Well, we are approaching summer time when the heat and humidity are at their best. Summer is the ideal time for liver spots to flourish. Pharmacists and medical doctors see many clients with the condition during this period.
A major question for some pharmacists is whether to refer the client with liver spots to a medical doctor or to recommend topical over-the-counter products. I usually recommend the over-the-counter products, but tell the clients that the condition is sometimes stubborn to treat and if response to the treatment is unsatisfactory, the medical doctor should be consulted.
Truth be told, the over-the counter products for liver spots are often effective and, while many clients return to me to register their satisfaction with them, others do not have the same experience and would require a medical examination and prescription drugs. Interestingly, oral and topical prescription drugs do not prevent recurrence of the spots either.
What are liver spots?
Liver spots (tinea versicolor) is a skin condition caused by a fungus. The fungus is so 'normal' that it is found in the skin of about 20 per cent of infants and in the skin of about 90 to 100 per cent of adults! Most adults have this fungus growing quite harmlessly and invisibly on their skin and, so, the condition is not considered contagious. It is mainly a cosmetic problem.
Liver spots are not due to a liver problem. The fungus which causes liver spots is known as Malassezia furfur or Pityrosporum orbiculare. It is not known what causes some people to actually develop the condition, but we do know that some people who are immuno-compromised are much more likely to develop it.
Dark skin
Warm, moist conditions encourage the growth of this fungus. The fungus becomes invasive and releases chemicals which interfere with the pigment cells in the skin, and therefore change the colour of the skin. Pale pink, dark tan, brownish or whitish patches are seen on the skin, depending on the person's skin colour.
In dark skin there is loss of colour and in light skin there is increase in colour. The upper body and arms are most affected, but the face and neck are sometimes involved. One form of liver spots affects the hair follicles, and typically appears on the back, chest and arms. This form is usually seen in people who have diabetes or who are receiving steroid, antibiotic or immuno-suppressant therapy.
Treatment
The upper body and arms are most affected by liver spot
Although liver spot is a chronic disease and is recurrent in some persons, it is treatable. Most people are treated only with applications to the skin. Tea tree oil, selenium sulphide 2.5 per cent shampoo, benzoic acid with salicylic acid (Whitfield's Ointment), and sodium thiosulphate solution (New Glow) are popular over-the-counter options.
Prescription-only applications include ketoconazole two per cent shampoo and cream (Nizoral), clotrimazole cream (Clotrimaderm, Canesten) and terbinafin cream (Terbisil, Lamisil). The shampoos are applied to wet skin and washed off 30 minutes later. This is repeated daily for two weeks.
Oral medications are more convenient to use, especially since clients may not like the feel or smell of some topical treatments. Oral prescription-only medications include ketoconazole (Nizoral), fluconazole (Apo-fluconazole, Diflucan) and itraconazole (Sporanox).
To reduce the recurrence of liver spots, one fluconazole capsule may be given once monthly for six months. Intermittent application of topical agents such as tea tree oil or regularly adding a small amount of any above-named shampoo to bath water is also helpful. After treatment, the patches will take a few months to regain the original colour of the skin.
Note: Age spots (sun spots, lentigos) which older persons get on the face, hands, shoulders and arms are also known as liver spots, but they are completely different from the liver spots caused by the fungus.
Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.
