Wil Dubois

Welcome back to our weekly diabetes advice column, Ask D'Mine -- you know, the place to find straight-up honest and candid answers about whatever the diabetes topic may be, thanks to your host Wil Dubois (himself a longtime type 1 who works as a clinical diabetes educator.)

This week, Wil tackles a question about some scary unknown skin spots. What Wil says may surprise you, so read on.

Ask DMine column

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Cassie, type 2 from Kentucky, writes: Help! I’m developing areas of brown, circular skin on my hands. My elderly aunt says they are “liver spots.” Are they dangerous? What causes them? Do I need to get my liver checked? 

[email protected] D’Mine answers: Not to worry. Despite their name, liver spots have nothing whatsoever to do with the liver. No need to run out and get your liver functions checked.

Liver spots, also called age spots, and medically referred to as solar lentigines, are simply areas of skin pigmentation gone amuck. They’re common in white folks, presumably because, even if they were present in darker-skinned people, they wouldn’t be visible. The spots run a gamut of color from palest tan, to khaki, to brown, to red, to gray, to black. They are oval and flat. Remember that, as flat vs. not flat will become important in a moment. Liver spots are typically one-to-three centimeters in size, and usually show up on the hands, arms, face, and sometimes the shoulders and tops of the feet — basically whatever parts of your body got a lot of sun exposure throughout your life.

And sun exposure is the key, because liver spots are caused by the effects of ultraviolet (UV) light from the sun, or from chronic tanning bed use, on a natural substance in your skin called melanin. Melanin is a pigment that’s responsible for the color of your skin, hair, and your eyes — if you have dark eyes. For what it’s worth, nearly all God’s creatures have melanin except spiders. I don’t know what’s up with that, but I found it interesting.

When melanin reacts with UV light, it darkens. That’s the science behind that great beach tan. Should you ever need to impress a group of dermatologists at a cocktail party, although I have a hard time imagining why you’d need to do that, the scientific name for the tanning process is called melanogenesis.

As we age, the melanin “pools” into concentrated areas, so liver spots are really just localized tanning. What causes these concentrations as we age? Well, everything droops with age, right? Boobs, waistlines, eyelids, and even noses. So, too, apparently, melanin.

Liver spots typically show up in folks over the age of 40, and blondies and other fair-skinned folks are more likely to develop them. See, brunettes? Blondes don’t really have more fun, after all. At least not in the long run.

Are people with diabetes more likely to suffer from liver spots than sugar normals? To be honest, I couldn’t find any concrete statistics about that one way or another, but as diabetes (at least when it’s not well controlled) can speed up all manner of aging processes, even cataracts, it wouldn’t surprise me if many D-Folks get liver spots earlier than their sugar-normal peers.

Because liver spots are medically harmless, they generally aren’t treated. That said, they totally gross some people out, so what to do? Apparently, they can be bleached out. Don’t try this at home with Clorox, but dermatologists can prescribe special bleaching creams to lighten the spots. A word of warning, however: Make sure the dermatologist knows you have diabetes, as bleaching creams are often used in conjunction with steroid creams and steroids are notorious for spiking blood sugar through the roof.


Or, in the kind of irony that I just love, liver spots can be frozen off using liquid nitrogen. I find this ironic because they are caused by heat and cured by cold. I just love the way the universe works. Oh, but a word of warning: This process sometimes leaves scars.

Upping the ante, a medical Dremel tool can be used to scour off the liver spots. This is called dermabrasion. For Star Wars fans, lasers can be used to zap the melanin-producing cells. And last, but not least, acid can be used to dissolve the outer layers of the skin so that liver spot-free skin grows back to replace it. This is said to be the most painful of the options.

Ya think?

Not that this helps you, Cassie, but I’d be remiss to not mention to our younger readers that an ounce of sunscreen is worth a pound of bleach, liquid nitrogen, Dremel tools, lasers, and acids. The best “treatment” for liver spots is to not get them in the first place. You can’t do anything about the melanin, but you can reduce your UV exposure. A bottle of sunscreen from the dollar store is the best prescription for prevention.

But, hey, why are the damn things called liver spots in the first place if they have nothing to do with the liver? Apparently back in the early days of medicine, they were believed to be caused by the liver due to their similar color.

Even though later disproved, the name had already stuck.

Now, while liver spots are harmless to all but the sensitive ego, something more sinister can sometimes be mistaken for a liver spot: Skin cancer, which can also be caused by UV exposure.

When in doubt, have your doc take a look-see, but in general, skin cancers have a few distinguishing features that set them apart from liver spots: First, liver spots have smooth, well-defined edges. Skin cancers tend to be irregularly shaped. Second, liver spots are flatter than pancakes. Well, actually, totally flat. Liver spots are smooth and indistinguishable from the surface of the surrounding skin because they are part and parcel of the skin. Cancers, being growths, are sometimes raised above the surrounding skin. Likewise, a “rough” surface suggests cancer. Third, regardless of what lovely hue your liver spots are, they are monochrome. Skin cancers can have mixed colors. Fourth, liver spots develop in slow motion. Cancers can be fast. If you have a fast-growing spot on your skin, scamper to your doctor without delay. And lastly, liver spots are painless, whereas skin cancers can trigger sensations like itching, tenderness, or pain. Oh, yes, and any weird skin thing that bleeds needs medical oversight — right now.

One last thing about skin cancers. They are like icebergs. Nine-tenths of them are beneath the surface. Don’t disregard a strange appearance on your skin because it’s small. It may be just the tip of the iceberg. If it’s cancer, there’s a whole lot more to it than meets the eye.


Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.