma. These types of pigmentation often more difficult to treat than sunspots. More information about these types of pigmentation can be found here.

Lentigines (singular lentigo) or sunspots usually worsen with age and typically occur on sun exposed sites or areas of prior sunburn. Sunspots are often easy to treat once the patient is on regular DAILY sun protection; however, once the melanocytes or skin cells that make pigment are stimulated, a big dose of sun can cause their return.

Because the development of sunspots require repetitive exposure to sun or sunburns, sun spots can also be a sign that you are at risk for precancerous spots (actinic keratoses) and skin cancer. Therefore, if you have any spots on your body, we recommend a skin evaluation.

Common Causes of Sunspots Include:

  • Sun Exposure

    Ultraviolet (UV) light from the sun stimulates the melanocytes, the skin cells that produce pigment. Sun spots often present or worsen in summer because of the increase in UV light exposure.
  • Medications

    Rarely, there are medications that can predispose you to sunburn, worsening lentigines, or pigmentation. It is, therefore, important to wear sun protection DAILY.
  • Skin color or skin type

    Although all people are at risk for sun spots, the lighter your skin tone, the more likely you are to get sun spots. Additionally, a person’s genetic makeup determines their likelihood of developing lentigines. Prevention is key; daily sun protection, seeking shade, and medical grade anti-oxidants are the only way to prevent the development of sun spots.
  • Genetic factors

    There are genetic conditions that can predispose you to lentigines or sunspots which include but are not limited to LEOPARD (Noonan) syndrome, Peutz-Jeghrers syndrome, and Hyperkeratosis-hyperpigmentation (Cantu) syndrome or pigmentation. Some of these have associated cancers and other medical ailments like intestinal polyps. Those with an unusual number of lentigines (especially at a young age) or sunspots clustered in a single location (like the lips), should seek care and diagnosis from a board-certified dermatologist.

Common Causes of Sunspots Include:

Providers at Pure Dermatology select medical grade skincare and procedures tailored to each patient. We offer many safe and effective treatments for sunspots like laser, chemical peels, curettage, cryotherapy, and electrodessication. A series of treatments is necessary for clearance, and maintenance treatment periodically is recommended.

Treating sunspots requires a partnership with the patient and a dedication to sun protection and safe sun practices. Strict sun protection and habitual skincare is critical to preventing lentigines.

Our providers, Dr. Holcomb, Dr. Haseltine, and Cherie Albro, NP, offer a variety of prescription and medical grade topical options for fading and eliminating sunspots. These treatments provide additional benefits to improve the appearance and texture of your skin, such as softening wrinkles and tightening the skin. We help you choose the most efficient and effective way to treat and prevent sun spots and feel comfortable treating lentigines in even the darkest skin.

Medical grade topical treatments are critical to prevent and treat brown discoloration and sunspots in a safe and healthy way. While laser treatment is the optimal treatment for quick treatment, topical skincare is the cornerstone of prevention and maintenance of healthy skin. DAILY SPF is necessary for anyone interested in the treatment and prevention of sunspots or lentigines. We offer and help select medical grade cosmeceuticals specific to your skin needs like skinbetter science, Heliocare, GliSODin, SkinMedica, and Revision Skincare. Nurse Practitioner Cherie excels in helping you to find your best and favorite SPF, the most important step in sunspot treatment, and in designing your customized skincare plan. Sunspots will return within 1 year if you do not have an effective topical skincare plan in place.

Enlighten Laser is the treatment of choice for age spots and sunspots may be used in some forms of hyperpigmentation. It also gently tightens and refreshes the skin. There are 2 portions to the Enlighten laser treatment, a directed spot treatment of sunspots which flake away over 5-7 days and the PICO genesis laser toning which further clarifies and brightens skin and improves wrinkles. This laser takes about 20 minutes and it is a minimal discomfort treatment. It does not require numbing medication. The PICO genesis is a favorite at Pure Dermatology as there is minimal to no downtime or healing time. There is a specific method for treating melasma using PICO genesis that must be directed by our board-certified dermatologists to make sure it is safe for each patient.

