Lentigo Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: May 31, 2011
 

Medical Care

Noninvasive topical creams are also used. After several months of application, tretinoin cream and hydroquinone cream can lighten lentigines.

The efficacy and safety of cryotherapy and trichloroacetic acid (TCA) were compared for the treatment of solar lentigo.[24] Cryotherapy was more effective than TCA 33% solution in the treatment of solar lentigines of the back of the hands, particularly in lighter-complexioned individuals. For darker-complexioned people, TCA 33% may be preferred, although postinflammatory hyperpigmentation remains a risk for both modalities.

The effect of a bleaching solution containing 2% mequinol (4-hydroxyanisole, 4HA) and 0.01% tretinoin (Solagé) applied twice daily for 3 months on solar lentigines present on the back of one hand demonstrated a significant lightening effect after 2 months of treatment and was maintained at least 2 months after stopping treatment.[25]

Skin-lightening products commercially available target natural melanin production, many as competitive inhibitors of tyrosinase.[26]

A selection of related clinical trials is as follows:

Also see the clinical guideline summary from the Australian Cancer Network, Lentigo maligna. In: Clinical practice guidelines for the management of melanoma in Australia and New Zealand.

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Surgical Care

Treatment of solar lentigines with a focal medium-depth chemical peel may be clinically superior to treatment with cryosurgery, owing to the paucity of adverse effects (eg, hypopigmentation, pain) associated with chemical peels.[27]

Cryosurgery[28] is a simple treatment for isolated lentigines. Many consider the first-line therapy for solar lentigines to be ablative therapy with cryotherapy.[29] This procedure is often successful because of the susceptibility of melanocytes to freezing with liquid nitrogen. Squamous cells resist injury at -20°C, whereas melanocytes freeze at -4 to -7°C.

Lasers are effective in the treatment of various lentigines. The recent development of short-pulsed, pigment-specific lasers to selectively destroy the pigment within the solar lentigo has led to significant clinical improvement, a low risk of adverse effects, and high patient acceptance.[30] The frequency-doubled, Q-switched Nd:YAG laser,[31] the HGM K1 krypton laser, and the 532-nm diode-pumped vanadate laser are all used with success.[32]

Intense pulsed-light (IPL) treatment is another option.[33]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Jason F Okulicz, MD  Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center

Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sergiusz Jozwiak, MD  PhD, Head, Professor, Department of Child Neurology, The Children's Memorial Health Institute of Warsaw, Poland

Sergiusz Jozwiak, MD is a member of the following medical societies: Sigma Xi

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Neil Shear, MD  Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  33. Campolmi P, Bonan P, Cannarozzo G, et al. Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. Jan 2011;25(1):68-73. [Medline].

 
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Thirteen-year-old Greek adolescent with xeroderma pigmentosum.
Ephelides (ie, freckles) on the forearm of a 26-year-old redheaded patient.
Woman with solar lentigo.
Close-up view of a woman with solar lentigo.
 
 
 
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