INTRODUCTION
What are Lentigos/ Age Spots / Liver Spots?
The above terms are all used to refer to a lesion known as a solar lentigo. Solar lentigos are benign harmless brown patches on the skin that are caused by exposure to ultraviolet (UV) radiation. This causes localised multiplication of melanin producing cells and accumulation of melanin within the skin.
What do Solar Lentigos look like?
A solar lentigo is a flat brown well defined patch. They can be round, oval or irregularly shaped and range from a few millimetres to several centimetres in diameter. They can be slightly scaly. They are typically found on uncovered sun exposed skin such as the back of the face and back of the hands. The photos below illustrate the appearance of solar lentigos on the back of the hands and face.
Photos courtesy of Derm Net NZ
Caution
Pigmented lesions must be correctly diagnosed and confirmed as benign prior to treatment. Certain types of dangerous skin cancer such as lentigo maligna and melanoma must not be missed. Dr Hussein will take a history and carefully look at your lesion and examine it with a special instrument called a dermatoscope. If there is any suspicion a biopsy may need to be taken.
TREATMENT
Dr Hussein will often treat these lesions with type of laser called a Q-switch laser. This type of laser is a special type of laser that has a very short pulse width that is adapted to the treatment of pigmented lesions. The 532nm Q-switch laser works very well for the treatment of Solar Lentigos. There will be temporary whitening of the skin immediately after treatment. The treated area then becomes red and mildly raised. In the next few days a superficial crust will form over the treated area. This crust will come off within 7-10 days after the treatment. The underlying new skin will be a little pink in appearance and takes in the region of 6 weeks to normalise.
Dr Hussein has included a video of treatment and some before and after photos so you can see how this treatment works. Occasionally Dr Hussein may opt for a different type of laser such as the Erbium YAG laser. This is sometimes used for a type of benign lesion known as a Macular Seborrheic Keratosis which can sometimes look similar to a solar lentigo. If patients present to Dr Hussein with multiple solar lentigos Dr Hussein may recommend a full-face laser resurfacing treatment such as CO2 laser resurfacing or Fraxel 1927nm laser resurfacing. This will give a much better result when there are many solar lentigos to be treated.
POTENTIAL COMPLICATIONS
Transient darkening (post inflammatory hyperpigmentation) of the treated area can occur in some cases. This is more likely in darker skins (e.g. Asian, Oriental). It may initially appear that treatment has been unsuccessful but this is not actually the case. This type of darkening is transient and unlike a solar lentigo it will lighten over the course of a few weeks. Dr Hussein may even prescribe a cream to speed this process up.
Occasionally a blister may form. This type of blistering is due to separation of the outer layer of skin from the deeper layer of skin. It is not harmful and should heal without scarring.
Demarcation can occur. This is because the skin which forms in the treated area is new. It may be slightly lighter than the surrounding skin. If the patient also has many freckles it is important to note that this patch of new skin may be freckle free and this may be noticeable.
Side effects like scarring and permanent hypopigmentation are extremely rare in this kind of treatment as Dr Hussein is and experienced laser surgeon.
