They come with age, those brownish spots on the face or back of the hands, harmless yet telltale signs of the passing years. Some grudgingly accept these so-called liver or age spots like combat medals. But for those who powder or preen in frustration and futility, a team of Boston researchers has come up with a space-age solution to this ancient problem.
Using a carbon dioxide laser, doctors Bruce Smoller and Jeffrey Dover of Beth Israel Hospital and Harvard Medical School have removed not only liver spots but sun spots and other discolorations of the skin's pigment without leaving scars.
The carbon dioxide laser is not new. "You would probably find a CO2 laser in any major dermatology center in the country," Dover said. "Dermatologists use the CO2 laser primarily in a high-energy mode to remove recalcitrant warts."
Dover and Smoller, however, have used the laser at a low-energy setting to remove about 200 age and liver spots on 50 patients. Less than nine watts of power is applied, its beam from the pencil-like probe concentrated on a spot from .1 to .2 centimeters in diameter.
"You press a button and it basically zaps for one-tenth of a second over the spot, removing it without a scar," Smoller said.
At such low power, the laser--which at higher wattages can cut to the bone--does not penetrate the epidermis. That outer layer of skin, just .1 millimeter or 10 cells thick, contains the pigment that provides both skin color and the unwanted discoloration.
"The carbon dioxide laser fries everything in its path," Smoller explained, "but because it does not penetrate to the dermis, there is no scar."
It takes about six weeks for the treated area to fully heal, the doctors report, and the process is painless. "It doesn't hurt at all," said Smoller, who has used the device on himself. "We don't use a topical anesthesia. It feels like a pinch at the highest dosage used."
In 70% of their patients, Smoller said, the offending pigmentation was entirely removed while another 20% showed partial success and 10% showed no significant difference. Most important, he added, in no cases was there scarring.
Dover and Smoller are now working to predict which spots or types of skin make poor candidates.
Dr. Allan Wirtzer, a Van Nuys dermatologist and assistant clinical professor of medicine/dermatology at UCLA, is also "pleased with the laser treatment for sun-induced spots. Not only does the laser minimize the risk of scars, but also there is less skin destruction than when liquid nitrogen is employed to remove the spots."
Smoller and Dover say the CO2 laser can also remove sun-induced actinic keratosis, those hard-to-see pink spots that afflict the fair-skinned and can lead to a form of skin cancer. They are currently removed with liquid nitrogen.
They also anticipate treating superficial lesions like seborrheic keratosis, the dime-sized "age warts" that can become irritated by clothing, jewelry or even perspiration.
The procedure holds promise, according to Dr. Jerome Garden, director of laser research and therapy at Northwestern University Medical Center in Chicago. Garden, who reviewed the Boston team's findings, noted that CO2 laser had been used to remove lesions, warts and for excising benign tumors.
But not everyone has embraced the new technology. Dr. Gail Drayton, a West Los Angeles dermatologist, acknowledged that "people are enthused by new modalities of treatment in Southern California" but said she plans to go slow. The carbon dioxide laser is still expensive, she noted, estimating its cost at more than $20,000.
"Liquid nitrogen treatments are $35 to $40. How much would I have to raise my fees to pay for the laser? If the laser gets cheaper, I will consider purchasing it."