Why Do We Get These Spots, Anyway?Surprise: Age spots aren't caused by getting older. Instead, you can blame them (and nearly every other form of unwanted pigmentation) on what's become the 21st century's public enemy number one: the sun. "Sunshine is an attack on the skin, and one way the skin defends itself is to make pigment," explains Ranella Hirsch, M.D., a cosmetic dermatologist in Cambridge, MA, and president-elect of the American Society of Cosmetic Dermatology & Aesthetic Surgery. If a patient is skeptical about her spots being solar related, Dr. Hirsch asks her to move her bra over a quarter of an inch to expose the skin that the sun never hits. "And then she sees what I mean," she says. "If these changes really came from aging, you'd have them all over."
There's one way in which age spots are truly associated with passing years: The older most people get, the greater the amount of sun damage they've accumulated, so the spots are more numerous and more visible. "That's why sunscreen and sun avoidance are key to any therapy you try," says Debra Wattenberg, M.D., assistant clinical professor of dermatology at Mount Sinai Medical Center in New York City.
Why Don't All Spots Look the Same?
Even though most spots are caused — or exacerbated — by the sun, they take different forms. See a dermatologist if a new kind of skin change shows up (to rule out anything dangerous such as melanoma), but here's a guide to help you determine what's what.
Freckles: These are small tannish spots that are usually less than half a centimeter. They may come and go, fading in the winter and darkening in the summertime.
Lentigines: Known as age or liver spots, these small-to-medium brown areas multiply as you get older, popping up most often on the face, hands, and chest — all places with maximum exposure to sun.
Uneven skin tone: Rather than a few specific spots, this involves larger areas of pigmentation that make your skin look darker in some areas, lighter in others.
Post-inflammatory hyperpigmentation: These are dark spots that develop after pimples, bug bites, or other flare-ups, and then stubbornly remain long after the initial inflammation has healed.
Melasma: More patchy than spotty, these brown outbreaks are hormone related, so they are likeliest to appear (on the cheeks, forehead, and around the lips) when a woman is pregnant or taking hormone replacement or birth control pills.
How Can I Treat Spots at Home?
Try hydroquinone. This bleaching agent, available in department and drugstores or by prescription, works by interfering with an enzyme that helps your skin produce melanin, the brown pigment that shows up as spots. (Dr. Hirsch recommends using hydroquinone in conjunction with a prescription-strength retinoid, such as Renova or Tazorac, which helps lighten by exfoliating the skin.) "Hydroquinone is the gold standard for pigmentary disorders," says Rebat Halder, M.D., professor and chairman of the department of dermatology at Howard University. Look for it over the counter in concentrations up to 2 percent; prescription versions will usually have 4 percent.