Lentigo solaris L81.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 16.12.2020

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Synonym(s)

Age pigmentation; age spot; Age spot; lentigo senilis et actinicus; liver spot; photoaging; senile freckle; senile lentigo; solar lentigo; Sunspot

Definition
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Acquired, roundish, oval or also irregularly configured, light to dark brown, usually sharply delimited spot(s) in chronically light-exposed skin areas. Lentigo solaris is caused by an initially purely melanocytic proliferation, and with prolonged exposure also by a mixed epidermo-melanocytic proliferation. A solar lentigo, depending on the predominant proliferation pattern, may be transformed into:

transition. Only lentigo maligna requires treatment.

Occurrence/Epidemiology
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In the Central European population, 90% of the 60-year-olds are present in one or more cases. No gender prevalence.

Etiopathogenesis
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Chronic UV exposure.

Manifestation
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Occurs in the middle (40-60 years) and higher (> 60 years) age groups. No gender preference.

Localization
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Especially face, back of the hand, forearm extensor sides. In women, lower legs and the décolleté are also frequently affected. In fair-skinned (genuinely redheaded) persons, multiple lentigines are also found on the shoulders and back.

Clinical features
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  • A few millimetres to several centimetres in size, oval or roundish, also bizarrely configured, sharply defined, yellow-brown to brown spot. Increase in pigmentation due to exposure to sunlight. Only slight fading in winter. Multiple lentigines as they occur after excessive and recurrent UV exposure of the skin are called solar lentiginosis.
  • Reflected light microscopy: Regular pigment network with varying degrees of pigmentation.

Histology
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Atrophic epithelium between still preserved or flattened reticules, but also irregular, often club-shaped, sometimes net-like extension of the reticules (transitions to Verruca seborrhoica are possible). Pronounced basal hyperpigmentation. Also slight melanocytic hyperplasia is possible. Melanophages frequently appear in the upper dermis. Mostly actinic elastosis of varying degrees of severity.

Differential diagnosis
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Verruca seborrhoica; Ephelids; Lentigo maligna; Non-solar lentiginosis can be a symptom of a syndromal disease. S.u. Lentigines Syndromes

Therapy
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  • Symptomatic; cosmetic coverage with commercial make-up.
  • Initially, an experiment with a 5% hydroquinone ointment can be carried out under controlled application. S.a. the application of Resorcin.
  • Superficial curettage with sharp curette (Fa. Stiefel).
  • Cryosurgery (cryopeeling); in an open spray procedure short "freezing" of the lentiginous lesion.
  • In any case, for prophylactic reasons, light protection (especially postoperatively), either textile or with commercially available preparations (e.g. Eucerin Sun, Anthelios).

Progression/forecast
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Transition to a lentigo maligna after years to decades is possible.

Naturopathy
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Soybean extract contains serine protease inhibitors which are said to have a skin-lightening potential. In a double-blind, placebo-controlled study, a brightening effect was achieved with a soy cream.

Literature
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  1. Andersen WK et al (1997) Histopathology of solar lentigines of the face: a quantitative study. J Am Acad Dermatol 36: 444-447
  2. Bottoni U et al (2013) Ink spot lentigo: singular clinical features in a
    caseseries of patients. Int J Immunopathol Pharmacol 26:953-955

  3. Bastiaens MT et al (1999) Ephelides are more related to pigmentary constitutional host factors than solar lentigines. Pigment Cell Res 12: 316-322
  4. Kang S et al (2003) Assessment of adapalene gel for the treatment of actinic keratoses and lentigines: a randomized trial. J Am Acad Dermatol 49: 83-90
  5. Kawada A et al (2002) Videomicroscopic and histopathological investigation of intense pulsed light therapy for solar lentigines. J Dermatol Sci 29: 91-96
  6. Kawada A et al (2002) Clinical improvement of solar lentigines and ephelides with an intense pulsed light source. Dermatol Surge 28: 504-508
  7. Nakamura M et al (2015) Environment-Induced Lentigines (EILs): Formation of solar lentigines beyond ultraviolet radiation. Exp Dermatol doi: 10.1111/exd.12690

  8. Praetorius C et al (2014) Sun-induced freckling: ephelides and

  9. solar lentigines. Pigment Cell Melanoma Res 27:339-350
  10. Todd MM et al (2000) A comparison of 3 lasers and liquid nitrogen in the treatment of solar lentigines: a randomized, controlled, comparative trial. Arch Dermatol 136: 841-846

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 16.12.2020