Enlighten laser also treats the following skin concerns:

  • Freckles
  • Liver spots
  • Unwanted tattoos
  • Pigmentation or hyperpigmentation
  • Melasma (select cases)
  • Uneven skin tone
  • Mild wrinkles and skin texture
  • Under eye texture
  • Face and body
  • Acne scarring (select cases)

At Pure Dermatology, we offer several peels that are safe and effective for sun damage and solar elastosis. As board-certified dermatologists, Dr. Haseltine and Dr. Holcomb have extensive experience choosing peels that are best for each skin type and need and peels are carefully selected for sunspots and sun damage. Superficial peels often cause minimal dryness to a few days of peeling while deeper peels, often used for sunspots often have up to a week of peeling but leave the skin completely refreshed afterwards and give the most rapid outcome. The cost ranges from $150-$500 depending on the degree of complexity.

Excel V is not the #1 treatment for individual sunspots (see Enlighten laser), but can be used in select patients with poikiloderma or sun damage, especially in those with a red background to their discoloration and often seen on the neck and chest. Depending on your skin type, Dr. Haseltine or Dr. Holcomb may recommend this treatment as part of your comprehensive and unique treatment plan. Treatment costs range from $150-$750 per treatment depending on the area treated.

Excel V also treats the following skin concerns:

  • Rosacea
  • Diffuse redness (red face)
  • Bruising seen after fillers, surgery, or injury
  • Scars
  • Poikiloderma (sun damage)
  • Blue veins under or around eyes
  • Broken blood vessels (Telangiectasias)
  • Acne
  • Acne scarring
  • Large pores
  • Melasma (in specific cases)
  • Folliculitis or hair bumps
  • Laser hair removal in dark skin types 
  • Spider veins
  • Stretch marks (early red color)
  • Leg Veins
  • Cherry angiomas (hemangiomas)

OxyGeneo 3-in-1 Super Facial gently bubbles away damaged skin cells and helps improve cell stimulation. This action can prime the skin for topical treatments. OxyGeneo also oxygenates and infuses nutrients into the skin, revitalizing a dull complexion. This treatment has no downtime and is safe for patients who suffer from sunspots and sun damage.

Radiofrequency microneedling, aka Secret RF, does not completely erase sunspots but it addresses many of the concerns associated with sun damage like wrinkles, skin texture and tone, pore size and neck lines. This type of microneedling has the added benefit of radiofrequency (RF) transmitted as heat into the deep layers of skin resulting in further collagen stimulation and skin tightening. The addition of heat also seals up the blood vessels resulting in no downtime in most patients. Most patients need 3-4 treatments spaced 4-12 weeks apart and 1-2 maintenance treatments per year.

Secret RF also treats the following skin concerns:

  • Acne scars
  • Dull complexion
  • Sun damaged skin or premature aging
  • Scars from injury or surgery
  • Skin revitalization or adding luminosity to the skin
  • Active acne (especially when combined with topicals)
  • Overall skin rejuvenation
  • Stretch marks also known as striae
  • Large pores 
  • Neck lines (necklace lines)
  • Skin tone and texture
  • Fine lines and moderate wrinkles
  • Blackheads
  • Mild skin laxity
  • Crepey skin of the neck, knees, and upper arms
  • Hyperhidrosis (excessive sweating)

This well-established procedure is best for deep pores or ice-pick acne scars. Also known as Chemical Reconstruction of Skin Structures, TCA CROSS is a micro-spot chemical peel using high strength trichloroacetic acid (TCA) which makes acne scars less deep. Dr. Holcomb and Dr. Haseltine each have been performing TCA CROSS for over a decade. Cherie Albro, NP, rounds out our team of providers who use TCA CROSS to treat acne scars. Treatments are performed every 4-6 weeks for 5-8 treatments and have about 1-3 days of downtime. Price ranges from $75-$375 depending on the area and number of scars.

Fillers may be injected into indented or depressed scars to make them less noticeable.  Fillers injected under the scar will make the scar appear smoother. This result is temporary, although can be long-lasting. Generally, lightweight filler is used for an acne scar.

Subcision involves breaking up scar tissue to help soften deep acne scars. Scar subcision involves injecting saline under the skin to stimulate production of new collagen. Dr. Holcomb and Dr. Haseltine each have been performing subcision for over a decade and we recommend 2-4 treatments spaced 6-8 weeks apart. There can be temporary redness and swelling at subcision sites and bruising is likely due to the nature of the depth of scars. If bruising occurs, we offer complimentary treatment with the Excel V laser, which can decrease the duration of the bruise by 66%. Downtime is usually over a weekend and price ranges from $150-$500 depending on the area and number of scars.

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