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YUM, I CAN ALMOST TASTE THE CHOCOLATEY GOODNESS NOW….. WAIT A MINUTE, A DERM-NERD DOESN’T TALK ABOUT THOSE KINDS OF BROWNIES, RIGHT?!
As your resident Summit County “Derm-Nerd” (t-shirts coming soon), I am obsessed with the condition of people's health through their skin. One question I get all the time is about those sometimes unsightly but very common brown spots, mostly found on the face, hands, arms, neck, and chest that can be a result of years and years of solar UV exposure and tanning bed/sun lamp UV exposure.
I call these "Brownies." No, not those brownies.... although since Fall is officially here in the high country, a warm plate of fresh baked brownies would be nice right about now. Okay sorry, back to the topic at hand.
SO, WHAT IS A “BROWNIE” or Brown Spot?
Have you ever heard of Lentigo (pronounced Len-Tie- Go) or Lentigines for plural? This is the official name of brown spots and there are several variants which I will talk about below.
These lentigines are defined as a condition marked by small, usually flat brown patches on the skin that typically develop in middle aged to elderly people.
TUNE IN FOR THIS INTERESTING STATISTIC-
A November 2011 article of Dermatology Times documents that 90% of all Caucasians over the age of 60, even those who think they have used sunscreen diligently throughout their life, will have solar lentigines. Does anyone else besides me think this is a scary statistic? And to make matters a little more horrifying, 20% of younger individuals (less than 35 years of age) will develop single or multiple brown spots. These brown spots may occur more abundantly on fairer-skinned people and those with a history of chronic sun exposure (yes, I'm talking to you outdoorsy folks out there).
In all reality though, brown spots do not know an age limit. Lentigines can appear in children, although the brown spots seen in childhood are more likely to be genetically linked.
IMPORTANT POINT. TAKE OUT YOUR MENTAL PEN AND WRITE THIS DOWN.
Lentigines (a.k.a brown spots or brownies) are not just a potential side effect from sun exposure. Nope. Other UV sources, especially the recently popular tanning bed craze or sun lamps from the 60's and 70's can cause these brown spots as well.
THE DIFFERENT TYPES OF BROWN SPOTS
So now that we have a better understanding of what lentigines are and how they may be caused, let's look at some examples. Ready class?
Lentigo simplex (eg, simple lentigo, juvenile lentigo) is the most common form of lentigo. Lentigo simplex is not induced by sun exposure, and this condition is not associated with systemic disease. The cause of lentigo simplex is unknown.
On exam, these lesions are round, flat brown spots, 3-15 mm in diameter, and typically do not cause any symptoms. Their borders can be either jagged or smooth. Pigmentation ranges from brown to black and is evenly distributed throughout. There are usually few lesions seen and they may occur anywhere on the skin or mucous membranes such as the lips/inside of the mouth. These brown spots generally appear in the first few years of life, but they can also be present at birth.
The solar lentigo (eg, actinic or senile lentigo, sun spot, liver spot) is the most common lesion found on the most sun-exposed areas, including the face, arms, hands, upper chest and back.
These initially small brown spots, (generally less than 5 mm at first) are usually flat and may be associated with fine wrinkles on your skin. And (stay tuned for more bad news...) they can increase in number and size over time to eventually form large brown patches. (Ugh, really)?
If you are between 30-50 years old, you may already see these spots appearing. However, younger folks are seeing them more commonly due to the effect of artificial UV, especially from tanning beds, also known as "Cancer Coffins" as we like to call them here at Renew Dermatology.
MENTAL NOTE: YOU MAY NOT HAVE ANYTHING WRONG WITH YOU
Sometimes you may hear these spots referred to as “liver spots,” but these solar lentigines are NOT a sign of systemic disease or anything wrong internally.
Ink-spot lentigo (ie, reticulated black solar lentigo) appears just as it sounds, like an ink splatter on the skin. They have an irregular shape and are typically dark in color.
These spots can be primarily found in areas exposed to the sun and may also be found hanging out in the middle of a larger patch of solar lentigines (SEE PIC).
However in contrast to solar lentigines which usually show up in multiples, individuals will traditionally only have 1 ink-spot lentigo.
For men and women who have extensively used sources of artificial UV light such as tanning beds, you get your very own appropriately named brown spot.
Commonly found on overly exposed areas, such as chest, neck, face, arms, and legs.
These spots are irregularly shaped and can vary in size and color with strange outlines or abnormal pigmentation patterns.
In addition, these can pop up suddenly (SURPRISE!) after a single trip to the tanning salon or with intense or prolonged use of tanning beds or sun lamps.
MENTAL NOTE: REGULAR INSPECTION OF THESE SPOTS IS KEY
Unfortunately, the potential for these lesions to turn into an abnormal lesion or malignancy is unknown so you should have them checked regularly by a dermatology provider who thoroughly examines your entire body.
Nevus Spilus appears as multiple pigmented flat or raised spots within a lesion that has been present since birth or one that has developed over time. This is a special type of skin lesion that is both a lentigo and melanocytic nevus (mole) and it has been shown to potentially develop into melanoma over time.
Based on this information, it is important to have these spots checked regularly just like the recommendation above for tanning bed lentigines.
