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You steer clear of midday rays and smear sunscreen all over your body. You use moisturizer daily. But despite your best efforts, you're noticing one of the first signs of aging skin: small, flat dark spots on your hands, chest or face. You may have heard them called "liver spots," but they have nothing to do with your liver. Technically, these changes in skin color are called senile or solar lentigines and they're usually brought on by sun exposure. That's why they're most common on the parts of your body that get the most sun (unless you're a nudist, you're unlikely to find one on your rear end). Although these sun spots usually start appearing after age 40 in people with light skin and become more widespread after 50, they're likely the result of long days at the beach many years earlier.
You probably don't notice the spots in the winter, but they're difficult to ignore at this time of year, when you're wearing your most revealing clothing. It's important to point out these spots generally aren't dangerous. But you should see a dermatologist if a spot starts out as a large tan freckle and then develops black pigmentation or irregular borders. This could be a sign of a type of skin cancer called lentigo maligna melanoma (it represents from 5 to 15 percent of melanoma cases). For more on warning signs of skin cancer, check out this site from the American Academy of Dermatology.
Even if they are medically harmless, sun spots can be a distressing cosmetic problem. Both men and women get them, but dermatologist Susan Goodlerner, a clinical assistant professor at UCLA, says her female patients are the most determined to get rid of them. Sun spots are a little like gray hair—an unwelcome reminder of aging. While you can get rid of the gray with hair coloring, it's not so easy to disguise these spots. They're harder to cover up with makeup than freckles, which appear at much earlier ages and are much lighter and more uniform in color. "Solar lentigines have a larger number of pigment cells and the pigment goes deeper," Goodlerner says.
Fortunately, a range of treatments—from bleaches to laser therapy—can make the spots much less noticeable and can even make them vanish. Many women try bleaching creams first. Over-the-counter products (either in the drugstore or pricier department-store brands) are not as effective as prescription-strength bleaching cream you can get from a dermatologist. Often, these creams are combined with Retin-A. "The Retin-A increases the penetration of the bleaching cream," Goodlerner says, "but it's not always successful or permanent."
The most effective remedy is, not surprisingly, also the most expensive: Fraxel laser treatments or a pulsating laser that has a special attachment to target dark spots. These can cost as much as $1,000 for one treatment. If you only have a few spots, your skin could be clear in just a few treatments, Goodlerner says. "If they have 20 or more, it could take four or five treatments." After a spot has been zapped by the laser, it turns darker and peels off. Lasers used today are much safer than in the past, but side effects are still possible, including occasional changes in skin color around the spot as well as some blistering as the spots heals. To avoid problems, make sure your doctor is well-trained. The American Academy of Dermatology has a "Find a Dermatologist" feature on its Web site. Older treatments—such as peeling agents like trichloroacetic acid—also take off lentigines, says Goodlerner, but they are not as predictable as lasers, which go deeper into the skin.
After the spots fade, you have to be scrupulous about using sunscreen or they'll reappear. Look for products that protect against UVA rays, because those are the rays responsible for pigmentation, Goodlerner says. Specifically, that means using sunscreens with zinc oxide (including the new transparent zinc oxides) or oxybenzone, avobenzone and parsol 1789 as the main ingredients. Among the sunscreens Goodlerner recommends as most effective are Neutrogena Ultra Sheer Dry Touch SPF 55 (which contains avobenzone) and Obagi Nu-Derm Healthy Skin Protection SPF 35 and Blue Lizard Australian Sunscreen SPF 30, both of which contain transparent zinc oxide. (There's also a children's version of Blue Lizard.) Wearing sun-protective clothing also helps; one recent study in the medical journal Lancet indicated it may be more effective than sunscreen in keeping out harmful rays. Although almost any clothing provides some shield from the sun, you might want to look for products treated with UV-absorbing chemicals, such as titanium dioxide. These provide even more protection.
And as you're trying to prevent the formation of more spots, consider all the ways you may be exposing your skin to harmful rays. Goodlerner, who has a private practice in Torrance, Calif., says many of her patients are commuters. "In L.A., a lot of people drive a good distance every day," she says, "and they tend to have more signs of sun damage on the left sides of their faces, because of the sun coming in their car windows as they drive back and forth from work every day." Most car windows block some but not all UV rays; for more protection, you can buy treated windows or install special shades. Finally, avoid indoor tanning salons if you're worried about sun damage to your skin. The American Academy of Dermatology says that these rays can actually be more harmful than natural sunlight. For more on protecting your skin from the sun, visit Medline Plus.