Freckles: Treatment and Prevention

What are freckles?

Freckles are flat, tanned circular spots that typically are the size of the head of a common nail.The spots are multiple and may develop randomly on the skin, especially after repeated exposure to sunlight. These are particularly common in people of fair complexion on upper-body skin areas like the cheeks, nose, arms, and upper shoulders.They may appear on people as young as age 1 or 2.

Most freckles on a person’s skin are usually uniform in color. On different people, freckles may vary somewhat in color — they may be reddish, yellow, tan, light brown, brown, or black — but they are basically slightly darker than the surrounding skin. They tend to become darker and more apparent after sun exposure and lighten in the winter months. Freckles are due to an increase in the amount of dark pigment called melanin and are not due to an increase in the total number of pigment-producing cells called melanocytes. The word freckle comes from the Middle English freken, which, in turn, came from the Old Norse freknur, meaning “freckled.” (Some speakers of Old English and Old Norse must have had a tendency to developing freckles.)

How do freckles develop?

Freckles are thought to develop as a result of a combination of genetic tendency (inheritance) and sun exposure. Two people receiving the same sun exposure may not have an equal chance of developing freckles. Natural sunlight and artificial suntanning lights emit ultraviolet (UV) rays. After exposure to ultraviolet rays, the outer layer of the skin (the epidermis) thickens and the pigment-producing cells (the melanocytes) produce the pigment melanin at an increased rate. (This production of melanin may in fact give some protection against future sun exposure.)

Of course, people differ a great deal in their reaction to sunlight. To take an extreme example, there is no pigmentation in the skin of an albino because of a defect in melanin metabolism. On the other hand, people with dark complexions are relatively less sensitive to sun exposure than fair-skinned people. However, people with dark skin are not entirely resistant to the effects of the sun, and they, too, can become sunburned with prolonged exposure. People with blond or red hair, light-colored eyes, and fair skin are especially susceptible to the damaging effect of UV rays.

Irrespective of skin color, freckling is caused by the uneven distribution of the melanin pigment in the skin.. A freckle is essentially nothing more than an unusually heavy deposit of melanin at one spot in the skin.

How can freckles be prevented?

Since we cannot change our own genetic component of freckling, our main prevention measures are aimed at sun avoidance and sun-protection, including

  1. use of sunscreens with SPF (sun protection factor) 30,

  2. use of wide-brimmed hats (6 inches),

  3. use of sun-protective clothing (shirts, long sleeves, long pants),

  4. avoidance of the peak sun hours of 10 a.m. to 4 p.m., and

  5. seeking shade and staying indoors.

Ideally, freckle prevention is more effective than later trying to remove freckles that have already developed. Freckle-reduction treatments are more difficult and not always satisfactory.

People with known hereditary tendencies of freckling should start sun protection early in childhood. Much of the sun and UV skin damage occurs often while children are under age 18.

Fair-skinned people who are more prone to freckling and sunburns are also generally more at risk for developing skin cancers. Freckles may be a warning sign of sensitive skin that is highly vulnerable to sunburn and to potential skin cancer.

How can freckles be treated?

Several safe and effective methods are available to help lighten or reduce the appearance of freckles: Frequently, multiple or a combination of treatments may be required for best results. Not everyone’s skin will improve with similar treatments and freckles can easily recur with repeated UV exposures.

  1. Bleaching or fading creams: Products containing hydroquinone and kojic acid can be purchased with and without a prescription. Higher concentrations of hydroquinone (over 2%) require a prescription. These products can help lighten freckles if they are applied consistently over a period of months. Bleaching or fading creams are most effective in combination with sun avoidance and sun protection.

  2. Retinoids: Sometimes used in conjunction with other bleaching creams, tretinoin (vitamin A acid, Retin-A), tazarotene (Tazorac), adapalene (Differin) also may help lighten freckles when applied consistently over a period of several months.

  3. Cryosurgery: A light freeze with liquid nitrogen in the physician’s office can be used to treat some types of freckles. Not all spots respond to freezing or burning.

  4. Laser treatment: Multiple types of lasers may help lighten and decrease the appearance of freckles safely and effectively. Like cryosurgery, this is a simple and safe procedure with a high success rate and a low risk of scarring or skin discoloration.

  5. Photofacials or Intense Pulsed Light treatments are another method to lighten and remove freckles. This is not a true laser technique but an intense light source.

  6. Chemical peels can also help lighten freckles and improve irregular pigmentation.

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