What are age spots? And what causes age spots?
When it comes to the causes of age spots, we will see that most websites paint an oversimplified picture.
Age spots are also called liver spots, aging spots, sunspots, lentigo senilis, old age spots, senile freckles, senile lentigo or solar lentigines.
Age spots are small, flat, darker areas of the skin. They can be found mostly on areas exposed to sun, like the hands, face, shoulders, upper back, and arms. They are often irregular in shape and vary in size. They are very common in adults over 50 (R). Unlike freckles, which are common in children, they do not fade when there is no sun exposure (R).
Age spots versus skin cancer (melanoma)
Age spots are harmless. For that reason, it’s important not to confuse age spots with skin cancer like melanoma.
Melanoma is characterized by spots that have an irregular border, increase in size, and have different combinations and shades of colors (R).
If you have had regular or strong bouts of sun exposure, you are at an increased risk of skin cancer, so it’s important to get checked regularly at the dermatologist.
What causes age spots? And why are most of them on my face and hands?
It is often said, online and in books, that age spots are caused by exposure to too much sunlight.
Sunlight plays an important role, but is only part of the story.
In general, sunlight is very damaging to the skin. Even a short exposure to sunlight damages the DNA in the cell nucleus of our skin cells.
Responding to this DNA damage, skin cells “build” a protective shield around the nucleus to protect it from further damage by UV light. This shield is made up of melanin, a brownish pigment molecule. This causes our skin to look tanned. In other words, getting a “healthy tan” is far from healthy: one gets tanned because there is too much DNA damage going on in the cell nucleus!
Luckily, most of this DNA damage gets repaired. But not all of it. This explains why people who had a lot of sun exposure have older looking, sun-damaged skin. They have more wrinkles, more sagging skin, and more age spots!
Age spots are caused by melanin production that went into overdrive. The melanin has been overproduced, started to clump, and the cells cannot get rid of it anymore. This also explains why age spots are mostly found on regions of the body that had a lot of sun exposure, like the face or back of the hands.
However, the idea that age spots are mainly caused by sunlight is only part of the story. Specific aging processes also play an important role, explaining why age spots become so much more prevalent in elderly people compared to young people (R).
Aging exacerbates the occurrence of age spots. One way is through an important aging mechanism, called “senescent cells”, which arise everywhere in the skin.
Senescent cells are “zombie” cells that stop dividing but keep living on. Senescent cells arise because of too much damage (e.g., caused by the sun, or by aging). They secrete substances that damage healthy surrounding cells. This causes us to age (R,R).
Senescent cells in the blood vessels damage the blood vessels, senescent cells in the liver harm the healthy liver cells, and senescent cells in the skin damage the skin, making it more thin, more wrinkly, and causing age spots.
Senescent keratinocytes (skin cells), and even senescent fibroblasts in the deeper skin layers, secrete substances that upregulate melanin production, which greatly contributes to age spots.
So age spots are not only caused by sun damage, it’s the aging process itself that makes the skin much more susceptible to forming liver spots.
Can I remove age spots?
It’s not easy to get rid of age spots. Sometimes treatments can completely remove age spots (see further down), but this is successful in less than 50 percent of people.
This can be done with bleaching creams containing hydroquinone. However, hydroquinone can irritate the skin and can even cause post-inflammatory hyperpigmentation, especially in people with naturally darker skin.
There are various other treatments to prevent age spots, or make their appearance less noticeable. Keep in mind that it can often take many months to start to see a difference.
1. Tretinoin cream
Tretinoin (a derivative of vitamin A) skin creams can improve the appearance of age spots (R).
2. High-dose vitamin C cream
High-dose vitamin C creams, sometimes combined with kojic acid (a gentle skin peeler – see further on) can also reduce age spots. It’s important that the vitamin C cream is highly dosed, e.g. with 10 to 20 percent vitamin C.
3. Niacinamide cream
Niacinamide creams could also decrease aging pigments.
4. Azelaic acid cream
Azelaic acid can also reduce pigmentation of the skin. Often, it takes many months to see an effect. Interestingly, azelaic acid could perhaps also reduce senescent cells in the skin.
5. Laser therapy or pulsed light treatment
Laser light has specific frequencies, destroying the clumpy brownish melanin that forms the age spots, but leaving other cells intact.
This approach involves sharp tools removing the outer layer of skin. The skin starts to heal itself, which can lead to reduced or removed age spots. It takes several months for the skin to heal and to see an effect.
Microdermabrasion is a “lighter” version of dermabrasion: instead of sharp tools, tiny particles are used to sand away the upper skin layers. It can sometimes work for mild age spots.
8. Chemical peels
Chemical peels are somewhat similar to dermabrasion: instead of removing and damaging the outer layers of the skin with sharp tools, chemicals are used. It can take several months for the skin to properly heal itself.
Liquid nitrogen is used to freeze the age spots.
10. Hydrogen peroxide
Sometimes hydrogen peroxide is used to remove age spots. Hydrogen peroxide is a strong free radical, causing oxidative damage not only to the age spots but also to surrounding healthy cells. We don’t recommend using this approach.
Dermabrasion, chemical peels and cryosurgery can sometimes do more damage than good, causing scarring, darker or lighter spots on the skin, and disappointing results.
Protection against the sun is paramount to prevent further age spots or to make the existing age spots bigger and darker. You can do this by:
Wearing a strong sunscreen (with a SPF of at least 30). If you are worried about not having enough sunlight to convert vitamin D in your skin, just take a vitamin D supplement.
2. Cover your head
Try to wear a hat or cap as much as possible when going outside. You can also use a sun umbrella.
3. Avoid sunbathing
Not go sunbathing between noon and 3 pm, when the sun’s UV rays are the strongest.
4. Cover your body
Cover your body with clothes, like wearing long sleeves or wearing a T shirt while swimming.
5. Avoid tanning beds
Do not use tanning beds. They have been associated with increases age spots, accelerated aging and skin cancer.
If you want tanned skin, use a self-tanner product.
6. A healthy diet
Consuming a healthy diet can also protect the skin against damaging UV light. Olives, olive oil, tomatoes, fruits like pomegranate, green tea, and various vegetables contain substances that protect the skin against UV-damage. Salmon contains astaxanthin, a potent antioxidant that studies have found can potentially reduce UV-damage, and omega-3 fatty acids, which can quell inflammation.
7. Slow down aging
Given sunspots are also caused by aging, it’s important to slow down the aging process. For example, through diet or through longevity supplements like NOVOS Core and NOVOS Boost, which address the 9 causes of aging, including senescent cells.
Additional natural ways to remove liver spots
Some websites recommend natural ways to get rid of age spots, mostly by homemade skin creams that are composed of apple cider vinegar, papaya, onion, lemon juice, aloe, vera, horseradish, onion juice, and so on.
Some of these homemade remedies, like apple cider vinegar, castor oil, buttermilk, lemon juice, onion juice etc. contain acids which could theoretically exfoliate the skin and reduce the appearance of liver spots, but in most cases these treatments have not been tested and sufficiently validated.
A large study looked into natural ways to reduce or remove age spots, and fount that some ingredients did show some potential benefit, such as azelaic acid, ascorbic acid iontophoresis, arbutin, ellagic acid, licorice extracts, niacinamide and mulberry (R,R). There are skin creams that combine azelaic acid and niacinamide.