Lentigines (Age Spots) – Consultant Diagnosis & Laser Treatment in London

What are lentigines (age spots)?

Lentigines are well‑defined, flat pigmented macules created by a localised increase in melanin within the epidermis as a result of cumulative UV exposure. They most often appear on the face (cheeks, temples, forehead), scalp margins, backs of the hands and forearms, shoulders and upper back—areas routinely exposed to sunlight. Unlike freckles, lentigines typically do not fade noticeably in winter and tend to persist unless treated.

Types of lentigines (and similar lesions)

• Solar lentigo: The common “age spot” linked to chronic sun exposure.
• Lentigo simplex: A benign, often solitary pigmented macule that is not sun‑related (may occur at any age).
• Ink‑spot lentigo: Small, sharply defined black macules after intense UV; harmless but striking in appearance.
• Lookalikes: melasma (patchy pigment), seborrhoeic keratosis (warty plaques), actinic keratosis (scaly pre‑cancer), and melanoma in situ (lentigo maligna) on sun‑exposed facial skin.

Causes & risk factors

UV radiation from sunlight and tanning devices is the principal driver. Repeated exposure stimulates melanocytes to produce more melanin and transfer it to surrounding keratinocytes, forming discrete darkened macules. Risk increases with:

• Outdoor lifestyle or work: Sports, gardening, travel and occupations with sun exposure.
• Ageing: DNA repair slows and epidermal turnover decreases, allowing pigment to persist.
• Skin type: Lighter phototypes show lentigines more readily; darker skin can still develop them.
• Genetics: Family tendency to develop pigmentary changes.
• Sunbeds: Artificial UV accelerates photodamage, increasing mottling and lentigines.

Are lentigines dangerous?

Classic solar lentigines are benign. However, pigmented skin cancers can mimic an age spot—especially on chronically sun‑exposed facial skin. Any lesion that is new, changing, asymmetric, irregularly bordered, variegated in colour, larger than ~6 mm, or evolving should be professionally assessed (see our ABCDE mole check). If there is diagnostic uncertainty, we may use dermatoscopy, Wood’s lamp, digital skin analysis and, when needed, a skin biopsy.

Appearance & symptoms

• Flat, smooth macules with sharp edges (round, oval or irregular).
• Uniform tan to dark brown; occasionally near‑black.
• Cluster in sun‑exposed areas; persistent through the year.
• Usually asymptomatic—cosmetic concerns drive treatment decisions.

How we diagnose safely (and why that matters)

A correct diagnosis ensures you receive the right treatment and avoid unnecessary procedures on lesions that need monitoring or biopsy. Your consultation includes a targeted history, examination under good lighting and—where useful—dermatoscopy (a non‑invasive, magnified view that helps distinguish benign pigment networks from atypical features). We may use Wood’s lamp to assess the depth of pigment and digital skin analysis for baseline documentation and progress tracking. If features are atypical or changing, a tiny biopsy can be taken to confirm the diagnosis—your safety comes first.

Treatment options for lentigines

Treatment isn’t medically required, but many patients choose to lighten or remove age spots to restore a clearer, more even skin tone. We tailor the plan to your skin type, pigmentation pattern and goals:

1) Medical skincare (foundation for all plans)

• Brightening/normalising agents: Protocols often include azelaic acid and retinoids, chosen to match your sensitivity.
• Benefits: Non‑invasive; improves background mottling and supports device results.
• Limits: Discrete, very dark macules often need targeted device therapy for best clearance.
• See also: Hyperpigmentation treatment, Skin texture, pores & tone.

2) Chemical peels (global tone)

Carefully selected peels help exfoliate and normalise pigmentation. Ideal for diffuse sun damage and mild to moderate dyschromia. Often combined with skincare and, if needed, spot‑targeted devices.

3) Cryotherapy (selected isolated macules)

Liquid nitrogen can lighten individual lentigines quickly. It is simple and effective for specific lesions. Potential temporary light/dark shift or rare hypopigmentation means we select cases carefully and discuss expectations.

4) Device‑based options (targeted and predictable)

• Q‑switched pigment laser: Our Q10 laser delivers short pulses targeting melanin in discrete spots, fragmenting pigment for the body to clear—precise for well‑defined lentigines.
• Pigmentation laser/IPL: For freckling and mixed photodamage, see vascular & pigmentation laser—helps blend uneven tone across larger areas.
• Fractional CO₂: When photoageing includes texture change and fine lines, fractional CO₂ can improve both pigment and skin quality in a single pathway.

Fitzpatrick skin types & expectations

We adjust device choice and settings for your phototype to balance results and safety. Lighter skin often clears quickly with pigment‑specific devices. Darker skin can be treated with careful protocols; we discuss the (generally small) risk of post‑inflammatory hyperpigmentation and how aftercare minimises it.

What results to expect (and when)

• Discrete lentigines: Often lighten significantly or clear after 1–3 sessions with Q‑switched laser, with transient darkening (“coffee‑ground” appearance) before shedding.
• Diffuse photodamage: IPL/laser blends freckling and background redness over a short series.
• Texture + pigment: Fractional CO₂ improves tone plus fine lines/pores with a planned downtime window.

Results are maintained by good sun protection and a home regimen. Because UV exposure continues through life, new lentigines can form—maintenance is about prevention and early touch‑ups rather than repeating full courses.

Safety, downtime & aftercare

• Immediately after treatment: Mild redness or warmth is common. With pigment lasers, spots can darken before flaking over 7–14 days.
• Aftercare: Gentle cleansing, emollients, and strict daily SPF (broad‑spectrum 30+) are essential. Avoid picking or scrubbing while the skin settles.
• Risks (uncommon): Temporary hyperpigmentation/hypopigmentation, small crusts, or rarely blistering—minimised by correct candidate selection, parameters and aftercare.
• Contraindications/deferrals: Active infection, open lesions, recent intense sun exposure, pregnancy for certain devices, or very recent isotretinoin use. We’ll review your history to time treatment safely.

Prevention & long‑term skin health

• Daily broad‑spectrum SPF 30+ (reapply with outdoor exposure).
• Hats and protective clothing; plan shade between 11:00–15:00.
• Avoid sunbeds; they accelerate sun damage and pigment formation.
• Regimens that target background hyperpigmentation help maintain an even tone.
• Regular skin checks—particularly with many pigmented lesions or a history of skin cancer.

Why choose Skinhorizon Dermatology London?

• Consultant‑led diagnosis: We differentiate benign age spots from lesions that need monitoring or biopsy, using dermatoscopy and digital analysis.
• Multiple device options: From precise Q‑switched laser to pigmentation laser/IPL and fractional CO₂.
• Personalised plans: Combine device therapy with skincare for durable, natural‑looking results.
• Medical setting: Clear consent, realistic expectations, and comprehensive aftercare guidance.

Your first visit — what to expect

1. Consultation: Medical history and targeted skin examination with dermatoscopy.
2. Diagnosis: Confirm lentigines and rule out lookalikes (melasma, actinic keratosis, melanoma mimics).
3. Treatment plan: Skincare vs device options based on skin type and goals.
4. First treatment: May include test spots or an initial laser/IPL session where suitable.
5. Follow‑up: Review results, adjust settings, and build a maintenance strategy to minimise recurrence.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025