What it is
Sun spots are the discrete flat brown marks that collect over years on the face, chest, shoulders and backs of the hands; photodamage is the wider change that comes with them — roughness, dullness, visible vessels and, in some people, rough precancerous patches. Assessment comes first, because a spot that is growing, irregular, multicoloured or newly dark is examined and sampled rather than lasered. Treatment then combines daily photoprotection and topical agents with targeted laser or light for the spots that justify it, and a separate medical pathway for anything precancerous.
What this page covers
- Solar lentigines and freckles: assessment, photoprotection and topical agents first
- Dermoscopy of pigmented lesions and the urgent pathway for a suspicious lesion
- Glogau photoaging grading, read with the caveat that it was described in lighter skin
- Photoprotection counseling including visible light, tinted sunscreen and planning for ihram
- Topical thiamidol, vitamin C, retinoids and antioxidant regimens for photodamage
- Q-switched 532 nm for superficial lentigines
- Picosecond laser for pigmentation, including fractional delivery
- Intense pulsed light and broadband light photorejuvenation
- Non-ablative fractional laser (1550 nm erbium glass, 1927 nm thulium) for field photodamage
- Cryotherapy for seborrheic keratoses and lentigines
- Electrocautery and curettage of seborrheic keratoses; dermatosis papulosa nigra
- Actinic keratosis and field photodamage treatment with cryotherapy, 5-fluorouracil or imiquimod
- Photodynamic therapy for field treatment
- TCA peel where the depth is justified and the phototype allows
- Long-pulsed Nd:YAG and telangiectasia treatment for the vascular component
- Neck and décolletage assessment, treated on its own settings rather than the face's
- Skin biopsy of a pigmented or unexplained lesion
- Mole mapping and digital total-body photography
Honestly
Spots return with further sun exposure and freckles in particular come back without daily protection; the pigment lasers that clear a lentigo most readily are also the ones most likely to blister or darken Fitzpatrick IV-VI skin, so test spots, conservative settings and no treatment at all on recently tanned skin are the rule, and freckles in children are protected rather than treated.