Environ
Solar Lentigo
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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
Melanocyte
s, increasing melanization in response to
Sun Exposure
Contrast with
Freckles
which are a result of increased
Melanin
production
Signs
Characteristics
Small
Macule
s 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 Lait
Macule
s
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
Keratolytic
s (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
Sunburn
s 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]
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