Solar lentigines amenable to multiple treatment options

Atlanta - There is a spectrum of modalities available for clearing solar lentigines, but management of those pigmented lesions should be individualized based on patient-related factors and be integrated into a general skincare program that simultaneously addresses comorbid features of photoaging and prevents future damage, says Jonathan S. Weiss, M.D., assistant clinical professor of dermatology, Emory University School of Medicine, here.

"Some persons are more susceptible to develop solar lentigines, but the appearance of these hyperpigmented spots is a marker that other ultraviolet light-induced skin changes are also present. Therefore, in patients who seek treatment for solar lentigines, it is worthwhile to take a more comprehensive approach to treat and prevent photodamage in general," Dr. Weiss observes.

To treat underlying collagen damage in facial skin, Dr. Weiss favors use of a topical retinoid applied to the entire face. The retinoid by itself can also help to fade solar lentigines, although clearing of individual lesions can be enhanced with the use of combination products containing a depigmenting agent, such as the triple combination of fluocinolone acetonide 0.01 percent, hydroquinone 4 percent, and tretinoin 0.05 percent (TriLuma, Galderma), or the dual solution formulation containing mequinol 2 percent plus tretinoin 0.01 percent (Solagé, Barrier Therapeutics).

"These formulations are a little less irritating than other retinoid products and tend to be better tolerated by photodamaged skin that is prone to be more sensitive," Dr. Weiss explains.

Solar lentigines treatment

Photoprotective behavior, including sun avoidance plus use of protective clothing and a broad-spectrum sunscreen with SPF of 30 or higher is also of paramount importance in persons being treated for solar lentigines. This aids clearing of existing lesions and helps to decrease the recurrence of lentigines or the appearance of new hyperpigmented spots.

For the specific treatment of individual lesions, the options include cryotherapy, topical agents and phototherapy with various lasers or intense pulsed light (IPL) systems.

Cryotherapy

Cryotherapy remains an effective choice that may be particularly appealing for some patients depending on their budgets. However, it can result in adverse pigmentary changes, either hypo- or hyperpigmentation, especially in persons with darker skin.

"In my experience, cryotherapy is safest and most effective in persons with phototype III or lighter skin, and particularly for lesions on the backs of the hands. However, because of the potential for pigmentary alterations, it may still be worthwhile to test the results on a few small spots before proceeding with treatment of larger or more numerous lesions," Dr. Weiss tells Dermatology Times.

Topicals

Discussing topical treatment, Dr. Weiss notes he was involved in the original vehicle-controlled pivotal trial demonstrating the efficacy and safety of Solagé for treatment of solar lentigines on the face, hands and forearms.

"Mequinol is a very potent depigmenting agent and the combination with tretinoin is quite effective and well-tolerated. Considering the results it can provide, this combination product is probably under utilized. Having to compete with lasers and IPL may be an important factor limiting its popularity among clinicians," Dr. Weiss says.

Chemical peels, IPL

Either chemical peels or an IPL device can be used for more extensive full-face rejuvenation procedures while also accomplishing fading of solar lentigines, and treatment with an IPL system or various lasers can be used to target individual lesions. Useful lasers for the latter purpose include the long-pulsed, Q-switched, frequency-doubled, 532 nm Nd:YAG laser or the 532 nm diode laser (KTP, Iriderm DioLite and others).

"The 532 nm solid phase laser is a less expensive choice than the Q-switched Nd:YAG, has the advantage of a very large, 14 mm spot size and has worked well for us in treating solar lentigines. However, we have also achieved good results using the Nd:YAG laser, especially for clearing solar lentigines on the extremities without causing significant inflammatory reactions that can lead to hyperpigmentation," Dr. Weiss says.