Spending a lot of time in the sun, especially if you are fair-skinned, can lead to the development of age spots. These are areas of increased melanin production that cause pigmented patches or spots that are tan, dark brown, and/or blackish in appearance. While age spots are not harmful, they can look similar to cancerous growths and should be evaluated by a knowledgeable professional. 

These sun or liver spots are very common in those with fair or lighter skin, appearing in as many as 90% of whites older than 60 years and 20% of whites younger than 35 years. 

Even if you are one of the many who have accumulated these spots, there are ways to improve skin appearance and health! An integrative approach to age spots can help protect the skin from photoaging, lighten excess pigmentation, and keep the skin healthy. 

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What Are Age Spots?

Melanin is the pigment that gives skin color. When your skin is exposed to UV radiation from the sun over time, it can produce excess melanin that causes darkened spots or patches of skin. These lentigos are also known as age spots (lentigo senilis), liver spots, or sun spots (solar lentigos). 

They are most common on parts of the body that are exposed to the most sun, such as the face, hands, or arms. Nevi (moles), ephelides (freckles), and lentigines are all different types of flat brown spots. Nevi most common first appear in the first decade of life and grow in size and shape over the next two decades and are not correlated with sun exposure. 

On the other hand, ephelides are largely determined by genetics but brought out by exposure to sunlight compared to lentigines, which are caused by sun exposure and UV photodamage of the skin. Like freckles, age spots tend to cluster in these exposed areas. 

Age spots appear as pigmented flat, circular, or oval patches that can form in various sizes, ranging from about a tenth of an inch to half an inch across. They commonly evolve slowly over years of sun exposure, but in some cases, they can appear rather suddenly. They can be mostly one-tone or have a variegated appearance, ranging from tan to darker brown or black. They do not itch or cause other discomfort. 

In addition to those over 50 years of age, people with fair skin tone, a history of severe sunburns, and those who spend a lot of time in the sun or tanning beds are more likely to develop age spots.

What Are The Possible Causes of Age Spots?

With time, your skin is exposed to the elements, including UV radiation from the sun and pollution. Age spots most commonly form due to chronic exposure to UV radiation from the sun or tanning lamps. With repeated exposure to UV radiation, melanocytes in the skin increase their production of melanin, the natural pigment that gives skin color. They can also develop after radiation therapy or with psoralen and UVA (PUVA) treatment used for psoriasis.

Aging results in changes in the function of melanocytes. Normally, your cells have mechanisms functioning to repair ongoing damage and recycle failing or dead parts in a process known as autophagy or “self-eating.” With age studies show that areas with age spots have significantly lower levels of autophagy, which impacts the function of melanocytes.

Studies suggest that repeated exposure to radiation causes changes in certain genes that may predispose you to developing age spots by increasing melanin production and skin inflammation. For example, microarray analysis of solar lentiges showed up-regulation of genes related to inflammation, fatty-acid metabolism, and melanocytes and down-regulation of genes involved in the formation of the cornified envelope.

Certain genetic conditions also involve the formation of multiple lentigines, including xeroderma pigmentosum (XP), LEOPARD syndrome, Peutz-Jeghers syndrome, and inherited patterned lentiginosis.

Functional Medicine Labs to Evaluate Skin Health

Functional medicine testing looks for underlying factors that may contribute to the development of age spots and excess inflammation in the skin. This allows for a targeted approach to the treatment and prevention of future skin issues.

Vitamin D

The active metabolites of vitamin D3 have anti-aging and photo-protective effects on the skin. Adequate levels of vitamin D in the blood are needed for balanced immune function and preventing skin damage and aging. Measuring levels of vitamin D in the body helps to determine if supplementation may be needed to replenish low levels to reduce the risk of UV damage and prevent age spots.

Micronutrients

In addition to vitamin D, other micronutrients like vitamins C, A, and E as well as zinc play important roles in skin health and aging. A Micronutrients Panel looks at a variety of nutrients involved in skin health.

Additional Labs To Test 

Age spots are generally diagnosed clinically with a physical exam. If the diagnosis is not clear and other causes of pigmentation need to be ruled out, a skin biopsy can be done to distinguish an age spot, skin cancer, moles, infection, or other skin conditions. A biopsy is done by removing a small skin sample and looking at it under the microscope to evaluate distinguishing features. 