Sounds dreadful, but don't worry.... these are benign spots and are the most common skin growths which happen to have a variety of looks. (see pic at left for a commonly seen brown and scaly presentation)
These do tend to develop with increased frequency as you get older. And as with most of the other brown spots we have talked about today, these are especially found on, you guessed it, sun exposed skin.
Due to Mom and Dad and that whole gene pool thing, some folks receive the ability to produce these lesions genetically.
Caucasians are more susceptible to having these spots show up, although darker skinned individuals can develop a variation known as "dermatosis papulosa nigra". (See Pic Below) Just think of Morgan Freeman's face to get an image of these special spots in your mind.... yep, the majority of you will never forget this fun bit of trivia, huh?
These lesions found on the face and upper cheeks are usually more skin-tag like than their seborrheic keratosis cousins but either type can catch on clothing and become irritated, itch, grow, or bleed.
Nevertheless, scratching seborrheic keratoses or trying to pick them off the skin can result in scarring or a secondary infection, so it is best to leave them alone until they are examined by a trained professional.
Overall, seborrheic keratoses generally do not resolve and usually grow larger and thicker with time. :(
MENTAL NOTE: ALTHOUGH BENIGN, SEBORRHEIC KERATOSES CAN....
* Obscure the detection of an abnormal mole, malignant melanoma or other skin cancer when an individual has a large number of seborrheic keratoses or several grouped together
* Look very similar to malignant or abnormal lesions.
* Allow secondary tumors such as Bowen’s disease (squamous cell carcinoma in situ) or malignant melanoma to arise within them.
***For all of these reasons listed above, you should have these spots checked regularly by your dermatology provider, especially if you notice any changes in a spot you have had or a new spot develops suddenly.
Ok..... red haired, fair-skinned, "I love the sun, but the sun doesn't love me" folks out there...you know who you are and this is your cue to listen up!
Ephelides (the fancy word for “freckles") are flat, brown or tan colored, typically symmetric spots found on the face, forearms and the back sides of hands.
Some freckles may disappear over time while others persist throughout the person’s lifetime.
These lesions are especially seen during summer months in individuals with blonde or red hair and light skin, but they can also occur in people with dark hair and dark skin. And, these are sneaky little spots as some freckles are not able to be seen with the unaided eye until a Woods lamp is used! (see link below)
When freckles develop, they are usually well-defined, can have irregular or regular borders, and are seen in either a sporadic or dense pattern. The size of these spots varies and the color tends to darken after sun exposure, ranging from pale yellow to brown or even black.
Woods Lamp Resource: https://www.skinsight.com/skin-conditions/cosmetics/woods-lamp-examination
"SO WHAT?" YOU MAY BE ASKING.
WHY THIS INFORMATION IS IMPORTANT FOR YOU.
Brown spots, seborrheic keratoses, moles and many other skin growths are for the most part harmless and may never turn into an abnormal or malignant lesion in your lifetime. However, it is important to note that skin cancer can mask itself as one of these. Or, skin cancer can grow in the middle of these lesions. Or, some initially "normal" spots can turn into melanoma over time. That being said, getting thorough full skin examinations regularly can help detect any concerning lesions early and ensure that the overall health of your skin is in optimal shape.
Living, working and playing at altitude has its benefits for sure. Regardless if you live at high altitude or just visit, you recognize the majestic beauty of the mountains, the clean crisp air, the abundant wildlife, the four very distinct seasons, etc.
I can go on and on… and on…and on.
But with the benefits come a few inherent risks. Have you ever been to a restaurant or grocery store where you can order a nice succulent juicy rotisserie chicken? Golden brown and smells oh so delicious? That’s a result of slow roasting for several hours in a warm environment.
But if you put that same chicken in the microwave, what happens?
Uh, yeah….all of the folks in Summit County are hanging out at 9000+ feet where the sun is like a microwave, cooking and crisping your skin in minutes, not hours, if not properly protected.
The lack of humidity also makes your skin more susceptible to drying out and becoming damaged more quickly. And UV exposure will sneak up on you when you least expect it. Case in point: have you ever noticed that the left side of your face has more brown spots, wrinkles, or looks older than the right side of your face?
That's from the UV affecting your cells when you don’t even think about protecting your skin while driving in the US. Check out this popular picture and video clip of a truck driver’s skin after 28 years of his career:
BOTTOM LINE: YOU DON’T HAVE TO WORK HARDER, JUST BE SMARTER
Taking care of your body and your overall health (both short term and long term) encompasses many tactics and habits. From getting enough sleep, to drinking enough water, to exercising, eating healthy, and protecting your skin with sunscreen on a daily basis, they all go hand in hand.
I just want to make sure that you live the most active, fulfilling life possible, and if my “Derm- Nerd” skills can help, then I have fulfilled my life's purpose.
Thanks for reading. Please note that this information is based on my training, the never-ending study of "The Practice of Medicine," and my experience as a Certified Physician Assistant and is not to be deemed as medical advice. Please see the references and sources I have attached for the information obtained to support this blog.
Kelly Ballou, PA-C
Co-Founder Renew Dermatology
Frisco, Colorado (Summit County)
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