Laser and Skin

Age spots: the skin's light account

Age spots are not a symptom of age but a record of ultraviolet dose: they appear where the skin has collected the most sunlight over decades, which is why up to 90% of fair-skinned people over 60 have them on the backs of the hands, the forearms and the face. A pigment laser lightens most of them in 1 to 3 sessions, pooled trial data show complete clearance in about 43% of laser-treated cases and 65% with combined treatment, and only daily sun protection stops new ones from forming.

Why they appear where they appear

The name misleads. Age spots, known to dermatologists as solar lentigines, do not form because a birthday passes. They form because melanocytes, the pigment cells in the lowest layer of the epidermis, have been hit by ultraviolet light for 30, 40 or 50 years and have settled into local overproduction. Each flat, sharply bordered patch is a cluster of cells that keeps making more melanin than its neighbours, and it stays.

That is why the spots follow the light and not the calendar. The backs of the hands lead, followed by the forearms, the upper chest, the temples and the forehead, then the shoulders and the shins. The back usually stays clear in people who never sunbathed on it. Look at your own distribution and you are reading your own sun biography: driving with one arm at the window, cycling, gardening, summers on the beach.

The numbers fit that picture. Up to 90% of fair-skinned people over 60 carry at least one solar lentigo, they are uncommon before the age of 12 unless childhood sun exposure was heavy, and most people notice the first ones between 40 and 50. Sizes run from a few millimetres to more than a centimetre. Roughly 95% of the ultraviolet reaching the ground is UVA, which passes through cloud and ordinary window glass, so the dose keeps accumulating on overcast days and in the car.

Age spot or something else

A classic age spot is flat, evenly coloured from light tan to dark brown, sharply outlined and stable from month to month. It does not itch, bleed or grow a rough surface. Anything that breaks those rules deserves a look under a dermatoscope before anyone points a laser at it, because 3 other conditions like the same sun-exposed sites: seborrhoeic keratosis, which is raised and waxy; actinic keratosis, which feels like fine sandpaper; and lentigo maligna, an early melanoma that can imitate a large, unevenly coloured age spot on the face.

This is the reason the order of events matters: assess first, treat second. A laser destroys pigment and with it the evidence a pathologist would need. Several European countries have drawn a legal line here, Germany among them since the end of 2020, where laser treatment of pigmented skin changes is reserved for doctors. In the UK and the US the rule is professional rather than statutory, but the practical consequence is the same: a spot that has changed in size, colour or border within the last 6 to 12 months is examined, not lightened.

What the treatments achieve

Pigment lasers, meaning Q-switched and picosecond systems, deliver pulses in the nanosecond or picosecond range that shatter melanin without cooking the tissue around it. The spot darkens within minutes, forms a fine crust and sheds in 7 to 14 days. On the hands and face, 1 to 3 sessions spaced 4 to 8 weeks apart are typical. Intense pulsed light works on the same principle with a broader spectrum, cryotherapy freezes the pigment cells with liquid nitrogen, and chemical peels lift the whole upper layer, which suits skin dotted with many small spots.

Two systematic reviews put figures on this. The first, published in 2023, pooled 48 studies with 1,763 patients and counted complete clearance in 65% of cases treated with a combination of methods, 43% with lasers, 21% with topical retinoids, 15% with cryotherapy and 6% with peels. The second, published in 2025, covered 41 clinical trials with 3,234 patients aged 24 to 92 and reported success rates of 68 to 93% for picosecond lasers, 75 to 90% for intense pulsed light, 36 to 77% for Q-switched lasers, 37 to 71% for cryotherapy and 12 to 46% for trichloroacetic acid peels. Cryotherapy, once the first-line method, came out with the more severe side effects in both reviews, mainly pale patches that stay.

The price of a laser session on both hands varies with country and clinic, commonly 150 to 400 EUR in Western Europe and 200 to 600 USD in the US, and a whole face costs more. If your skin is naturally darker (Fitzpatrick types IV to VI), ask for a test spot first: post-inflammatory hyperpigmentation, a brown shadow that appears 2 to 4 weeks after treatment, is the most common complication and can take months to fade.

Certain things move the appointment rather than rule it out. Clinics commonly wait 6 months after the last dose of isotretinoin, since the skin heals less predictably while the drug is active. Pregnancy and breastfeeding are reasons most practices postpone treatment as a precaution, not because a documented risk exists. Blood thinners such as warfarin or aspirin raise the chance of bruising around the pulse, so mention them at booking, and a cold sore history near the temples calls for antiviral cover before a facial session. Skin that is tanned or freshly sunburned is not treated either: the extra melanin absorbs more of the pulse and turns a routine session into a burn or a pale mark, so most clinics ask for 4 weeks without a tan first.

