How Can I Erase The Liver Spots on My Face, Hands, and Chest?

You know those annoying brown spots that show up on your face, hands, and chest in your 30s and older? Well, they're known as liver spots and sunspots, and most, if not all of the time, we want to hide them. "These spots are caused by overactive melanocytes (the area in your skin that creates pigment). Sun is a primary factor for these spots, as it accelerates pigment production in the skin," says esthetician Candace Marino.

Though liver spots are most frequently caused by sun exposure, they aren't always; some brown spots on the face (melasma) can be caused by a surge in hormone levels due to pregnancy, oral contraceptive use, or hormone replacement therapy (HRT) during menopause. Unlike sunspots, melasma spots tend to fade once hormones moderate. A dermatologist can diagnose melasma by using a special light. "The best prevention for liver spots is aggressive sun protection starting from a young age," says Jason Miller, MD. He recommends broad-spectrum sunscreen, "especially physical blocking agents with zinc and iron oxide," and sun-protective clothing such as shirts, hats, and sunglasses.

Brown spots are mainly a cosmetic problem—they likely cause no health risks—but they can be annoying. There are ways to tone them down and camouflage them. Read on for esthetician- and dermatologist-approved prevention and treatment options for liver spots.

Meet the Expert

• Candace Marino is a celebrity esthetician known as The LA Facialist. Her impressive client list includes the model Miranda Kerr, the singer Grimes, and many more.
• Jason Miller, MD, of Schweiger Dermatology Group, is a board- certified dermatologist specializing in medical dermatology, including skin cancer removal and cosmetic dermatology.

Stay Out of the Sun

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The best way to prevent liver spots from cropping up in the first place, according to Marino, is to wear SPF. The ultraviolet light (UV) increases the production of melanin in your skin. With frequent UV exposure, the melanin actually becomes clumped in certain areas, resulting in age spots. "The number one complaint I have from my more mature clients is 'I wish I stayed out of the sun,'" she says. "Once the damage is done, it’s extremely hard to repair. Not only does the sun rapidly break down collagen and pigment, but it also destroys the texture and radiance."

Marino recommends staying out of the direct sunlight and skipping the tanning bed. If you will be outside when the sun’s UV rays are the strongest—between 10 a.m. and 2 p.m.—make sure you are covered up. Wear a wide-brimmed hat and sunglasses, as well as clothing that protects your skin. You can even find clothing that has UV protection built in to keep you extra protected.

Timing is also important when it comes to applying SPF. Make sure you slather it on 15-30 minutes before going outside—and keep reapplying. Experts recommend reapplying at least every two hours, or more frequently if you are in the water or exercising and sweating.

Wear Vitamin C Serum

"As a rule of thumb, people should be using a vitamin C serum daily to protect the skin from the environment and the sun," says Marino. "It’s like an insurance policy for your SPF." A vitamin C skin care product "coats the cells and helps them fight off the free radicals that enter the skin that can create pigment." The powerful antioxidant Vitamin C also helps to produce collagen to reduce wrinkles and fine lines.

Marino's favorite vitamin C-based products are iS Clinical Pro Heal ($155) and SkinBetter Alto Defense Serum ($155).

Miller seconds the recommendation, noting that products containing vitamin C, Kojic acid, and niacinamide can be "effective in helping to decrease pigment."

Make sure the vitamin C in the product is in the L-ascorbic acid form, as this form is the most effective in providing results. Other derivatives of vitamin C that aren’t as effective are listed as magnesium ascorbyl phosphate or ascorbyl palmitate.

Try a Chemical Peel

Glycolic acid peels administered by a doctor work by removing the top layer of skin. You may need to be treated more than once to see the best results. Marino's go-to treatment for this purpose is called Cosmelan. "It helps suppress pigment production while lifting dark spots from the skin," she says.

"I call Cosmelan a Xanax for the melanocytes because this compound shuts off the skin's ability to create pigment by blocking an enzyme called tyrosinase, which is a primary component in pigment production," Marino explains. "At the same time, this peel contains a high dose of retinol, known for its rapid cellular turnover rate, which helps to lift the pigment from the skin to reveal a more unified complexion."

Another option is a TCA peel, which uses trichloroacetic acids instead of glycolic acid to remove the outer layers of the skin to decrease age spots. Talk to your dermatologist to see which one is right for you.

Can't make it to the dermatologist? Try the Renée Rouleau Triple Berry Smoothing Peel ($89) at home.

It's highly recommended that you wait until after pregnancy or breastfeeding to treat melasma or sunspots and always keep your treated skin out of the sun by wearing sunscreen of at least SPF 50 and a hat.

See a Dermatologist for a Laser Treatment

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Ablative laser resurfacing is perhaps the most effective (and costliest) way to remove brown spots. This procedure is done in a dermatologist's office.

