Liver spots is a type of simple benign pigment spot that occurs under the influence of ultraviolet rays against the background of age–related metabolic disorders. It appears in elderly patients who in their youth did not protect the skin from ultraviolet radiation. It is a flat brown pigment spot with blurred borders up to 1 cm in diameter. It is localized on open areas of the skin. It is diagnosed on the basis of anamnesis and clinical picture using dermatoscopy and biopsy. Disease does not require therapy. At the request of the patient, after consultation with a cosmetologist, photo rejuvenation, the use of exfoliating and skin whitening agents is possible.
Liver spots is a benign proliferation of melanocytes in elderly patients with the formation of a spot provoked by the action of sunlight. From this point of view, liver spots resembles freckles or a vulgar pigment spot that occurs as a result of age-related hyperkeratosis of the skin. The main difference between lentiginous spots is mixed pigmentation, when lentigo appears against the background of age-related changes, hormonal shifts and sunburn. According to Russian dermatologists, more than 50% of patients aged 60 years have at least one or two lentiginal spots. Such spots are formed as a result of the cumulative effect of ultraviolet rays with constant hyperinsolation. People with very fair skin are more likely to suffer.
Liver spots has no gender coloring, debuts at any time of the year, non-endemic. Unlike other varieties of lentigo, it is never malignized, but requires accurate diagnosis, since it may resemble a borderline nevus or malignant lentigo. Until the middle of the twentieth century, there was an idea in dermatology that lentigo refers to one of the varieties of flat melanocytic nevus. However, since 1962, thanks to the work of the Vienna School of Dermatology, lentigo has been considered as an independent nosology. The relevance is associated with aesthetic discomfort, especially with multiple pigment spots localized on the face.
The immediate cause of the appearance of a benign senile lentiginal spot is ultraviolet rays affecting the epidermis. This layer of skin contains the most (up to 85%) keratinocytes, which are responsible for tanning – the skin’s response to sunlight. Ordinary cells of the epidermis do not produce melanin themselves, but receive it by transporting pigment through cellular processes from melanocytes. Melanocytes are the main sources of melanin and the second largest cells of the epidermis. The epidermis of patients with fair skin contains a small amount of melanin, which provides a less pronounced protective reaction of the skin to the action of sunlight.
Hyperinsolation stimulates the production of pigment in melanocytes, a tan appears on the skin. At the same time, part of the cells overflowing with melanin rises to the surface of the skin, and part does not reach its surface and is deposited at the level of the granular layer. There is a cumulative accumulation of melanin. Keratinocytes filled with melanin, which have reached the surface and performed the function of protection against UVI, subsequently transform into horny scales and exfoliate. Approximately one month after the cessation of insolation, these cells are replaced with new ones containing a normal amount of melanin. The skin acquires a normal color.
The transitivity of keratinocytes has a positive and negative side. On the one hand, melanin is an antioxidant, a useful substance that inhibits the oxidation process, binds free radicals and prevents skin aging. On the other hand, over time, melanin itself begins to produce free radicals that destroy skin cells and their DNA, acquires the ability to tumor transformation. After 50 years, the prooxidant activity of melanin begins to prevail over the protective oxidant. At this moment, liver spots appears on the skin. It can occur both after another tan, and spontaneously, due to the cumulative effect of melanocytes.
In parallel, patients suffering from diseases of the digestive tract or alcoholism have a violation of bilirubin metabolism. Due to pathological malfunctions in the liver, bilirubin accumulates in the skin. Toxic damage to the cells of the epidermis significantly reduces the protective properties of the skin, slows down metabolic processes. This situation creates a background of chronic inflammation, which additionally stimulates the appearance of liver spots.
Clinically, the disease manifests itself by the spontaneous appearance on the skin of one or many flat painless pigment spots of yellow, brown or dark brown color with a diameter of no more than 1 cm. In rare cases, the spot of liver spots reaches 3 cm in diameter. The polychromacy of the spots creates a mosaic multi-colored picture. The contours of liver spots are fuzzy, most often oval, blurred. Sometimes they take the shape of a geographical map. Liver spots is localized in open areas of the skin – in the decollete area, on the forearms, face, rarely on the back of the palm. Liver spots never peel off, do not have a tendency to peripheral growth, do not change color. Pigmented formations are randomly scattered on the surface of the skin, while each spot of liver spots is isolated.
The formation of elements does not cause any subjective sensations, but it can cause aesthetic discomfort, especially when localized on the face. Usually liver spots is not accompanied by an exacerbation of pathological processes in the gastrointestinal tract, although it occurs against the background of formed gastric ulcer, inflammatory liver changes, alcohol abuse. Such “quiet” symptoms require close attention, since a borderline or malignant nevus may be hidden under the mask of liver spots. In this case, the most important feature is the color of the spot and its bulge. With any shade of black and minimal bulge of the spot, an urgent consultation with an oncologist is required.
Diagnosis and treatment
A dermatologist makes a diagnosis based on anamnesis and a typical clinical picture of liver spots. Additionally, dermatoscopy and biopsy are used to exclude oncological pathology. Histologically, the proliferation of melanocytes of the epidermis, its thickening is clearly visible in liver spots. At the same time, the interstitial spaces of the epidermis resemble a mace in shape, which is a diagnostic sign of liver spots. Sometimes a blood test for cancer markers is used in diagnostics. The differential diagnosis of liver spots is carried out with freckles, birthmarks, flat nevus, chloasma, senile keratosis. Simple benign liver spots does not require special therapy if it does not cause aesthetic inconvenience to the patient.
At the request of the patient, after consulting with a cosmetologist and conducting skin allergic tests for liver spots, conservative skin whitening is performed with the help of special cosmetics. Exfoliation with photodestruction of melanocytes is used. In white-skinned patients with a large area of pathological pigmentation, it is possible to use chemical facial peeling. Patients with dark skin should be careful about such a procedure, since along with the pigmented spot, the surrounding healthy tissues are also lightened. The most modern method of treatment of liver spots is considered to be photo rejuvenation. Single spots of liver spots can be removed using laser cosmetology methods.
Prevention of lentigo consists in excluding contact with sunlight or limiting insolation by wearing wide-brimmed hats, sunglasses, and long-sleeved clothing. In summer, sunscreens are mandatory. Patients with liver spots should give up bad habits that provoke a pathological process. The prognosis regarding recovery is uncertain, while the disease does not pose a danger to the life and health of the patient.