Freckles
(Ephelides)
Freckles are tan, flat spots found on the skin. They are usually multiple in numbers and become more apparent with sun exposure. In many individuals they are often imperceptible in the winter months. Although freckles are mostly harmless, they may be seen in association with some diseases such as xeroderma pigmentosum.
Freckles may be found in varying degrees in most, if not all, individuals. Ephelides are more common in fair-skinned and red- or blond-haired white people than in individuals of other races. There is a strong hereditary component and are more common in people living in temperate climates. Freckles are distributed equally between the sexes, first appearing at age 2 years and then increasing in number into young adulthood. As you age the number of freckles usually decreases.
Freckles present during childhood as scattered areas of increased
pigmentation, mainly limited to body regions above the waist. Simple put freckles are multiple, small, tanned flat spots, ranging from 1-5 mm in diameter, with uniform pigmentation. The spots are asymptomatic and are more numerous on sun-exposed areas, such as the nose, the cheeks, the shoulders, and the upper part of the back. They fade and become smaller in the winter. The spots may stand alone or may coalesce into larger irregular shaped ones.
Treatment is not necessary. If a patient wishes to alter the cosmetic appearance, then sun avoidance and makeup can be used. Sunscreens may be used to prevent enhancement of the freckling caused by sun exposure.
Chemical peels, cryotherapy, and laser treatments have all been attempted to make ephelides less pronounced. Several different types of lasers have been used with varying degrees of success. If laser therapy is implemented a test spot will be required to insure that the treatment does not make the appearance worse. Usually any improvement is temporary if sun exposes is not reduced or eliminated.
Freckles may be cosmetically unappealing, but they are not associated with any complications. Studies have shown that individuals with skin types susceptible to ephelides are at greater risk for developing skin cancers. This association is simply because freckles and skin cancers are more common in people who are regularly exposed to the sun and have more fair skin types than in other people.
Xeroderma pigmentosum is a rare hereditary disease where individuals sunburn and freckle easily with minimal sun exposure. Excessive freckling in dark-haired individuals suggests the possibility of this disease. The Xeroderma Pigmentosum Society has an informative web site, www.xps.org.