Skincare Case 113

Age: 72 years old
Gender: Male
Fitzpatrick: 4
Skin type: Dry
Main concern: Dark spots on hands
History: He used to drive long distances. He never used any sunscreen.
He thinks these dark spots, also called liver spots, are a sign that his liver is damaged.
He wants to remove the spots anyway.
Homecare routine: He uses Aquaphor for dryness of his hands.
To protect himself from COVID and other contagious diseases, he washes his hands several times daily and also uses plenty of hand sanitizer.
Findings: His skin is overly dry with lots of tiny cracks on the skin
The spots have sharp borders under Wood’s lamp, and the skin is dry.
Very poor skin elasticity, and the skin looks thin and fragile.

Skincare Exams case 113
Case Discussion (Please click here)

This case involves a 72-year-old male with Fitzpatrick skin type IV and dry skin, who presents with the main concern of dark spots on his hands. He has a history of long-distance driving without using sunscreen. He incorrectly believes these dark spots, sometimes colloquially called liver spots, are a sign of liver damage. The patient’s current home care routine involves using Aquaphor for hand dryness and frequent hand washing and hand sanitizer usage to protect against COVID-19 and other infectious diseases. On examination, the skin is overly dry with numerous tiny cracks, and the dark spots have sharp borders under Wood’s lamp. The skin exhibits poor elasticity and appears thin and fragile.

Causes

The patient’s dark spots, or “liver spots,” are actually a condition known as solar lentigines or age spots. These are harmless and occur due to years of sun exposure, which causes melanocytes in the skin to produce excess pigment. His dry, thin, and fragile skin is likely due to intrinsic aging, but exacerbated by excessive hand washing and hand sanitizer usage.

What is Done Wrong

  1. Lack of sun protection: The patient’s history of long-distance driving without using sunscreen likely contributed to the development of his solar lentigines.
  2. Frequent hand washing and sanitizer use: While this is necessary to prevent the spread of infectious diseases, it can strip the skin of natural oils, leading to dryness and cracks.
  3. Use of only Aquaphor: While Aquaphor can help to seal in moisture, it does not provide hydration to the skin. It should ideally be used in conjunction with a hydrating moisturizer.

Office and Home Treatment Options

Office treatments:

  1. Laser therapy or intense pulsed light (IPL): These treatments can help lighten or remove solar lentigines.
  2. Cryotherapy: This treatment involves freezing the age spots to destroy the extra pigment.
  3. Chemical peels: These can help to remove the top layer of skin, lightening the appearance of the spots.
  4. Dermabrasion or microdermabrasion: These treatments work by removing the surface layer of the skin to reduce the appearance of age spots.

Home treatments:

  1. Topical lightening creams: These can help to lighten solar lentigines over time. They often contain ingredients like hydroquinone, kojic acid, or retinoids.
  2. Sunscreen: This is crucial in preventing further sun damage and the development of more age spots.
  3. Regular moisturizing: This can help to combat dryness and keep the skin supple.

Preventions

  1. Sun protection: Regular use of a broad-spectrum sunscreen, wearing protective clothing, and limiting sun exposure can help prevent further sun damage.
  2. Regular moisturizing: Keeping the skin moisturized can help prevent dryness and maintain skin health.

Home Care Daily Routine

Morning:

  1. Cleanse hands with a gentle, hydrating cleanser.
  2. Apply a moisturizer to keep the skin hydrated.
  3. Apply a broad-spectrum sunscreen with an SPF of at least 30.

Throughout the day:

  1. Reapply moisturizer after hand washing.
  2. Reapply sunscreen every two hours, or more frequently if sweating or wiping hands.

Evening:

  1. Cleanse hands with a gentle, hydrating cleanser.
  2. Apply a hand cream containing urea or lactic acid to help exfoliate and hydrate the skin.
  3. Apply a layer of Aquaphor or a similar occlusive to seal in moisture.

If the patient follows this routine and uses sun protection regularly, he should see an improvement in the dryness and texture of his skin. For the solar lentigines, it’s important to remember that treatment results can vary and it may take time for the spots to lighten. Furthermore, it’s crucial for the patient to understand that while these spots are often called “liver spots,” they are not indicative of liver damage or disease. Regular follow-ups with a dermatologist can help monitor the progress and make any necessary adjustments to the treatment plan.

It’s also recommended that the patient seek a consultation with a dermatologist before starting any new treatments, particularly those involving exfoliants or lightening creams, to ensure they are suitable for his skin type and condition. If his skin is overly sensitive or if he experiences any adverse reactions, he should stop the treatment and consult his dermatologist immediately.

Additionally, considering the patient’s age and the thin, fragile condition of his skin, he should be mindful of any signs of skin cancer such as new growths, spots, bumps, moles, or sores that do not heal. Regular skin checks by a dermatologist are recommended for early detection and treatment of potential skin cancers.