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Liver spots (also known as age spot, solar lentigo, "lentigo senilis", "old age spot", "senile freckle") are
blemish Blemish may refer to: * Acne, skin imperfections * Blemish (album), ''Blemish'' (album), a 2003 album by David Sylvian See also

* Flaw (disambiguation) * Imperfect (disambiguation) {{disambiguation ...
es on the skin associated with
aging Ageing (or aging in American English) is the process of becoming Old age, older until death. The term refers mainly to humans, many other animals, and fungi; whereas for example, bacteria, perennial plants and some simple animals are potentiall ...
and exposure to
ultraviolet radiation Ultraviolet radiation, also known as simply UV, is electromagnetic radiation of wavelengths of 10–400 nanometers, shorter than that of visible light, but longer than X-rays. UV radiation is present in sunlight and constitutes about 10% of t ...
from the
sun The Sun is the star at the centre of the Solar System. It is a massive, nearly perfect sphere of hot plasma, heated to incandescence by nuclear fusion reactions in its core, radiating the energy from its surface mainly as visible light a ...
. They range in color from light brown to red or black and are located in areas most often exposed to the sun, particularly the hands, face, shoulders, arms and forehead, and the scalp if bald. The spots derive their name from the fact that they were once incorrectly believed to be caused by
liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...
problems, but they are physiologically unrelated to the liver, save for a similar color. From the age of 40, the skin is less able to regenerate from sun exposure, and liver spots are very common in this age group, particularly in those who spend time in the sun. In the overwhelming majority of cases, liver spots pose no threat and require no treatment, though they occasionally have been known to obscure the detection of
skin cancer Skin cancers are cancers that arise from the Human skin, skin. They are due to the development of abnormal cells (biology), cells that have the ability to invade or metastasis, spread to other parts of the body. It occurs when skin cells grow ...
. However, despite being a benign condition, liver spots are sometimes considered unsightly and some people choose to have them removed. This can be done by electrosurgery, laser treatment,
cryotherapy Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy can be used in many ways, including whole body exposure for therapeutic health benefits or may be used locally to treat ...
, or the use of depigmentation agents, such as
hydroquinone Hydroquinone, also known as benzene-1,4-diol or quinol, is an aromatic organic compound that is a type of phenol, a derivative of benzene, having the chemical formula C6H4(OH)2. It has two hydroxyl groups bonded to a benzene ring in a ''para' ...
,
tretinoin Tretinoin, also known as all-''trans'' retinoic acid (ATRA), is a medication used for the treatment of acne and acute promyelocytic leukemia. For acne, it is applied to the skin as a cream, gel or ointment. For acute promyelocytic leukemia, ...
, topical cysteamine, azelaic acid, or
alpha hydroxy acids Alpha hydroxy carboxylic acids, or α-hydroxy carboxylic acids (AHAs), are a group of carboxylic acids featuring a hydroxy group located ''one'' carbon atom away from the acid group. This structural aspect distinguishes them from beta hydroxy acid ...
.


Causes

Differently from the melanotic nevi and the verrucous nevi on the skin, age spots change in color and in shape with time. Wang-Michelitsch and Michelitsch propose a hypothesis inspired by their misrepair-accumulation aging theory for the development of age spots. They propose that aged
basal cells The stratum basale (basal layer, sometimes referred to as ''stratum germinativum'') is the deepest layer of the five layers of the epidermis, the external covering of skin in mammals. The stratum basale is a single layer of columnar or cuboida ...
contain
lipofuscin Lipofuscin is the name given to fine yellow-brown pigment Granule (cell biology), granules composed of lipid-containing residues of Lysosome, lysosomal digestion. It is considered to be one of the aging or "wear-and-tear" pigments, found in the l ...
bodies that cannot be removed and might promote the aging of neighboring cells, generating a feedback loop that causes more and more neighbor cells to become aged and contain lipofuscins. Such cells might then aggregate into a spot with an irregular shape. They propose that the protrusion of a flat spot is a result of the death of aged cells in the spot and release of lipofuscin bodies. The aggregating cells would form a capsule, and the dense lipofuscin bodies make the protruding spot soft and dark in color. However, this proposal appeared as a
preprint In academic publishing, a preprint is a version of a scholarly or scientific paper that precedes formal peer review and publication in a peer-reviewed scholarly or scientific journal. The preprint may be available, often as a non-typeset versi ...
in 2015, has little direct empirical support, and has never been published in a
peer review Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work (:wiktionary:peer#Etymology 2, peers). It functions as a form of self-regulation by qualified members of a profession within the ...
ed journal. Another group has reported that "age spots" taken from human skin biopsies of patients facial senile lentigo of Fitzpatrick skin type III or IV aged 55–62 are enriched with senescent fibroblasts compared to surrounding skin. The dark coloration appeared to be due to higher
melanin Melanin (; ) is a family of biomolecules organized as oligomers or polymers, which among other functions provide the pigments of many organisms. Melanin pigments are produced in a specialized group of cells known as melanocytes. There are ...
levels and activity of
tyrosinase Tyrosinase is an oxidase that is the rate-limiting enzyme for controlling the production of melanin. The enzyme is mainly involved in two distinct reactions of melanin synthesis otherwise known as the Raper–Mason pathway. Firstly, the hydroxy ...
in the senescent fibroblasts than in the controls, potentially related to lower SDF1 expression. Patients were then administered six weekly treatments of microneedle fractional radiofrequency aimed at eliminating
dermal The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...
senescent fibroblasts; this led to a marked decrease in epidermal pigmentation compared to baseline, accompanied by a decrease in the synthesis of collagen and the normalization of suppressed SDF1 expression.


Treatment

Treatment for liver spots is almost never done for health-related reasons, though it is sometimes done for cosmetic ones. Skin-bleaching products that inhibit pigmentation or cosmetic creams containing the ingredients
alpha hydroxy acid Alpha hydroxy carboxylic acids, or α-hydroxy carboxylic acids (AHAs), are a group of carboxylic acids featuring a hydroxy group located ''one'' carbon atom away from the acid group. This structural aspect distinguishes them from beta hydroxy aci ...
s or
retinoid The retinoids are a class of chemical compounds that are natural derivatives of vitamin A or are chemically related to it. Synthetic retinoids are utilized in cosmetic formulations, clinical dermatology, and the treatment of some forms of cancer ...
s are known to be effective. Liver spots can also be frozen off with
liquid nitrogen Liquid nitrogen (LN2) is nitrogen in a liquid state at cryogenics, low temperature. Liquid nitrogen has a boiling point of about . It is produced industrially by fractional distillation of liquid air. It is a colorless, mobile liquid whose vis ...
; that is, via
cryosurgery Cryosurgery (with ''cryo'' from the Ancient Greek ) is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. Cryosurgery has been historically used to treat a number o ...
.


See also

*
Freckle Freckles are clusters of concentrated melaninized cells which are most easily visible on people with a fair complexion. Freckles do not have an increased number of the melanin-producing cells, or melanocytes, but instead have melanocytes that ov ...
*
Lentigo A lentigo () (plural lentigines, ) is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. It is a harmless (benign) hyperplasia of melanocytes which is linear in its spread. This means the hyperpl ...
*
List of cutaneous conditions Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the Human body, body and composed of Human skin, skin, hair, Nail (anatomy), nails, and related muscle and glands. The major function o ...


References


External links

* {{Pigmentation disorders External signs of ageing Melanocytic nevi and neoplasms Human skin color