Liver spot

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 28, 2016
StartDiseasesLiver spot

Skin is the body’s largest organ. Because it covers the outside of the body, it is easy to see changes, such as when age spots or liver spots develop. They also known as solar lentigines, senile lentigo, and sun-induced freckles.


Definition & Facts

Age spots are tan, brown or black skin blemishes that vary in size. While they are more common among middle aged people and senior citizens, people of any age can get them. They are caused by sun exposure.

Despite that they are commonly called liver spots, these areas of discoloration have nothing to do with the liver. While they may be considered cosmetically undesirable, liver spots are usually harmless and are not a sign of skin cancer.

Symptoms & Complaints

Age spots stand out because they are darker than the skin surrounding them. People with lighter skin are more prone to develop liver spots, but darker skinned people can get them as well. Age spots are usually flat and oval shaped. They can be as small as a freckle or up to one half inch across, and they may clump together. Colors range from tan to brown or black.

Age spots tend to be located in areas of the body that get more sunlight or ultraviolet light, including the face, feet, shoulders, backs of hands, and upper back. Since age spots are harmless, there is no need for medical attention. However, people who find the dark spots unattractive can get medical treatment to remove them or reduce their appearance.

If the spots change in appearance, a doctor can do a visual exam or a biopsy to rule out the possibility of cancer. Changes to look for include a rapid increase in the size of spots, the border shape becoming irregular, and the spot becoming red, itchy, tender or bleeding. Also, one should seek medical advice if, instead of one color, the spot develops an odd color combination.


The main cause of age spots is exposure to the sun’s ultraviolet (UV) rays. When ultraviolet rays touch the skin, they pass through it and destroy skin cells. The ultraviolet light speeds up the production of melanin, or pigment, which is what gives skin its color. Because of this accelerated production of pigment, those cells with extra melanin clump together and the skin tans.

The darker skin then acts as a protector, shielding skin’s deeper layers from further UV damage. Younger skin quickly creates new skin to replace the damaged areas. Older skin reacts differently, developing age spots. Exposure needs to be frequent and prolonged, which is why liver spots are more common in people over the age of 50. These spots are most commonly seen in areas of the body that get the most sun exposure, such as the face and the backs of hands.

Another cause of age spots is tanning lamps and tanning beds which produce UV light. As with sun exposure, the UV lights speed up melanin production, which leads to age spots. Some causes of age spots are unknown.

Diagnosis & Tests

Age spots are easily recognizable, but a doctor is likely to do a visual exam of the skin to get an accurate diagnosis. If there is any doubt about what the spots are, the doctor may do a skin biopsy. A small sample of the age spot is removed and studied under a microscope. This procedure is performed in the doctor’s office with a local anesthetic.

One possible diagnosis, other than liver spots, is moles. They are small spots that have varied colors and size, and they are either elevated from the skin or flat. Seborrheic keratosis is another possible diagnosis. The non-cancerous spots, commonly seen on the face, back, chest and shoulders of older people, are either tan, brown or black. They are slightly elevated and look scaly and waxy.

What looks like age spots could be lentigo maligna melanoma, which is skin cancer. These spots are more like lesions and form in areas of the body that experience long-term exposure to the sun. With irregular shaped edges, the spots are tan, brown or black. Over time, the spots get darker and larger and may be elevated. Whenever a discolored spot on the skin changes in appearance, it is best to call a doctor.

Treatment & Therapy

While treatment and therapy is not necessary, several options are available to lighten age spots or remove them. A doctor can help determine which treatment is best.

  • Skin lightening - Retinoids, mild steroids and hydroquinone, which is found in bleaching creams, help age spots fade. The process usually takes a few months. Side effects includes red, dry, burning or itchy skin.
  • Cryotherapy - Liquid nitrogen acts as a freezing agent and is applied directly to age spots. It destroys the pigment in the liver spot and the skin gradually lightens. Cryotherapy patients risk skin irritation, scars and permanent skin discoloration.
  • Chemical peel - A doctor applies acid to age spots to burn them away. Old skin peels off, leaving new, lighter skin. Chemical peels typically require several treatments to be effects. Side effects include skin irritation and discoloration.
  • Dermabrasion - With dermabrasion, doctor’s use a rapidly rotating brush to sand down the surface layer of skin. New skin grows without liver spots. This treatment may result in temporarily red skin and scabs.
  • Laser therapy and intense pulsed light - Over several sessions, laser and light therapies destroy cells that produce melanin. These treatments do not usually damage skin’s surface. Some skin discoloration may occur.

Prevention & Prophylaxis

When it comes to preventing age spots, the best advice is to stay out of the sun, especially during the middle of the day. The sun’s rays are strongest from 10 a.m. to 3 p.m. If being outside is necessary, one should use a good sunscreen with an SPF rating of 30 or higher, applying about one ounce of sunscreen 30 minutes before going outside so it has time to adhere to skin.

It is prudent to reapply sunscreen every two hours, adding a layer of protection by covering up. It is also advisable to wear sunglasses, a wide-brimmed hat, long-sleeved shirts and pants or skirts.