What matters after the laser

The crust that forms after the pulse is the treatment doing its work. It falls off on its own in 7 to 14 days and should not be helped along with fingernails or scrubs, because a picked crust leaves a pale patch that is often harder to hide than the spot was. For the first 4 to 6 weeks the treated skin gets no direct sun, no sunbed and no self-tanner, and it wears SPF 50 whenever it goes outside.

Lightening ingredients hold a result better than they create one. Azelaic acid, vitamin C, niacinamide, tranexamic acid and retinoids slow melanin production and need 8 to 12 weeks of daily use before the effect shows; a spot a few shades darker than the surrounding skin typically fades over 6 to 12 months with topical treatment alone. Hydroquinone, the classic bleaching agent, is not permitted in cosmetic products in the EU and is prescription-only in most other markets. Whatever the cream, it works only while it is used, and it cannot outrun unprotected sun. The Ingredient Decoder tells you which of these actives a product on your shelf contains.

Prevention that works

The only lever that stops new spots is a smaller light account from today on. A broad-spectrum sunscreen with SPF 30 or higher, on face, neck and the backs of the hands, every day rather than only on holiday, is the whole trick. Reapply every 2 hours in the open and after hand washing, since the hands lose their protection at the basin 5 or 6 times a day. Between 11am and 3pm from March to October the dose is highest in northern latitudes, and a UV index of 3 or higher is the threshold at which protection is worth the effort; the Sun Exposure Timer turns that index into minutes for your skin type.

Sunbeds add to the account instead of replacing it, which is why the UK has banned their use under 18 and the WHO advises against artificial tanning devices altogether. Gloves for driving and gardening, a brimmed hat for the temples and forehead, and sunglasses that block 99 to 100% of UVA and UVB complete the picture. None of it removes a single existing spot, but it decides whether the ones you had lasered come back alone or with company.

Sun protection that reaches the hands

Frequently asked

Are age spots dangerous?

A true solar lentigo is benign and stays benign. A spot that grows, changes colour, develops an irregular border, itches or bleeds is not an age spot until a dermatoscopic examination says so, because lentigo maligna, an early melanoma, can look very similar on the face.

How many laser sessions do age spots need?

Usually 1 to 3 sessions with a Q-switched or picosecond laser, spaced 4 to 8 weeks apart. Each spot darkens, crusts and sheds within 7 to 14 days, and trials report success in 36 to 93% of cases depending on the device.

Do creams remove age spots?

Azelaic acid, vitamin C, niacinamide, retinoids and tranexamic acid slow melanin production and lighten spots over 8 to 12 weeks, with full fading of a light spot taking 6 to 12 months. They are best at keeping a laser result, and they only work while you use them.

Why do I have age spots on my hands first?

Because the backs of the hands are uncovered all year and rarely get sunscreen, so they collect the highest cumulative ultraviolet dose of any body part. The lower back, covered nearly always, stays clear in most people.

Can age spots come back after laser treatment?

A treated spot rarely returns, but new ones form in the same sun-exposed skin if the dose continues. Daily SPF 30 on face, neck and hands decides whether the result lasts 2 years or 20.

Why do I get age spots at 40?

Because the trigger is accumulated ultraviolet dose, not age. Fair skin, childhood sunburns and sunbed use bring the first spots forward into the late 30s, while someone who always covered up may reach 70 with none.

Sources

• DermNet: Solar lentigo · prevalence up to 90% over 60, sites, sizes, differential diagnosis, treatment options
• Mardani G et al., Treatment of Solar Lentigines: A Systematic Review of Clinical Trials, J Cosmet Dermatol 2025 (PMC) · 41 trials, 3,234 patients aged 24 to 92; success rates per laser type, IPL, cryotherapy, peels and topicals
• Mukovozov I et al., Treatment of Lentigines: A Systematic Review, Dermatol Surg 2023 · 48 studies, 1,763 patients; complete response 65% combination, 43% laser, 21% retinoids, 15% cryotherapy, 6% peels; publisher page answers 403 to automated requests, abstract verified via PubMed 36533790
• NHS: Sunscreen and sun safety · SPF 30 minimum, 11am to 3pm from March to October, reapply every 2 hours, UV index 3, sunbeds illegal under 18

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This guide is for general information. It does not replace medical or professional cosmetic advice or an examination.