"Spot-like pigmentation" of the skin is often perceived as a disturbing impairment of the external appearance. In Latin America and Asia, they are even one of the most common reasons for consulting a dermatologist.
Such dark spots are called hyperpigmentation and tend to increase with age. This is why they are also known as age spots. The medical term is senile and/or actinic lentigines (senile = in old age; actinic = damaged by light). The spots mainly appear on areas of the body that are frequently exposed to sunlight.
In many cases, age spots are harmless. However, for those affected who are otherwise healthy, there is a desire for treatment due to the impaired aesthetics.
Pigment spots of other origins, in particular malignant skin changes, can be accompanied by increasing pigmentation. A consultation with a dermatologist is therefore essential before any cosmetic medical treatment. The doctor will determine whether it is an age spot or a symptom of another disease.

Age spots are dark skin pigmentations that increase with age © Symfonia | AdobeStock
The following diseases, among others, must be distinguished from the widespread age spots:
Melasma (chloasma)
Melasma appears as irregularly configured, gray-brown spots on the face, especially on
- the cheeks
- the nose,
- the forehead,
- on the chin and
- on the upper lip.
It mainly affects women with phototypes IV-VI. Melasma is an acquired, symmetrical hypermelanosis.
The most important causes are genetic predisposition and exposure to UV light, as well as
- pregnancy,
- medication (e.g. oral contraceptives/pill),
- hormone replacement therapies,
- thyroid dysfunction,
- cosmetics and
- phototoxic substances.
The histological examination of a melasma shows at cellular level that the melanocytes are not increased in number but are enlarged. They also have prominent dendrites.
Post-inflammatory hyperpigmentation
Post-inflammatory hyperpigmentation can develop anywhere on the body. They occur after various inflammatory skin changes have healed, most frequently after, for example
- Acne vulgaris,
- eczema,
- trauma,
- psoriasis (psoriasis),
- Lichen ruber planus (nodular lichen) or
- medicinal exanthema.
The darker the skin type of the person affected, the more likely it is that post-inflammatory hyperpigmentation will develop.
On a microscopic level, post-inflammatory hyperpigmentation shows that the melanin pigment produced in excess is abnormally distributed. It can be deposited exclusively in superficial cell layers, but also in deeper cell layers. The number of melanocytes is not altered.
Nevus cell nevi
Nevus cell nevi are benign birthmarks in which, depending on the type of birthmark, the melanocytes are histopathologically
- exclusively in the upper layer (epidermal),
- exclusively in the dermal layer (dermal) or
- combined in all layers (epidermal and dermal)
are distributed.
Malignant melanoma, lentigo maligna
Malignant melanoma and lentigo maligna is a malignant black skin cancer. The melanocytes degenerate, grow uncontrollably and can form metastases (metastases) in other parts of the body.
Before treating age spots, the presence of malignant melanoma and lentigo maligna must be ruled out.
Other types of hyperpigmentation
The following are also considered in the differential diagnosis of hyperpigmentation (less common)
- Riehl melanosis (face),
- Poikiloderm Civatte,
- Phototoxic hyperpigmentation, Berloque dermatitis,
- Nevus fuscocoeruleus (Ito),
- Oculodermal melanosis (Ota),
- Mongolian spots.
Treatment of age spots with bleaching preparations
Depigmenting preparations (so-called bleaching agents) are categorized into three groups:
- Phenolic derivatives,
- Non-phenolic substances,
- combination products.
The most effective is a triple combination consisting of hydroquinone, a retinoid and a corticosteroid:
- Hydroquinone is a phenolic substance, a tyrosinase inhibitor that inhibits melanin formation. The whitening effect occurs after several weeks of daily topical application.
- Tretinoin (retinoid) accelerates the superficial cell turnover and thus facilitates the penetration of hydroquinone into the skin. This counteracts "steroid atrophy".
- The corticosteroid minimizes the irritation of the skin caused by hydroquinone and tretinoin.
There are commercial preparations for this in Europe, but also "home-made formulations" prepared by dermatologists.
The use of hydroquinone must be limited to two to three months and combined with sun protection! Prolonged use may result in a gray discoloration of the skin and/or nails (ochronosis). Discoloration of the nails has been observed in particular in dark-skinned patients.
Contact allergies to hydroquinone have also been described as a potential side effect.
Other substances used for the external treatment of age spots:
- Hydroquinone derivatives mequinol and arbutin,
- Various retinoids,
- Kojic acid (5-hydroxy-2-hydroxymethyl-4-H-pyran-4-one),
- L-ascorbic acid (vitamin C),
- licorice,
- soy extract,
- N-acetyl-glucosamine,
- niacinamide.
Most of these preparations lead to a temporary lightening of the unwanted pigmentation. However, it returns after discontinuation of the respective preparation.
In many cases, bleaching agents are also used before and after other treatment methods. As a result, they enhance their bleaching effect.
Treatment of age spots with chemical peeling
Peeling methods can be used to remove pigments located in the horny layer of the skin. There are superficial, medium-depth and deep peelings. They use 70 percent glycolic acid or trichloroacetic acid in concentrations of 10 to 35 percent.
The individual peeling variants differ particularly in terms of the depth of penetration. This results in different effects on the individual skin layers.
The so-called "light" peelings work by loosening and subsequently removing superficial keratinized skin cells of the epidermis (peeling effect).
Medium-depth peelings can also be used to treat deeper pigmentation disorders and repair sun damage.
Treatment of age spots with laser and light systems
Laser and light systems whose wavelengths are absorbed by melanin can also be used to treat age spots. Their pulse times are in the nanosecond range according to the principle of selective photothermolysis.
Paradoxically, there is a risk of post-inflammatory hyperpigmentation with all peeling and laser methods. This is why these methods should only be used by experienced therapists. The therapeutic goal and potential side effects must be weighed up for each individual case.
In order to achieve a satisfactory result in the long term, the skin region treated with peeling or laser/light must be protected from the sun. This applies in particular to the time immediately after treatment, when the skin area is still reddened.
Protection is provided by avoiding UV exposure and using sun cream with a high sun protection factor (e.g. factor 50). Otherwise, undesirable pigment shifts could occur again.
The redness can last from a few days to several weeks, depending on the intensity of the treatment. During this time, the skin may be covered with tinted cosmetics.