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dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4069
Experience:  30 years practice in general and cosmetic dermatology
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What procedure is best for age spots? I have them on my face

Customer Question

What procedure is best for age spots? I have them on my face and there are plenty. How do I rid of these?
Submitted: 8 months ago.
Category: Dermatology
Customer: replied 8 months ago.
I said age spots in my question but they are more sun spots I guess. What procedure will get rid of these?
Expert:  Dr. Captain replied 8 months ago.


Welcome to the question/answer interface.

I am a Family Medicine doctor, board certified with active licenses and certification in Internal Medicine, Pediatrics, Obstetrics and Gynecology, as well as Integrative Medicine & Naturopathy, with advanced training in Neurology, Cardiovascular Medicine, Gastroenterology, Endocrinology, and Psychiatry. I am also well-trained in Functional Medicine. For your review, here is my direct link with my current ratings:

I have read your post and observations. I will first provide a summary answer to your question, AND, if you would prefer some additional back-and-forth, with additional questions and more details clarified, I'm more than happy to stay around with you, free of any additional cost to you. You can continue to ask questions and receive answers without additional charges.

Our goal here is for your satisfaction, and I’ll do my best to take the appropriate time to help you.

Expert:  Dr. Captain replied 8 months ago.

Do you have the ability to take a picture of these spots? I would love to be able to direct an appropriate answer to your exact concern. That being said, I'll offer a summary that addresses all of the options for skin concerns which are benign and non-cancerous. The only appropriate way to judge the difference, of course, would be with a physical exam by a clinician, in-person

Expert:  Dr. Captain replied 8 months ago.

"Sun spots" are typically benign nevi, but some people sometimes confuse sun spots for actinic keratoses. Both can be addressed in analogous ways. Here is an UptoDate review of Actinic Keratoses, and how they are defined, and what can be done about them. The same scope of options is available for benign nevi.

What is actinic keratosis? — Actinic keratosis (AK) is a skin condition caused by sun damage. It causes scaly, rough, or bumpy spots on the skin. If an area of skin has more than one spot, the spots are called “actinic keratoses.”

AK is most common in people who:

●Spend a lot of time outside, or did when they were young – People who work outside, such as farmers and lifeguards, have a higher risk of AK.

●Have fair (light) skin and hair

●Have freckles

●Sunburn easily

●Cannot get a tan easily

AK is more common in older people. This is because sun damage builds up over time. Both men and women get AK, but it is more common in men. AK is not common in people with olive-colored or dark skin.

Having one or more painful sunburns in your life raises your risk of getting AK.

Common places for AK include the:

●Scalp, in people who are bald or losing their hair


●Side of the neck

●Backs of the hands and forearms

●Legs or feet, especially in women

What are the symptoms of actinic keratosis? — AK looks like an abnormal area of skin. The area of skin can be:

●Red and swollen

●Thick, crusty, or scaly

●Smooth and red

●Sticking up, pointed, and hard like a finger nail

One kind of AK can happen on the lip. It can cause a rough, dry, or scaly spot. The lip might also crack or get a sore on it.

Should I see a doctor or nurse? — Yes. Show your doctor or nurse any changes in your skin. AK can turn into a form of skin cancer called “squamous cell carcinoma.”

Is there a test for actinic keratosis? — No, there is no one test. The doctor or nurse will do an exam and check your skin. He or she can usually tell if you have AK by looking at any skin changes and touching them.

If the doctor is not sure whether AK is causing the skin changes, you will have a test called a biopsy. You might also have a biopsy if a spot is hard, bleeding, growing quickly, or larger than a certain size.

During a biopsy, a doctor takes a small sample from the abnormal area of skin. Or he or she takes out the whole area. Then another doctor looks at the skin under a microscope to check for skin cancer.

The doctor can also do a different test. In this test, he or she looks at the skin with a small microscope that has a light on it. The doctor holds this over the area with skin changes. The microscope and light help the doctor see under the skin. It can help show if a spot is an AK or something else.

How is actinic keratosis treated? — A few people have AK that goes away on its own. This usually only happens in younger people. Most AK needs treatment. The spots can grow, spread, and turn into skin cancer.

The right treatment depends on the size of the AK, where it is on the body, and whether there are one or more spots.

Doctors can:

●Freeze the AK off with a special cold liquid (called liquid nitrogen)

●Do surgery to remove the AK

●Give a strong cream or gel to put on the AK – The medicine in the cream or gel can get rid of the AK. If you have an area of skin with several AKs, the doctor might tell you to put cream or gel on that whole area.

●Remove the AK with a strong chemical

●Do therapy with lights – In this treatment, a doctor puts cream on the skin. This makes it sensitive to a special kind of light. Then, he or she shines the special light on the skin. This reacts with the cream to get rid of AKs.

What happens after treatment? — After treatment, you need to be checked to see if the AK comes back or you get more AKs. The doctor will do an exam and check your skin for changes. You should also keep checking your skin for any new changes. Show any changes you find to your doctor or nurse.

Can actinic keratosis be prevented? — Yes. You can help prevent AK by protecting your skin from the sun. To lower the chance of getting AK, you can:

●Stay out of the sun in the middle of the day (from 10 a.m. to 4 p.m.).

●Wear sunscreen – An SPF of at least 30 is best. The SPF number is ***** the sunscreen bottle or tube.

●Wear a wide-brimmed hat, long-sleeved shirt, long pants, or long skirt outside.

●NOT use tanning beds

Even if you already had treatment for AK, protecting your skin can help keep you from getting more.

Customer: replied 8 months ago.
I have taken a photo. Where do I send it?
Expert:  Dr. Captain replied 8 months ago.

if you load it onto your computer, you can attach to the writing dialog with the "paper clip" icon above the box where you type.

Customer: replied 8 months ago.
Can you open? It's titled spots.
Expert:  Dr. Captain replied 8 months ago.

I have just received it, opening now. Thank you!

Expert:  Dr. Captain replied 8 months ago.

These look like benign nevi. They would be addressed with the same options I listed above, the freezing, surgical removal, or some of the creams that are called Keratolytics. I have found that light therapy is less useful for these than for AKs.

Customer: replied 8 months ago.
not a laser peel or anything like that? They are all flat so I don't want to do surgery. That would just leave scars. I really would like to lighten them up. I was in the sun alot when I was younger and tanning beds in my early 20's.
Expert:  Dr. Captain replied 8 months ago.

I see! Laser dermatology surgery can have mixed results. Depending on the practitioner, the laser, and the patient, some people have great results with minimal effort and pain, and some people have scarring that is worse than the initial lesions. There is really no standard of care yet, and no way to know where you would fall. I typically don't recommend that as a first option. I would probably recommend cryotherapy as a first option. Freezing tends to cause local blistering that makes things look worse temporarily, and then they vanish, almost miraculously!

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