DEAR READER: Folk remedies include apple-cider vinegar combined with orange juice; castor oil; lemon juice; grated onion; and green (unripe) black walnuts. Then there are vitamins C and E and zinc. So what more can I say? If clear nail polish worked for you without side effects, it may have to be added to the list of possibilities. Before using home remedies, have a doctor examine the lesions to ensure that they are not cancerous.

DEAR READER: Liver spots, also known as age spots, are common in people who are over the age of 40 and in those who may have had chronic sunlight exposure without protective sunscreen. The spots are harmless and do not require treatment. They typically appear on light-skinned people but can affect anyone. Exposure to ultraviolet light speeds up the production of melanin, the dark pigment in the outer layers of skin that give it color. Additional melanin is what creates the darker color, primarily in Caucasians, known as a tan. When melanin clumps into higher-than-normal concentrations, age spots appear. What many of us fail to realize is that people of African descent are as susceptible to sun damage as are fair-skinned Caucasians.

If you are put off by the appearance of the spots, start with a referral to a dermatologist. There are several treatment possibilities. Prescription creams that bleach the skin might fade the spots over a period of several months. There are many choices from which to choose and this is the least expensive therapy, depending on how often the cream is applied and how dark the spots are. In order for treatment to be successful, the cream or lotion must penetrate through the top layer of skin where the excess pigment is located. This method of treatment might take weeks or months before progress is seen.

Beyond creams and lotions, cryotherapy applies a freezing agent such as liquid nitrogen to the spots, breaking up the areas that contain the excess pigment. Laser therapy, while expensive, can destroy the excess melanocytes that created the darkened areas of pigment. There is no damage to the surface of the skin with lasers, and results are apparent over a period of several weeks or months. Chemical peel involves applying an acid application to the outer layer of the skin where the age spots appear. The skin then peels, new skin forms, and the spots are no longer present. Dermabrasion sands down the surface of the skin with a brush that rotates rapidly. Again, this removes the surface skin, a new layer grows, and the spots disappear. This process may leave temporary scabbing and redness.

To avoid future age spots, protect your skin — primarily that on the backs of your hands, face, shoulders and upper back — with a sunscreen applied about a half-hour prior to exposure. Then reapply it in a timely manner according to the manufacturer’s recommendations. Wear protective clothing when out of doors that might include a wide-brimmed hat, long-sleeved shirts and long pants.

Should any of your lesions change in color, enlarge, raise or modify in unusual ways, be sure to return to your physician for evaluation because skin cancer can develop from long-term sun exposure.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44091-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I’ve tried many facial products with no improvement. And, at age 70, I do not wish to try invasive treatments such as chemical peels. I have not found makeup or a concealer that provides good cover.
Is there a product you would recommend, or should I just learn to live with these discolorations? Any suggestions would be greatly appreciated.

DEAR READER: As we age, it is common to see darkened spots on the face, backs of our hands and in other areas of the body exposed to sunlight. They are known as age spots or liver spots. The spots vary in size and are brown or black in appearance. They can range in size from that of a freckle to the size of a dime. As a general rule, they are harmless and do not require any medical care.

Ultraviolet light increases the production of melanin, the pigment that gives skin its normal color. The production of additional melanin causes the darker color to appear. This generally develops over time — whether exposed to the sun’s rays or not.

It is my guess that you have benign lesions that can be disregarded unless their appearance bothers you. There are creams available by prescription to bleach the spots; cryotherapy, which applies a freezing agent to the spot to destroy the pigment; dermabrasion, which sands down the area with a rotating brush; laser therapy, which destroys melanocytes that created the darker pigmented area; or chemical peel that involves the application of an acid that burns off the outer layer of the skin.

Over-the-counter remedies include topical creams or lotions containing hydroquinone, glycolic or kojic acid, or deoxyarbutin. If you choose this route, speak with your pharmacist if you have any questions about which product is best. Keep in mind that prolonged use can result in skin irritation.

Readers who wish to avoid liver spots should take precautions when going out in sunlight by wearing protective clothing and appropriate sunblock. For example, a broad-brimmed hat should prevent direct exposure to the face.

If there is any question of new lesions that appear on the skin or if any spot darkens, enlarges or changes, be sure to make an appointment with a general practitioner or dermatologist for clarification.

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.