So-called liver or age spots are typically flat, brown marks up to an inch in diameter. They're the result of concentrated amounts of the skin pigment melanin (MEHL-uh-nihn). Most often they're caused or made worse by sun exposure; hormonal changes due to pregnancy or birth control pills can also lead to these spots. Typically, the spots appear on the face, hands, arms, and back. There are a number of methods for removing liver spots, such as fade creams containing a substance called hydroquinone (hy-droh-KWIHN-oan). Most over-the-counter fade creams aren't strong enough to give dramatic results, though they may help if the spots are in the superficial skin layers. Prescription fade creams are a bit more effective and tend to work best when used with a retinoid (REHT-ih-noid) product to slough off the skin. Stubborn spots may require more aggressive measures, such as freezing with liquid nitrogen or removing with a laser. Both nitrogen and laser treatments may need to be repeated several times for maximum lightening of the spots. Another option is a medium-depth skin peel using trichloroacetic (try-KLOOR-oh-uh-SEET-ick) acid. Once the spots are treated, patients must avoid the sun and wear sunblock daily to discourage their return.
