Dear Mary,

A spot of a situation you mention. Let's take a look at the many different types of "spots" that can show up on one's skin. Some of the most common include:

Age or Liver Spots
Despite their name, these typically harmless brown spots that appear on people's hands, feet, face, and back as they age are usually caused by exposure to the sun, not by liver problems. Creams advertised on television and in magazines will do nothing to "fade" liver spots, but prescription medicines and skin resurfacing treatments may help reduce or remove their appearance.

Actinic Keratoses or "Sunspots"
These red or brown scaly patches of skin may be flat or raised like warts. They are most often seen on the face or hands (places most exposed to the sun). Unlike liver spots, which are usually benign, these changes in the skin can signal the growth of pre-cancerous conditions that need to be evaluated (and possibly removed) by a dermatologist.

Cherry Angiomas
These clusters of dilated capillaries make small red or purple bumps on the skin, usually on the chest and back. Most are small (the size of a pin head), but they can grow larger and become raised and sponge-like. Although cherry angiomas are normal (most people over age forty have them) and cause no health problems, people may choose to have larger spots removed for cosmetic reasons. A dermatologist can eliminate an entire growth, with little to no scarring, by electrocautery or laser surgery.

Any suspicious looking spots need to be checked out by a health care professional to make sure they are not cancerous.

The spots you refer to could be the result of bruising or bleeding under the skin. Bruising easily or for no apparent reason (without any type of injury) may be a sign of a coagulation (clotting) disorder. This condition may be inherited or caused by certain types of medications or other illnesses. Signs of coagulation disorders include:

• Excessive bruising or bleeding from relatively small injuries or medical procedures
• Frequent nose bleeds
• Bleeding gums
• Heavy menstrual bleeding
• Blood in the urine or stool

Clotting disorders, once identified, may be treated through the use of medications to increase the blood's ability to clot and, when possible, addressing and treating any underlying causes of the problem. Because skin problems have a number of causes and possible treatments, people that choose to continue the quest to become spotless will do so by seeking the advice of a health care provider. After s/he has a chance to examine your spots and the surrounding skin, s/he'll be able to rule out some of the possibilities mentioned here, and offer advice on treatment and prevention. If you go to Columbia, you can make an appointment to go see Primary Care Medical Services on Open Communicator or by calling x4-2284.

As you can see, many of the causes of various skin spots are harmless. Some social pressures and beliefs lead people to use terms like "ugly" and think that all possible spots should be removed. Keep in mind that each person has her/his own spots. You may consider thinking about how these spots make you unique, like "beauty marks." Coming to terms with your distinct self may help address image or esteem concerns. Stay beautiful!

Alice

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