Dermatologist Dr Vanessa Lapiner imparts some valuable advice on how to avoid or get rid of your unsightly liver spots.
Ageing is a privilege but – as my patients keep telling me – it’s not for sissies! The skin changes with time and you might notice some weird and wonderful spots popping up – from the more serious skin cancers to easy bruising, senile warts or barnacles and little blood vessel growths called cherry angiomas.
Liver spots are those large brown spots which manifest in areas of your body which have been exposed to the sun: most commonly over the hands, face, decolletage and upper back. They can be a pale tan colour or very dark and can range in size from a few millimetres to several centimetres.
Why do we get them?
Liver spots have absolutely nothing to do with the liver.
They have EVERYTHING to do with the sun.
The correct name – solar lentigos – tells us that they are caused by too much UV exposure. When UV rays hit the skin, they cause DNA damage. The skin tries to increase its own self-protection against these UV rays by sending signals to its pigment-producing cells (the melanocytes) to make more pigment to absorb the UV rays. Over time, these little clumps of pigmentation called liver spots will appear as if to say: “Remember those sun-soaked days on Clifton Beach? Here’s a not-so-little memento.”
Is it safe to get rid of them?
It is critical to make sure what the brown spot is before trying to get rid of it. For instance, a lentigo maligna – a form of a malignant melanoma looks very similar to the garden-variety liver spot. It’s not advisable to treat any brown mark on the skin without knowing for certain what it is.
Copy that – it’s definitely a liver spot. Now how can we get rid of it?
If your liver spots are bothering you, there are many ways to remove them. The choice of method will depend on how many spots you have, your budget and how dark your skin phenotype is (the darker your skin type, the gentler the treatment needs to be).
What you can do at home
Home-care rules are the same for everyone. If you are treating any type of pigmentation, all treatments start with prevention.
- Keep your skin out of the sun: seek shade, wear hats and sun-protective clothing. If you drive a car, consider tinting your car windows or popping on a pair of gloves to protect your hands (I’m willing to bet you that your right hand and forearm have more spots than your left!)
- Put on enough sunscreen. Most of us are not putting on sunscreen every single day come rain or shine. And if you are, then you may not be putting on enough (think half a teaspoon for the face and neck) or you may be forgetting to reapply it every four hours if you’re not in direct sunlight and two hourly if you are in direct sunlight. If you are not applying sunscreen religiously, you will be wasting your money on any pigmentation treatment. As a bonus, look for a tinted sunscreen containing iron oxide which gives you extra protection against visible light.
- Apply a daily antioxidant to boost the efficacy of your sunscreen. UV (particularly UVA) is the villain when it comes to pigmentation and antioxidants are your superheroes. Look for ingredients such as Vitamin C, Resveratrol and Niacinamide. These do double duty as both antioxidants and skin-lightening ingredients.
- Incorporate specific anti-pigmentation skincare actives. There are a group of skincare ingredients called tyrosinase inhibitors which block the pigment pathway. From prescription options such as hydroquinone to over-the-counter options such as cysteamine (called Cyspera available now in South Africa at many aesthetic or dermatology practices) or others such as tranexamic acid, kojic acid, liquorice root extract, azelaic acid, thiamidol – there are many outstanding options available.
- Use a retinoid at night. Retinoids are like your skin’s personal renovation team: they speed up the rise of older, pigmented skin cells to the surface to be exfoliated while also dialling down pigment production by telling the pigment cells to chill out.
- Exfoliate twice weekly to lift away the pigmentation. Get rid of the skin cells carrying the clumps of excess melanin by exfoliating. Go for chemical exfoliation (glycolic acid or lactic acid containing products for example) over physical scrubs which can irritate the skin and actually exacerbate your pigmentation.
- Boost your UV protection from the inside out. Certain nutraceuticals such as polypodium leucotomas or carotenoids can increase your inherent defence against UV rays while others can actively target the pigmentation pathway (e.g. glutathione or French bark extract).
What you can do in practice
Your aesthetician or dermatologist will guide you in terms of which treatment is most appropriate. If there is a single solar lentigo in a lighter-skinned patient, then cautious cryotherapy (liquid nitrogen therapy) is an option. If there are many spots, then IPL or BroadBand Light therapy, lasers such as NanoLaser peels or Q-switched Nd:YAG, chemical peels with or without microneedling or mesotherapy would be better solutions.
Although my primary role as a dermatologist is to keep my patients safe and to make sure there’s nothing sinister going on with their skin, I also help them backpedal years of sun damage and the resulting unwelcome souvenirs on the skin. Ageing might be a privilege but you’re no sissy for wanting all its relics gone!
MBChB, MSc Med (Cell Biology), FC Derm (SA).
Dr Vanessa Lapineris a dermatologist based in Cape Town with key interests in integrative dermatology, mole mapping and dermo-cosmetology.Her research interests include pigmentation disorders, the gut: brain: skin axis, nutrition as a therapeutic tool in dermatologic disease management,healthy skin metabolomicsand cosmeceutical formulation technologies. She is the founder of TASH360, South Africa’s first integrative dermatology centre offering cutting-edge technologies and advanced diagnostic testing, as well as root4:high-performance, results-driven skincare and nutraceuticals marrying advanced science and safety. She is an active member of the DSSA, the SASDS,the VSSA and the Xeroderma Pigmentosum Society.
Click here to get an online consultation with Dr Vanessa Lapiner via the Dr. Derma Platform, Africa's LargestOnline Dermatology Provider.
- Dr Vanessa Lapinerhttps://www.aestheticappointment.co.za/author/dr-vanessa-lapiner
- Dr Vanessa Lapinerhttps://www.aestheticappointment.co.za/author/dr-vanessa-lapiner
- Dr Vanessa Lapinerhttps://www.aestheticappointment.co.za/author/dr-vanessa-lapiner
- Dr Vanessa Lapinerhttps://www.aestheticappointment.co.za/author/dr-vanessa-lapiner
