Treatment of solar lentigines

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Therapy for solar lentigines is diverse but can be divided into two broad categories: physical therapy and topical therapy. Physical therapies are frequently used with excellent clinical success rates, but this has to be balanced against associated side effects and recurrence rates with certain therapies. A range of topical therapies have been used and, more recently, fixed combinations of topical agents have been investigated. The Pigmentary Disorders Academy undertook to evaluate the clinical efficacy of the different treatments of solar lentigines in order to generate a consensus statement on their management. Clinical papers published during the past 20 years were identified through MEDLINE searches and methodology and outcome were assessed according to guidelines adapted from the US Preventive Services Task Force (USPSTF) on health care. The consensus of the group was that first-line therapy for solar lentigines was ablative therapy with cryotherapy. Although no large-scale studies have been completed, there is also good evidence to suggest that lasers are an effective treatment. An alternative to ablative therapy is topical therapy and there is good evidence to support the use of a fixed double combination, as well as retinoids, such as adapalene and tretinoin. Topical therapy can also be considered as maintenance therapy after the primary therapy has been applied. Because of the diversity of scoring systems used in the assessment of treatment outcome, the group recommends the development of treatment guidelines.

Section snippets

Cryotherapy

Cryotherapy is one of the most widely used techniques to remove solar lentigines, particularly in Western Europe and the United States. The technique can be used with a number of cryogens, including carbon dioxide, nitrous oxide, and liquid nitrogen. The most commonly used agent is liquid nitrogen, either applied with a cotton swab or more commonly with a small hand-held spray unit. The principle of the treatment in solar lentigines is tissue injury by cell freezing. Melanocytes are especially

Topical therapy

A range of topical therapies are currently available for the treatment of solar lentigines. The principal mode of action is the disruption of melanin formation. Hydroquinone (HQ) and tretinoin (retinoic acid [RA] or vitamin A acid) are the most widely used agents for the treatment of hyperpigmentation; other topical agents that have been used as monotherapy or in combination include mequinol (4-hydroxyanisole [4HA]), adapalene (synthetic retinoid), and azelaic acid. HQ inhibits the conversion

Recommendations

The PDA has reviewed the literature on treatment of solar lentigines and categorized the clinical findings for each treatment according to guidelines adapted from the US Preventive Services Task Force (USPSTF) on health care (Table II, Table III).37

As a result of reviewing the clinical evidence, as shown in Table II, Table III, the PDA has categorized each therapeutic option for solar lentigines as shown in Table IV.

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    Supported by Galderma International.

    Disclosure: All authors are members of the Pigmentary Disorders Academy (PDA) and receive honoraria from Galderma for their work on behalf of the Academy.

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