Conventional Treatments for Age Spots

While age spots do not typically require any treatment, there are options available for those who choose to lighten them for cosmetic reasons. 

Topical creams or gels such as hydroquinone (Eldoquin®, Lustra®, Melanex™), corticosteroids (Dermovate®), or retinoids (Retin-A®, Atralin™, Renova®) may be used to lighten the skin. 

Some more intense ways to remove the outer pigmented layer of the skin include chemical peels, freezing the cells (cryotherapy), laser resurfacing, or using an exfoliating device or scrub to smooth age spots away.

Integrative Medicine: Bridging the Gap Between Conventional and Complementary Treatments

An integrative approach to preventing and fading age spots incorporates diet, natural remedies, and lifestyle and integrative therapies to protect and heal the skin. Utilizing an individualized integrative approach can help address underlying issues and avoid potential side effects of more harsh treatments like chemical peels or steroids.

Natural Remedies for Skin Discoloration

Natural supplements and other remedies can help prevent and reverse UV damage in the skin that causes age spots and reduce  skin discoloration. 

Vitamin C

Vitamin C is a potent antioxidant that is commonly added to skin products. This vitamin blocks the synthesis of melanin by reducing the activity of tyrosinase enzymes, preventing the formation of melanin. Studies show that topically-applied vitamin C can prevent UV-induced skin pigmentation to reduce photoaging.

Curcumin (Turmeric)

Curcumin is a natural substance derived from turmeric. Studies show that curcumin protects against skin damage caused by chronic ultraviolet B radiation. Curcumin reduces inflammation in the skin that contributes to signs of skin aging, including age spots.

Vitamin E 

Alpha-tocopherol is the most abundant form of vitamin E in the body and is an active antioxidant in cell membranes and tissues, including the skin. Studies show that topical vitamin E has photo-protective effects and can cause depigmentation by blocking lipid peroxidation of melanocyte membranes, increasing glutathione inside cells to help with detoxification, and inhibiting the formation of melanin by blocking tyrosinase. 

Arbutin 

Arbutin is naturally occurring hydroquinone that is derived from the dried leaves of plants, including bearberry (Arctostaphylos uva-ursi), blueberry, cranberry, and pear trees. It is commonly incorporated into natural lightening creams due to its ability to inhibit melanosome maturation and tyrosinase activity, which blocks the synthesis of melanin.

Phalaenopsis Orchid Extract

Like vitamin C, topical phalaenopsis orchid extract has been shown to effectively fade age spots.

Nicotinamide (B3)

Nicotinamide is a form of vitamin B3 and the precursor of nicotinamide adenine dinucleotide (NAD+), an essential molecule for energy production (ATP). Studies show that oral and topical nicotinamide can reverse UV damage and enhance DNA repair after sun exposure, helping to prevent the activation of melanocytes and the formation of actinic keratosis that can lead to skin cancer.

Light Therapies

Laser and intense pulsed light therapies can be used to target and destroy melanocytes in the skin without damaging the rest of the skin's surface to reduce the appearance of age spots.

Dietary and Lifestyle Changes

Several nutrients can help to boost the skin’s ability to repair and prevent signs of aging like age spots. Plant-based compounds, antioxidants, vitamins, and nutrients help to repair signs of skin damage and protect against UV damage that can darken the skin. 

One way to protect your skin from UV damage and prevent age spots is to incorporate an anti-inflammatory diet rich in antioxidants like beta-carotene, astaxanthin, and vitamins C, E, and A. These antioxidants, along with omega-3 fatty acids, help to keep skin healthy and mitigate the damage caused by unstable free radicals that form from too much exposure to UV radiation from the sun that can cause melanocytes to produce excess pigment.

For example, vitamin C is an antioxidant that blocks skin damage from UV radiation and helps maintain skin health. Good food sources of vitamin C include citrus fruits, tomatoes, kiwis, sweet bell peppers, strawberries, and broccoli. 

To get the most out of vitamin C’s effects, it is important to combine it with an adequate intake of vitamin E. The vitamin E complex consists of a group of eight compounds called tocopherols that act together to scavenge free radicals and prevent oxidative damage. Therefore, vitamin E helps repair sun damage like age spots. Foods that provide vitamin E include sunflower seeds, almonds, hazelnuts, apricots, and avocados.

Carotenoids, including vitamin A, β-carotene, and astaxanthin, are another group of important nutrients for skin health. These potent antioxidants can also protect the skin from UV damage, reducing the risk of sunburn and photoaging like age spots. You can consume β-carotene by incorporating yellow, red, and orange-colored vegetables such as carrots, pumpkin, sweet potatoes, mangos, and papaya into your diet. 

Astaxanthin is biosynthesized by microalgae or phytoplankton, which are consumed by zooplankton or crustacea, so you can consume this nutrient when eating microalgae like spirulina, salmon, trout, krill, shrimp, crayfish, and crustaceans. 

Essential fatty acids help protect the skin from UV-induced inflammation. Incorporating fatty shellfish and fish like salmon, flaxseed, hemp oil, chia seeds, pumpkin seeds, sunflower seeds, leafy vegetables, walnuts, sesame seeds, and avocados into your diet can help supply these essential fats that your body cannot manufacture on its own.

Lifestyle measures and integrative therapies are also effective for preventing age spots. The most effective way to prevent age spots is to minimize UV damage to your skin. Reduce your time spent in the strongest sun between 10 a.m. and 4 p.m. when harmful UVB radiation is at its strongest. 

Sun-protective clothing and a wide-brimmed hat can help protect the delicate skin of the face that is prone to developing age spots. It is also important to avoid tanning beds, which provide a concentrated exposure to UV rays. In addition to protecting yourself from excessive sun exposure and UV damage, it is important to avoid smoking and drinking excessive alcohol to reduce oxidative stress that can contribute to skin aging. 

Another way to reduce skin aging and keep skin appearing at its best is to stay hydrated both internally and on the skin’s surface. Drinking plenty of water and consuming hydrating foods like fruits and vegetables can help you stay adequately hydrated. Opt for fragrance-free moisturizers like organic coconut oil or jojoba oil to avoid irritation but keep skin moisturized.

Acupuncture and Age Spots

In traditional Chinese medicine, extra pigmentation, especially on the face and head, is associated with blood stasis caused by qi deficiency, which results from aging. This qi deficiency can be addressed by acupuncture and/or herbal remedies like Huang Qi, Cang Zhu, Chuan Xiong, and Hong Hua, which aim to boost the qi and transform stasis. Acupuncture has been shown to improve the appearance and health of the skin, including reducing wrinkles and edema and improving facial muscle tone and skin texture.

Mind-Body Practices For Aging Skin

Physical and psychological stress creates increased oxidative stress and mitochondria dysfunction throughout the body, including in the skin. In addition, chronic psychological stress is associated with the shortening of telomeres, the sections of DNA that repeat at the ends of chromosomes that shorten with each cell division, leading to premature cellular aging. 

In addition, stress can disrupt the balance of microbes in the gut via the gut-skin axis, leading to systemic inflammation that impacts the skin and an impaired skin barrier. When the skin’s outermost layer is disrupted from chronic stress, it cannot effectively lock in moisture, resulting in irritated skin and exacerbating conditions like age spots. These impacts can accelerate skin aging.

Finding a stress management practice that is meaningful to you can help manage chronic stress and help your body initiate the parasympathetic nervous system to bring about rest and relaxation. Yoga, meditation, breathing exercises, prayer, tai chi, and other mindful practices can help establish this relaxation response and keep the body in a healing state. 

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Summary

As you get older, you may notice darkened patches on the skin on areas of your skin that are frequently exposed to the sun. These flat tan or brown patches or spots can resemble larger freckles and often cluster together. 

Although these spots do not usually cause issues, there are several ways to reduce the accompanying skin inflammation and fade their appearance if desired. The most effective way to reduce the formation of age spots is to protect your skin from too much sun exposure. Diet and natural remedies may also help to balance inflammation and reduce excess pigmentation in the skin to prevent UV damage and fade age spots.