Laser treatments target the melanin in your skin and are highly effective. The laser removes the top layer of the skin, along with those pesky age spots, in a procedure that takes about 20 minutes. Scabs will form within 24 hours on the treated area. Once the procedure is over, you can use Vaseline on the spots to protect them, and you'll need to stay out of the sun.

You'll find your spots will have faded with the treatments and some may disappear. The best news is once the skin heals, your skin should be much smoother and sunspot-free. Miller notes that these treatments are "typically safer for those with lighter skin types," so those with deeper skin tones may want to steer clear.

Try Over-the-Counter Skin-Lightening Creams

Over-the-counter skin lightening creams can be effective in lightening brown spots. Look for products with 2 percent hydroquinone in them. Popular OTC creams include Porcelana ($14) and Ebanel Dark Spot Remover ($17). Apply these to live spots twice daily. These should help lighten them, but they likely won't go away completely.

"Another great product for pigment prevention is Even Tone serum from SkinBetter Science," notes Marino. "It is a pigment inhibiting and evening serum that helps to brighten and unify the complexion."

Of note, hydroquinone is a fairly controversial ingredient. It isn't always safe for darker skin tones and violates the ishonest Clean Beauty Pledge. "Hydroquinone on darker skin can cause some lightening of the normal pigmentation as well as the liver spots, leading to a more blotchy final result," Miller cautions. "In rare cases, a condition called exogenous ochronosis (unexpected dark spots in the area treated) can occur if hydroquinone is used for too long." As with introducing any new ingredient or treatment to your skincare routine, consult a dermatologist before starting a hydroquinone regiment.

Talk to Your Derm About Prescription-Strength Creams

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Hydroquinone is available over-the-counter at a 2 percent concentration. If those aren't working, a stronger formula may be needed. Anything over 2 percent hydroquinone requires a prescription, so you'll need to consult a dermatologist to see if a prescription is right for you. "These can work a little faster, but also may be more irritating, so should be monitored by your dermatologist." Popular products for this purpose include Obagi Clear, Glyquin, Tri-Luma, and Solaquin.

Some people may have an allergic reaction to hydroquinone, so make sure you test it on a small area first to see how you will react. You should also be diligent about wearing sunscreen while using this product to see the best results.

Some doctors prescribe Tretinoin to combat sunspots. Tretinoin is a form of vitamin A and is proven to improve the appearance of fine lines, wrinkles, and liver spots. It comes in many brand forms including Renova, Retin-A, Avita, Retacnyl, or Stieva-A. There are also generic versions available that may cost you less money.

When to See a Doctor

Liver spots or age spots often do not require medical care, as they are harmless. Those with fair skin who have had frequent sun exposure are most at risk of developing sunspots. If you aren't sure if you have age spots or something else, talk to your doctor. It is a good idea to get regular skin check-ups from a dermatologist to check for melanoma, which is a form of skin cancer.

According to experts, if your spots change in any way, then you need to have them looked at. Warning signs include:

• Spots that change in size and get larger
• Irregular borders
• Bleeding
• Unusual color combination
• Black spots

If your age spots aren’t fading as fast as you would like with over-the-counter and lotions, talk to your doctor about in-office procedures, including peels and lasers, for faster results. Prescription creams can also work on stubborn spots.

Despite the name, liver spots have nothing to do with your liver function. As noted above, liver spots—or the more accurate name of sunspots—are caused by sun exposure. It is thought the name of liver spots started because they are the same dark color of the liver—and were once mistakenly thought to be a sign of liver issues.

No, age spots or liver spots will not progress to skin cancer and don’t require any treatment—unless you don’t like the look of them and want them removed. You should check in with your doctor if you are unsure if they are truly age spots or if your spots change shape, color, or have irregular borders.

Start by using a color-correcting concealer over the dark spots. Use orange for medium to dark skin tones, bisque for those who have light to medium tones, and a peach tone if you have fair skin. Next, apply a foundation over the concealer with a sponge and finish it off with powder.

Apple cider vinegar contains malic acid, which can help fade age spots. It must be diluted with water before applying to the skin at a ratio of one part apple cider vinegar to four parts water.

Tull SS, Raza S. Lasers & light therapies for skin rejuvenation. Mo Med. 2011;108(1): 69-72.

Ho ET, Trookman NS, Sperber BR, et al. A randomized, double-blind, controlled comparative trial of the anti-aging properties of non-prescription tri-retinol 1.1% vs. prescription tretinoin 0.025%. J Drugs Dermatol. 2012;11(1): 64-69.

Medline Plus. Liver Spots. (n.d.)

L'Oreal Paris. How to Cover Dark Spots with Makeup. (n.d.)

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