Sun spots: what they are and how to fade them

Sun spots are the flat brown spots that appear after years of sun, most often on the face, hands and shoulders. They are harmless, but they are also the dark spot most easily confused with skin cancer. This guide explains what they are, how to tell them apart from other spots, and what fades them. It is part of Skinli's guide to hyperpigmentation.

What sun spots are

MedlinePlus, the health library of the U.S. National Library of Medicine, describes sun spots as flat, brown or black spots on areas of skin exposed to the sun. It lists several names for them: liver spots, age spots and solar lentigines. They have nothing to do with the liver or how the liver works.

A sun spot is:

• Flat, level with the skin around it
• Light brown to black
• Painless
• Often oval, in tan, brown or black, per MedlinePlus

MedlinePlus says sun spots are common after age 50. They appear on the skin that has had the most sun over the years: the backs of the hands, the face, the forearms, the forehead, the shoulders and the upper back. They develop most often in people with fair skin, but MedlinePlus says people with darker skin can get them too.

Why the sun causes them

Skin makes melanin, a pigment, to protect itself from sunlight. The American Academy of Dermatology (AAD) explains that when sunlight hits the skin, it triggers the body to make more melanin. Sun spots form on the skin that has had the most of this sun over the years.

The AAD says that every time you go outside without sun protection, or use a tanning bed, ultraviolet (UV) light damages your skin. Over time, this damage builds up and shows as changes such as wrinkles, loose skin and age spots. People who use tanning beds see these changes sooner, often within a few years.

The AAD also says visible light, the ordinary light we see, can worsen dark spots caused by the sun. This is one reason a tinted sunscreen is useful. The pigments in a tinted sunscreen, called iron oxides, help block visible light.

Sun spot or something else?

Several spots that are common with age look similar. The table below compares them using AAD and MedlinePlus descriptions.

Spot	What it looks like	Is it harmful?
Sun spot (age spot, liver spot)	Flat, tan to black, on sun-exposed skin	Harmless
Seborrheic keratosis	A growth that can look warty or like a dab of brown candle wax. Most are tan or brown	Harmless, though it can look worrying
Actinic keratosis	A dry, scaly patch on sun-damaged skin	A pre-cancerous growth. See a dermatologist
Melasma	Brown or gray-brown patches on both sides of the face	Harmless. Linked to hormones and sun. See melasma
Melanoma	A spot that looks different from your others, has uneven edges or colors, or is changing	Skin cancer. See a dermatologist soon

The last row is the reason to be careful. The AAD lists "a spot that looks like a new mole, freckle, or age spot, but it looks different from the others on your skin" as one of the ways melanoma can appear. It also shows melanoma that looks like an age spot and spreads out as it grows.

Check before you treat

The AAD says what looks like an age spot could be skin cancer, so it recommends a skin exam by a board-certified dermatologist before treating age spots. If you use a fading product on a skin cancer, the AAD warns, the cancer can have time to grow and possibly spread.

MedlinePlus says a doctor usually diagnoses sun spots by looking at the skin. If a spot looks irregular or unusual, a biopsy can check for melanoma. A biopsy means taking a small sample of skin to look at under a microscope.

A dermatologist visit can also save money, the AAD says, because many creams for age spots are sold and it is hard to know which ones help. The page on when a dark spot needs a doctor lists the warning signs to look for.

Treatments for sun spots

MedlinePlus says most of the time no treatment is needed. Treatment is a choice for people who want the spots lighter or gone. The AAD describes two groups of treatment.

Creams and lotions

Creams need patience. The AAD says you must apply a cream or lotion once or twice a day for weeks or months to see results. It lists a prescription retinoid applied to the skin among the treatments dermatologists use for age spots.

One well-controlled trial tested tretinoin, a prescription retinoid. In a 1992 study in the New England Journal of Medicine, 58 people applied 0.1% tretinoin cream or a plain cream every day for 10 months. Facial liver spots lightened in 83% of the tretinoin group and 29% of the plain cream group. Spots that disappeared did not return for at least six months after treatment stopped.

A milder strength gave a different result. The FDA drug label for a 0.02% tretinoin cream says it did not show a benefit on mottled dark patches or lentigines in its trials. The retinol and tretinoin page compares the retinoids.

MedlinePlus mentions bleaching creams, most of which contain hydroquinone, and says hydroquinone can cause blisters or skin reactions in sensitive people. Talk to a doctor first. The FDA says no hydroquinone skin lightener is legally sold over the counter in the US, so these creams now need a prescription.

Procedures

The AAD says procedures work faster than creams, but cost more and carry a higher risk of side effects.

Procedure	What the AAD says
Laser treatment	One or two sessions can treat age spots quickly, with longer-lasting results than creams. It can cause crusting or temporary darkening
Cryosurgery (freezing)	A common treatment. Quick but can hurt, and may leave a blister, redness or swelling for a short time. Permanent side effects are rare
Chemical peel	Can treat age spots on the hands. Skin heals faster than after freezing
Microdermabrasion	Smooths away the spots. Works best when combined with a chemical peel
Intense pulsed light	A light-based treatment on the AAD's list for age spots

Creams or a procedure: how to choose

Both options can work, and the AAD describes the trade-offs plainly.

Creams cost less and carry fewer side effects, but they ask for discipline. You apply them once or twice a day for weeks or months, and you keep using sunscreen the whole time. Some people need a prescription-strength cream to see a change.

Procedures work faster and cost more. The AAD says one or two laser treatments can treat age spots quickly, with results that usually last longer than a cream's. They also carry a higher risk of side effects. After freezing, for example, the AAD lists possible permanent changes: a darker spot, lighter skin around the spot, or a scar. It adds that these are rare when a board-certified dermatologist does the treatment.

A dermatologist can tell you which option suits your skin. The AAD says a board-certified dermatologist can tell you whether a prescription-strength cream or a procedure would work better for you, and can create a plan for your own spots. In its directory, the AAD suggests choosing the specialty Cosmetic Dermatology.

Sun spots on darker skin

Sun spots are most common on fair skin, but MedlinePlus says people with darker skin can get them too. On darker skin, spots from other causes are also common, such as marks left by acne and melasma. That makes an exam more useful, because each type needs different care. The dark spots on darker skin page covers the extra steps, including why procedures need a dermatologist who often treats skin of color.

How to stop new sun spots

The AAD says age spots can return after any treatment, and that sun protection prevents this. MedlinePlus and the AAD give the same steps:

• Seek shade, and avoid the sun at midday when it is strongest.
• Wear a wide-brimmed hat, a light long-sleeved shirt, pants and sunglasses with UV protection. The AAD says clothing with an ultraviolet protection factor (UPF) label gives more protection.
• Put a broad-spectrum sunscreen of SPF 30 or higher on all skin that clothing does not cover. MedlinePlus says to apply it at least 30 minutes before going out and to reapply often.
• Use sunscreen on cloudy days and in winter. The AAD says up to 80% of the sun's harmful UV rays can pass through clouds.
• Skip tanning beds.

For more ways to fade spots on the face, read how to get rid of dark spots on your face.