Freckles, Freckle, Ephelides

  • Epidemiology
  1. Common occurrence in light-skinned, red-haired patients
  2. Onset in childhood, after Sun Exposure
  • Signs
  1. Characteristics
    1. Light, tan or brown Macules, each 1-2 mm with sharp demarcation
    2. Darkens with Sun Exposure
    3. Vary in number from a few to hundreds of Freckles
  2. Distribution
    1. Face and nose more commonly affected
    2. Neck, chest, arms, legs are also affected
  • Differential Diagnosis
  1. See Hyperpigmentation
  2. Lentigo (juvenile Lentigines onset in childhood, or Solar Lentigines in older adults)
    1. Lentigo does not darken on sunlight exposure
  3. Peutz-Jeghers Syndrome
    1. Pigmented lesions ("Freckles") on lips that crosses vermilion border
    2. Pigmented lesions are also found on the Buccal mucosa, periorbital face, hands and fingers
  • Management
  1. Skin Cancer Prevention
    1. Sun avoidance
    2. Sunscreen
    3. Frequent skin exam
  2. Cosmetic removal
    1. Typically not needed (lesions are asymptomatic and fade in winter)
    2. Same treatments used in Lentigo may be employed for Freckles
      1. Light Cryotherapy
      2. Hydroquinone
      3. Azelaic Acid
      4. Laser therapy