Age Spot and Bumps Newport Beach
As the body ages, the appearance and characteristics of the skin change. Aging is accelerated in those areas exposed to sunlight, a process known as photoaging. An individual’s risk for developing signs of photoaging correlates with his/her skin type (patients with more fair complexions are at higher risk). Chronic sun exposure and chronologic aging are additive. The areas primarily affected are those regularly exposed to the sun: the V area of the neck and chest, back and sides of the neck, face, backs of the hands and extensor arms, and in women the skin between the knees and ankles. Cigarette smoking also contributes significantly to aging skin. Signs of aging skin can be broken into three main categories: pigmentary (color) changes, blood vessel abnormalities, and growths/textural changes.
- Solar lentigines – Commonly known as age spots or liver spots, these are benign (non-cancerous) sun-induced lesions. Lentigines require no specific treatment unless desired for cosmesis. A broad-spectrum sunscreen may help to prevent further appearance and darkening of solar lentigines. Several creams may lighten lentigines if applied for a number of months or they may be treated with various modalities in the office by your dermatologist, including lasers, liquid nitrogen, and light chemical peels.
- Guttate hypomelanosis – These lesions are “white freckles.” They are small, flat white spots are most often found on the shins forearms, but may also arise on other sun exposed areas including the face, neck and shoulders. A broad-spectrum sunscreen may help prevent these spots and make existing ones less noticeable. Surgical techniques from cryosurgery to fractionated CO2 lasers have been used with varying success.
BLOOD VESSEL ABNORMALITIES
- Telangiectasias – Telangiectasias are widely open (dilated) blood vessels in the outer layer of the skin. When seen on the legs, they are often called spider veins. Telangiectasias can be seen anywhere on the body. They are common on the face (nose, cheeks, and chin) and legs. They are red, blue, or purple linear marks measuring less than 1–3 mm in width and several millimeters to centimeters in length. Telangiectasias are very common in healthy people and are usually caused by sun damage or aging. They are also seen with a number of diseases, including acne rosacea, birthmarks, scleroderma, several types of inherited disorders, or with prolonged use of oral or topical corticosteroids. They may be treated with lasers or injections (sclerotherapy) if desired.
- Cherry angiomas – Cherry angiomas may develop on any part of the body but they appear most often around the midtrunk. They can be red, blue, purple, or almost black. Cherry angiomas increase in number from about the age of 30. Their cause is unknown. Cherry angiomas are harmless, but sometimes they can be difficult to tell from skin cancer. If cherry angiomas are cut or injured they can bleed profusely. Any growth that suddenly changes in size, color, shape, bleeds, itches on a regular basis or becomes inflamed or irritated needs to be evaluated by a dermatologist. Cherry angiomas are easily removed by electrocautery or lasers for cosmetic reasons if desired.
- Solar (actinic) purpura – Solar purpura is a common condition in aging skin. It occurs almost exclusively in the older population, and the older a person gets the more likely solar purpura will appear. Approximately 25% of patients over 70 have some solar purpura. Typically it appears as purple, red, or blue patches on the back of the arms and hands. Over decades, ultraviolet light damages the connective tissue in the skin and it no longer supports the tiny blood vessels well. Slight trauma to the skin now causes tears in the blood vessels leading to bleeding into the skin. Frequently patients prone to this condition will be unaware of trauma preceding the appearance. Blood thinning agents such as Aspirin and Coumadin tend to aggravate the condition. As the bruises resolve, dusky brown spots can remain for months. Daily use of a broad spectrum sunscreen will prevent further damage to and thinning of the skin but will not reverse existing photodamage. Tretinoin has been observed to reverse many changes that occur with photodamage. The use of tretinoin may be beneficial in actinic purpura because photodamage is ultimately responsible for this disorder. Tretinoin increases the amount of dermal collagen and decreases the amount of abnormal elastin when applied topically.
- Solar elastosis – Solar elastosis, also known as actinic elastosis, is a skin condition in which the skin appears yellow and thickened as a result of sun damage. To the naked eye the skin appears yellow and thick, with bumps, wrinkles or furrowing. It is caused by ultraviolet damage to elastin fibers in the deeper layer of the skin. Elastosis is also a manifestation of premature skin aging caused by smoking. Ablative and non-ablative laser treatments, dermal fillers, botox injections have been used in attempt to improve the cosmetic appearance of solar elastosis. Sun protection and smoking cessation is recommended to prevent worsening of the condition. Topical prescription tretinoin and DNA repair enzymes are agents that can be used at home.
- Solar comedones – Whiteheads, blackhead, and occasionally even larger cystic lesions may develop on the face, particularly around the eyes, nose, chin, and ears, as a result of chronic sun exposure. Smoking may contribute to and exacerbate this condition. Extractions are performed in the office to treat solar comedones, which are often more persistent than those related to acne vulgaris. Using a broad spectrum sunscreen and applying topical prescription tretinoin at night will prevent worsening of the condition.
- Sebaceous hyperplasia – Sebaceous hyperplasia is a skin condition that occurs when the sebaceous glands in the skin become enlarged and grow above the surface. It appears as a small yellow bump with an indentation in the center on the forehead, cheeks, or nose. Although the exact cause of sebaceous hyperplasia is unknown, some factors that may promote its growth are sun exposure, immune deficiencies, aging and heredity. Procedures such as surgical excision, electrocautery, cryotherapy, or laser therapy are commonly used to remove lesions.
- Seborrheic keratoses – Seborrheic keratoses (SKs) are a common skin growths. They may look worrisome, but they are benign (not cancer). Some people get just one. It is, however, more common to have many. They are not contagious. Most often they start as small, rough bumps. Then slowly they thicken and get a warty surface. They range in color from white to black. Most are tan or brown. Seborrheic keratoses are great mimickers – they can look like warts, moles, actinic keratoses, and skin cancer. They have a waxy, “pasted-on-the-skin” look. Some look like a dab of warm, brown candle wax on the skin. Others may resemble a barnacle sticking to a ship. Sometimes a seborrheic keratosis can look like a skin cancer. If it does, the dermatologist will remove the growth so that it can be looked at under a microscope. Otherwise, they can be treated simply with liquid nitrogen or electrocautery and curettage.
- Skin tags – Skin tags are very common soft harmless lesions that appear to hang off the skin. They are also known as: acrochordons, papillomas, or soft fibromas. Skin tags develop in both men and women as they grow older. They are skin colored, tan, or brown and range in size from 1 mm to 5 cm. They are most often found in the skin folds (neck, armpits, groin, under breasts). They tend to be more numerous in obese persons and in those with type 2 diabetes mellitus but may occur in anyone. It is not known what causes skin tags. However, the following factors may play a role: chaffing and irritation from skin rubbing together, high levels of growth factors, particularly during pregnancy, or insulin resistance (diabetes). Skin tags can be removed for cosmetic reasons by cryotherapy, surgical excision (often with scissors), or electrosurgery.