DEAR DR. GOTT: I am 83 years old and have developed an appreciable number of dark spots on my face over the past few years. I read laser treatment might remove them, but unfortunately my insurance company won’t cover the procedure. Is there an alternative method for this cosmetic condition?
DEAR READER: Actinic keratoses (age spots) are one unfortunate development that affects many people as they age. The lesions most often appear on the backs of hands, faces and arms. They and are generally harmless unless they markedly change in appearance; that is, they darken, enlarge, or bleed.
You have several options at your disposal. However, as you indicated, cosmetic surgery is frowned upon by most insurance companies as unnecessary.
To begin with, there are over-the-counter creams containing glycolic acid that can fade spots.
Prescription bleaching creams containing hydroquinone can be prescribed. These creams can be used alone or in conjunction with retinoids and a mild steroid that can work toward fading the lesions. This treatment may take several months before any positive effects are noticed.
Dermatologists can use a freezing method known as cryotherapy that applies liquid nitrogen or other freezing agents to the spots. The procedure can pose a slight risk of permanent scarring or discoloration.
Another procedure known as dermabrasion can sand down the surface layer of the skin with a rapidly rotating brush. Temporary redness and scabbing can occur following dermabrasion.
Chemical peel can gradually fade spots. This procedure involves applying an acid that burns the outer layer of skin. The downside is that several treatments will be necessary before results are seen and people undergoing chemical peel should take precautions when going out into the sun — a reason for age spots appearing in the first place.
Laser therapy will also fade age spots. Depending on the type of procedure the physician uses, it may take a couple or several return visits.
Dermabrasion, chemical peels and laser therapy may not be covered by insurance. They are often considered to be cosmetic procedures and, therefore, are not medically necessary. Be sure to check with your insurance company to see what procedures are covered. If none, then ask about setting up a payment plan with the physician.
Most actinic keratoses can be prevented by taking proper care of your skin, such as using sun block and proper clothing when going outside. It is best to have a dermatologist look at all new skin lesions to ensure they are not cancerous before deciding on any treatment.
While all procedures sound distressing, they are safely performed by qualified professionals. Therefore, I suggest you be examined by a dermatologist who can further advise you which procedure, if any, might be appropriate.
To give you related information, I am sending you a copy of my Health Report “Medical Specialists”. Other readers who would like a copy should send a long, self-addressed, 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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