FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

LASERS ARE AN EFFECTIVE WEAPON AGAINST "LIVER SPOTS"

Question: I have brown spots on the top of my hands and also on my face. Some of my friends call these "age spots" while others call them "liver spots." One friend says that these spots start on the liver, and medicine is necessary to get them off the liver first. Then, they will come off the skin. Are liver spots also on the liver, and do they do any harm to it?

Answer: "Liver spots" are a skin problem primarily affecting Caucasians, although not unknown in people of other races. These spots - or lesions as we doctors prefer to call them - feature a dark area of pigmentation which is not raised or scaly as occurs in other skin conditions. The lesion differs from a common freckle in that the "liver spot" develops later in life and is generally larger. Freckles also fade after decreased sun exposure, such as over the winter, while "liver spots" do not.

"Liver spots" are purely a skin condition and have nothing at all to do with the liver. I assume the name is derived from the fact that these lesions are about the same color as raw liver. In part because doctors prefer fancy terms and also because it avoids confusion, we use the term "lentigo" to refer to these spots.

Lentigines - the plural of lentigo, for those of you needing to brush up on your Latin - are caused by damage from sun exposure. Therefore, as you would expect, they are most common on the back of the hands, the lower portion of the arms and on the face.

It is generally not necessary to treat lentigines, except for cosmetic reasons, since they do not usually develop cancer within them. However, other cancerous and non-cancerous lesions that also occur on sun-damaged skin can be confused with them. Therefore, I'd advise that you bring your "liver spots" to your doctor's attention to be sure they aren't something more sinister. If they are simply lentigines, then there are two treatments that can improve the appearance of your skin that you may want to consider.

Lentigines can be lightened in color by the regular application of hydroquinone. This medication is sold as a non-prescription drug under several brand names. It works relatively well if it is rubbed into the lesion twice each day for about one month. Exposure to sunlight will bring the dark coloration right back, however. So it is important to use sunscreen products with an SPF of 30 or higher when sun exposure is unavoidable.

Lasers can be used to treat lentigines quite effectively. One or two treatments typically makes the lesion vanish. It takes considerable expertise to wield these "high-tech" tools of medicine effectively, so you will need to see a dermatologist or plastic surgeon if you choose this type of treatment.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.