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Published on November 13, 2007

Liver spots or brown spots are caused by the sun. Either you haven't worn enough sunscreen, or you have sun-sensitive skin.

A mild chemical peel can help to reduce their visibility. Bleaching creams may be effective in lightening some pigmentation on the face.

Lasers can be used on liver spots, but the results are variable. But, neodymium-doped laser treatment does an excellent job. In most cases the spots can be totally removed and in others they can be effectively lightened and minimised so they are less noticeable.

However, there is a chance of recurrence, especially if you are exposed to the sun.

You can prevent them occurring with sunscreen.

A sun-protection factor of between 15 and 30 is recommended if you work in an office and between 30 and 60 if you work outdoors.

I get lots of brown spots. Does that mean I'm likely to get skin cancer?

"Brown spot" is used so loosely it's often unclear. There are three conditions that people tend to call brown spots.

The first is freckles. Freckles are small flat brown spots on the face and other sun-exposed areas. They are most often seen in fair-skinned people, especially those with red hair, but they are an inherited characteristic that sometimes affects darker skin types as well. Freckles are more prominent in summer and fade considerably in winter as the cells which accumulate pigmentation are replaced by new ones.

As people age, freckles generally become less noticeable. Apart from sun protection, you don't have to treat freckles. Nevertheless, many women want to.

The second type is "age spots" or "liver spots". Liver spots are larger flat, brown or black spots arising on the face and hands in middle age. Dermatologists call these solar lentigo. They are caused by cumulative sun exposure and darker because they are filled with excess melanin pigment which is our skin's defensive against the sun. If the colour is patchy and diffuse, it could be "melasma". In addition to sun exposure, female hormones worsen melasma, especially during pregnancy (also called pregnancy mask) or when taking oral contraceptives.

Unlike freckles, liver spots and melasma are frequently seen in Asian people or those with dark skin and they tend to persist for long periods and don't disappear as a person ages. The good news is that liver spots and melasma are harmless and can be lightened or minimised.

Thirdly, if the brown marks are scaly, they may be sun damage or solar keratose. However, if the lesion is thick, waxy and wart-like, it takes the name seborrheic keratosis.

These brown marks can also be faded or removed by chemical peels or lasers. Continued careful sun protection is essential because the pigmentation is likely to recur. However, these pigment lesions will rarely become cancerous.

If there is any doubt whether you have a cancerous brown mark - for example, if a lesion seems to be growing rapidly and has irregular pigmentation, or develops a sore - you should see a dermatologist for an examination.

Thanisorn Thamlikitkul, MD, is a member of the American Society of Cosmetic Dermatology and Aesthetic Surgery and qualified in dermatological laser surgery. Send your questions to info@romrawin.com. Her column appears twice-monthly on the Fashion and Beauty page.       

BY THANISORN THAMLIKITUL, MD

The Nation