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Solar Lentigo
Aka: Solar Lentigo, Lentigines, Lentigo, Solar Lentigines, Liver Spot
- Epidemiology
- Onset over age 30-40 years
- Most common in Caucasian skin (also seen in asians)
- Pathophysiology
- Proliferation of basal Melanocytes, increasing melanization in response to Sun Exposure
- Contrast with Freckles which are a result of increased Melanin production
- Signs
- Characteristics
- Small Macules 1-3 cm (up to 5 cm), well circumscribed
- Light yellow to light brown to dark brown in color (may be variegated)
- Round or oval with slightly irregular border
- Distribution: Chronically sun exposed areas
- Forehead
- Cheeks
- Nose
- Hand and Forearm dorsum
- Upper back
- Chest
- Shins
- Differential Diagnosis
- Hyperkeratotic lesions (distinguish from the smooth flat surface of Lentigo)
- Flat Seborrheic Keratosis
- Pigmented Actinic Keratosis
- Lentigo maligna (biopsy if suspected)
- Ephelides (Freckles)
- Cafe Au LaitMacules
- Syndrome with multiple Lentigines
- Peutz-Jeghers Syndrome
- LEOPARD Syndrome
- LAMB Syndrome
- Red Flags (suggesting biopsy)
- Rapid growth
- Lesions suspicious for Melanoma
- Symptomatic lesions
- Pain
- Recurrent bleeding
- Poor healing
- Management
- Light Cryotherapy (<5 seconds) with Liquid Nitrogen
- Risk of Hyperpigmentation
- Lesion will disappear for 1 to 3 years
- Combination Therapy (effective)
- Tri-luma (Hydroquinone 2%, Tretinoin 0.05%, Flucinolone 0.01%)
- Consider combining with light Cryotherapy
- Chemical Peel (recurrence is common)
- Trichloroacetic acid (Trichlor) 30-35%
- Laser therapy (ND:YAG Laser)
- Risk of Postinflammatory Hyperpigmentation
- Bleaching with Hydroquinone (Eldoquin Forte) 3-4%
- May result in blotchy Hyperpigmentation (ochronosis) and may take months to see result
- Also risk of acne-type eruption and Hypersensitivity Reaction
- Mequinol 2%/Tretinoin 0.01% (Solage) topical solution
- Keratolytics (less evidence than with other methods)
- Tretinoin (Retin A) 0.025 to 0.05%
- Tazarotene (Tazorac) 0.1% cream
- Adapalene (Differin) 0.1-0.3% gel
- Prevention
- Regular use of Sunscreen (esp. fair skin types 1-3)
- Avoid Sunburns before the age of 20 years old
- References
- Plensdorf (2017) Am Fam Physician 96(12): 797-804 [PubMed]
- Plensdorf (2009) Am Fam Physician 79(2): 109-16 [PubMed]