As we age we accumulate all sorts of damage to our skin. Some, like sun spots, are avoidable; and others, like seborrheic keratoses (noncancerous growths), are not.
Treatments for these types of age spots vary in effectiveness, cost, and rate of complications. However, removing these lesions is not the only aspect to consider. Many other skin lesions can mimic these benign types of spots, and a dermatologist who can sort them out is the best place to start.
Once the type of growth has been established, he or she can discuss what treatment makes the most sense for you. During the same visit, any lesion that is suspicious may be removed for a biopsy.
I have found several skin cancers hidden amongst the various age spots. One caveat for treating these: They are considered cosmetic by insurance companies and Medicare and patients are responsible for payment.
The most common “age spot” in men and women over age 45 are freckles or lentigines. These spots, also known as “liver spots” are the result of sun damage and genetics. I often see them on the backs of the hands where they give away aging even if the patient has had facial rejuvenation.
To treat these, I recommend liquid nitrogen, chemical peels, intense pulsed lights, or laser treatment. There are many differences among these treatments and before undergoing any of them, it is important to understand the risks, costs, and need for multiple treatments associated.

Age Spot Treatments
Liquid nitrogen works by freezing the skin and since the pigment cells are more susceptible to freezing, typically works more on the dark cells than on the normal ones.
Application may be with a Q-Tip cotton swab or with a canister that dispenses the nitrogen. The Q-Tip is gentler but may not be adequate for treating several large lesions.
Following treatment with nitrogen, the skin will crust or blister and gradually new skin grows. Usually there is minimal scarring with this procedure, but be aware that the skin underneath any dark spot will be lighter than adjacent skin because it has not seen the sun.
Chemical peels are a tried-and-trusted method of treating flat age spots. Various types of chemical peel acid include salicylic, trichloroacetic, and several others. Higher strength acids may be applied in one session, while moderate strengths require several visits.
Multiple, milder treatments are preferable because stronger treatments are associated with more complications, such as scarring. I use Theraplex Salicylic Acid peels on the hands, neck and face.
Intense pulsed lights (IPL) use broad spectrum light that is absorbed by various pigments including brown and red. Unlike lasers, which emit a single, high-energy light, these devices emit various colored lights.
They are able to treat flat brown spots but are not good for raised lesions and are also able to treat red vessels. Typical treatments involve three to five visits and may cost $300 to $500 per visit depending on the amount of area treated.
As with any procedure, the effectiveness depends on the device used (some are better and more expensive than others) and the energy levels used.
If you have been treated with IPL and it did not work, you may want to inquire about the type of device used and energy levels. While very high energy levels are not safe (especially for skin that is olive or dark), low levels are not going to be effective.
Lasers are intense light beams that are one wavelength and therefore each has its own specific treatment goal. They are expensive devices and most practices will not have more than one or two. Therefore, finding a doctor who has the right laser to treat age spots is the first step for those that want to embark upon this treatment.
For brown spots, there are two lasers that are widely used: the Nd:YAG and the alexandrite. Both focus energy on the pigment in the skin and vaporize it. One potential problem is that they see the pigment in surrounding skin and can lighten it as well.

No matter what type of treatment you decide to do, be realistic about the treatments and don’t expect the spots to disappear overnight. If you begin a treatment and it doesn’t work, speak with your doctor about alternatives. Some practices will refer you to a physician who has a particular device that may be suited to your needs.
Many dermatologists offer cosmetic treatments for age spots, so don’t be afraid to inquire. Once they are gone, you will look and feel better.

To learn more about Dr. Beer, visit www.idealskin.com and www.palmbeachcosmetic.com.