Lentigines and Dyschromia

Lentigines are benign, pigmented macules that are frequently a cosmetic concern for patients. Solar lentigines are an early sign of dermatoheliosis and are common in lighter skinned individuals. Procedures used alone or in combination to treat solar lentigines include topical creams, cryotherapy, microdermabrasion, chemical peels, intense pulsed light, and lasers. Nanosecond domain lasers and intense pulsed light sources are the workhorse modalities for treatment of lentigines, and experience is growing with picosecond lasers. Other methods include cryotherapy, millisecond domain long-pulsed lasers, non-ablative fractional lasers, and lightening creams, which can be used alone or in combination. Treatment approaches are tailored for each patient based on the skin and lesion color, as well as tolerance for downtime and multiple treatment sessions. Test treatments can help the clinician find the treatment with the most efficacy and the least side effects. Most treatment modalities are extremely well tolerated without significant adverse events. Strict sun protection is required to prevent post-inflammatory pigment alteration and lesion recurrence.