Freckles (Ephelides, Skin Blemishes)


Melanin is a skin pigment that gives color to the skin. Abnormal, small, and brown clusters of melanin give rise to skin condition known as freckles or ephelides. Freckles are commonly present on the face and arms. