Q: I have noted the appearance on my face and arms of a number of blotches that have gradually grown darker over the years. Can anything be done to make these spots go away or keep them from getting worse?
A: The darkened ares of skin you describe are commonly referred to as liver spots, though they have nothing to do with the liver. They are hyperpigmented spots resulting from exposure to the sun.
A recent study from the University of Michigan reported an impressive improvement in the appearance of liver spots when 0.1 percent tretinoin cream was applied to them each night over a 10-month period. Sixty subjects, mostly women, were enrolled in the study. Half were treated with the tretinoin while the others served as a control group that applied a cream without the medication. Liver spots on the face and arms disappeared or were much lighter in the people who received the tretinoin cream as compared with those in the control group. The liver spots were unchanged in 17 percent of the treatment group and 71 percent of the controls.
Fifteen of the individuals who had responded well to the 10-month treatment received either tretinoin or cream alone over an additional 6-month period. Spots treated with tretinoin tended to lighten even further, whereas spots were unchanged by application of the cream alone. This result suggests that the improvement produced by tretinoin persists for at least 6 months after its application is discontinued.
The only side effect of the treatment -- reddening and scaling in areas of the skin where the cream was applied -- occurred in 80 percent of those treated with tretinoin. These skin changes were apparently readily tolerated by the participants.
Tretinoin cream is only available by prescription.
Q: One of your recent columns indicated coffee does not increase the risk of pancreatic cancer. But I have heard coffee raises the cholesterol level. Is that true?
A: The bulk of the evidence shows no significant increase in blood cholesterol with the daily consumption of less than six cups of coffee brewed in typical American fashion -- that is, with a filter. Studies in Scandinavian countries, where coffee grounds are boiled in water and not filtered, have found that cholesterol levels do increase when people drink large amounts of coffee. Caffeine is not responsible since there appears to be no difference in the response of those who drink regular or decaffeinated coffee. Suspected instead is some other material in boiled coffee that is removed during the filtering process. The bottom line: a moderate amount of filtered coffee doesn't affect the cholesterol level.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.