What are the treatment options for solar lentigines (lentigines solares, also known as sun-induced freckles or age spots)?

From the Guidelines

Solar lentigines can be effectively treated with topical retinoids, such as adapalene 0.3% or tretinoin 0.01% and 0.05%, which have been shown to improve lentigines and reduce wrinkles 1. When considering treatment options for solar lentigines, it's essential to prioritize methods that promote cell turnover and fade pigmentation.

• Topical retinoids, like adapalene 0.3% or tretinoin 0.01% and 0.05%, are recommended due to their modest benefit in improving lentigines and reducing wrinkles 1.
• Prevention is also crucial, and daily application of broad-spectrum SPF 30+ sunscreen, as well as sun avoidance between 10am-4pm, can help prevent new lesions from forming 1.
• Additional treatment options, such as hydroquinone 2-4% cream, azelaic acid 15-20% cream, cryotherapy, chemical peels, laser therapy, or intense pulsed light treatments, can be considered for faster results or for patients who do not respond to topical retinoids.
• It's essential to note that while these treatments can be effective, they may have varying degrees of efficacy and potential side effects, and patient education on sun protection and prevention is vital to prevent new lesions from forming.

From the FDA Drug Label

HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation.

The treatment for solar lentigines (also known as senile lentigines) is hydroquinone (TOP), which is used for the gradual bleaching of hyperpigmented skin conditions, including solar lentigines.

• Key points:
  • Indication: hyperpigmented skin conditions
  • Specific condition: senile lentigines (similar to solar lentigines)
  • Treatment: hydroquinone (TOP) 4% skin bleaching cream 2

From the Research

Treatment Options for Solar Lentigines

• Combination topical therapy using 2% mequinol/0.01% tretinoin has been shown to markedly reduce lesion darkness with few side effects 3
• Chemical peels can give good results either alone or in combination with topical therapy 3, 4
• Cryotherapy is an effective and inexpensive way of treating solar lentigines 3, 4
• Intense Pulsed Light (IPL) and lasers are more costly treatment options 3, 5
• Topical retinoids, such as adapalene and tretinoin, can be used as an alternative to ablative therapy 6, 4

Efficacy of Treatment Modalities

• Combination-based treatments showed the greatest frequency of cases with complete response (65%) 7
• Laser-based treatments had a complete response rate of 43% 7
• Topical retinoids had a complete response rate of 21% 7
• Cryotherapy had a complete response rate of 15% 7
• Chemical peels had a complete response rate of 6% 7

Adverse Events

• Adverse events occurred most commonly with topical retinoids (82%) 7
• Combination-based treatments had an adverse event rate of 39% 7
• Cryotherapy had an adverse event rate of 33% 7
• Laser-based treatments had an adverse event rate of 23% 7
• Chemical peels had an adverse event rate of 19% 7