Sections

Lentigo

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.^[38]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.^[39]

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.^[40]

Skin-lightening products commercially available target natural melanin production, many as competitive inhibitors of tyrosinase.^[41] Phalaenopsis orchid extract may be useful as a novel treatment of solar lentigines.^[42] Favorable efficacy and safety were observed with Melasolv (3,4,5-trimethoxy cinnamate thymol ester, TCTE) in Southeast Asian women.^[43]

A weak but significant whitening effect on solar lentigos was documented using L-ascorbate-2-phosphate trisodium salt in Japanese women.^[44]

Imiquimod 3.75% cream has been suggested as possibly efficacious.^[45]

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.^[46]

Cryosurgery^[47]is a simple treatment for isolated lentigines. Many consider the first-line therapy for solar lentigines to be ablative therapy with cryotherapy.^[48]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.^[49]The frequency-doubled, Q-switched Nd:YAG laser,^[50]the HGM K1 krypton laser, and the 532-nm diode-pumped vanadate laser are all used with success.^[51]Use of a low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser is another choice.^[52]

Treatment with Q-switched Nd:YAG laser may work better than fractional carbon dioxide laser for solar lentigines,^[53]with repetitive low-fluence 1064-nm Q-switched Nd:YAG laser being a safe and effective approach for them.^[54]

Intense pulsed-light (IPL) treatment is another option.^[55]

Lentigines can also be treated with a 730 nm picosecond titanium: sapphire laser ^[56]

Prevention

The application of sunscreen helps decrease the rate of appearance and the darkening of solar lentigines. Summer darkening can be avoided by use a SPF-30 day skin cream.^[57]Limiting one's exposure to sun tanning and the use of artificial sources of UV light may help prevent 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.

Medication

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Media Gallery

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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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Clinical Instructor, Feik School of Pharmacy, University of the Incarnate Word

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Gilead Sciences.

Sergiusz Jozwiak, MD, PhD Professor and Head of Pediatric Neurology, Medical University of Warsaw, Poland

Sergiusz Jozwiak, MD, PhD is a member of the following medical societies: Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; Past President, American College of Mohs Surgery

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: QualDerm Partners; Novascan<br/>Have a 5% or greater equity interest in: QualDerm Partners - North Carolina.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

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

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Lentigo Treatment & Management

Medical Care

Surgical Care

Prevention

References

Tables

Contributor Information and Disclosures

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