5 Skin Spots, Dots and Blotches That Shouldn’t Worry You
Finding new growths can be scary, but many are harmless and just a sign of normal aging
When a 52-year-old friend noticed some "weird spots" developing on her body, she asked me, "What is this?" I replied, "This is the beginning!"
Scaly, bumpy spots. Bright red dots. Discolored blotches. These and other growths are common on aging skin and, in most cases, they are not cause for concern. But like my younger friend, you may not know anything about them. What exactly are they?
Seborrheic keratoses: Waxy, scaly growths that are brown, black or tan. Many people in the U.S. call them "skin barnacles." In France, they are known as "fleurs de cimetière," which translates as "cemetery flowers." (Grim!) The cause of seborrheic keratoses is unknown, but most people develop them in middle age or later.
"The skin is such a magnificent organ, and unlike with our internal organs, we get to watch every change."
Lentigines: Flat, oddly shaped blotches — most often brown — that usually appear on the face and arms. They are named for their resemblance to a small lentil. They are perhaps better known as liver spots or age spots. Most are caused by exposure to ultraviolet radiation from the sun or indoor tanning.
Angiomas: Little bright red dots, commonly known as cherry angiomas. They develop when blood vessels clump together. They do not have any known significance.
Stucco keratoses: Tiny white or gray wart-like lesions or dots, most often found on the feet or legs of older men.
Purpura: Purple spots that appear where small blood vessels have burst, causing the blood to pool under the skin. They sometimes are mistaken for bruises.
Not everyone experiences these skin growths because the aging process is different for everybody. Genetics may play a part in some of them, but often, sun damage inflicted long ago is to blame. When we are younger, our skin can repair some of that damage, but as we age it's not possible to reverse all of it.
In some instances, our spots, dots and blotches can be treated or removed, if they're bothersome. But aging skin has its defenders.
"The skin is such a magnificent organ, and unlike with our internal organs, we get to watch every change," says Dr. Daniel Butler, assistant professor of dermatology at the University of California, San Francisco (UCSF).
"If it smells good, it's no good for your skin."
"Skin is remarkable. Its plasticity, its ability to regenerate, its means of protecting us and even that it ages with us — all these are remarkable skills," he says.
Butler's research focuses on skin diseases in aging individuals. "Geriatric dermatology is a new field," he says. "We're looking at what happens to skin in the normal process of aging and also what can we do to make that a more understood process."
The geriatric dermatology clinic at UCSF was founded two years ago. Butler notes that other specialties, including orthopedic surgery and ophthalmology, also are turning more attention to older adults.
"We all need more nuanced practices for seniors in our care and, though there are not many geriatric dermatology clinics, most dermatologists are specialists in treating aging skin because they see so many older patients," says Butler.
Dump the Lotion Pump
Pruritis — that's itchy skin — is another condition common among older adults, according to the National Institute on Aging. Butler notes that those with the condition can't rely on remedies that have served them well in the past.
"Dry skin in your twenties is a different type of dry skin than when you are in your seventies, eighties or nineties," Butler says. "It may be the same diagnosis but [it] calls for a completely different approach," he adds.
As you age, your skin loses some of its collagen and its ability to create moisture, but you want to keep what you've got. Searching for the ideal over-the-counter moisturizer can be daunting, Butler admits, but he has two recommendations:
- Go with a cream or an ointment, not a lotion. “Any lotion that comes in a bottle with a pump has alcohol in it,” he says. “That will dry your skin, so look for a product that you have to scoop out of a tub.”
- Avoid anything with fragrance. “One of the most irritant-provoking substances across the population, specifically in aging adults, is fragrance,” says Butler. “If it smells good, it’s no good for your skin.”
Dr. M. Laurin Council, associate professor of dermatology and the director of dermatologic surgery at Washington University School of Medicine in St. Louis, recommends short, lukewarm showers or baths and limiting your use of soap, which also can dry out your skin.
"A moisturizing soap is better than an anti-bacterial soap," says Council, "and body washes can be more drying than a bar [of soap]." When you get out of the shower, "apply a heavy cream in a tube or jar to moisturize your damp skin, as that will help keep it hydrated," she adds.
While moisturizing, use that time to look for a spot, dot or splotch that has changed in some way. Maybe you scratched it and it's infected — or maybe you have an actinic keratosis, a rough, scaly patch caused by too much sun exposure, which may develop into a skin cancer.
An Epidemic of Skin Cancers
All skin cancers are on the rise, Council notes, but melanoma, the deadliest type because it can spread, is being caught earlier. Basal cell carcinoma and squamous cell carcinoma are non-melanoma cancers that are less recognized.
"We dermatologists do a decent job informing people about what melanoma looks like, but people are less well-versed about non-melanoma skin cancers, and now we're seeing an epidemic of those, due to sun-damaged skin," she says.
When do you need to see a doctor?
If a skin condition comes and goes (like eczema) you probably don't need to be concerned.
Skin cancers don't resolve on their own, though. "So, if you have a sore that's not healing after a month or more, or if a spot bleeds or gets bigger, you need to get it checked out," Council says.
The risk of getting skin cancer goes up around age 40. Council recommends that after that birthday, see a board-certified dermatologist for a baseline exam. She also suggests that everyone do self-exams once a month. "Get to know where your moles and spots are and look for changes," she says.
A few words about preventing sun damage always bear repeating. "Protect your skin with a broad-spectrum sunscreen that targets UVA and UVB rays," adds Council. "Find a product you're comfortable with and put it on every day, because if you don't wear it, it's not going to help you. You also can wear protective clothing, including a hat," she says.
Aging may bring unattractive skin growths, but it also confers wisdom.
"Enjoy the sun," says Council. "But do it sagely."