Lentigo Treatment & Management

Updated: May 04, 2017
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Treatment

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. [34] 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.

A triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% as adjuvant to cryotherapy for solar lentigines on the dorsal hands was found to be effective. [35]

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. [36]

Skin-lightening products commercially available target natural melanin production, many as competitive inhibitors of tyrosinase. [37]  Phalaenopsis orchid extract may be useful as a novel treatment of solar lentigines. [38]

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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. [39]

Cryosurgery [40] is a simple treatment for isolated lentigines. Many consider the first-line therapy for solar lentigines to be ablative therapy with cryotherapy. [41] 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 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. [42] The frequency-doubled, Q-switched Nd:YAG laser, [43] the HGM K1 krypton laser, and the 532-nm diode-pumped vanadate laser are all used with success. [44] Use of a low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser is another choice. [45]  

Treatment with Q-switched Nd:YAG laser may work better than fractional carbon dioxide laser for solar lentigines. [46]

Intense pulsed-light (IPL) treatment is another option. [47]

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Prevention

The application of sunscreen helps decrease the rate of appearance and the darkening of solar lentigines.

Limiting one's exposure to sun tanning and the use of artificial sources of UV light may help prevent solar lentigines.

Individuals of Celtic ancestry might limit their exposure to the sun to help prevent ink-spot lentigines.

The avoidance of a large single dose of ionizing radiation may prevent radiation lentigines.

Children with XP should avoid sun exposure because the acceleration of skin changes leads to the formation of neoplasms.

The avoidance of the intense or prolonged, regular use of tanning beds may help in preventing tanning-bed lentigines.

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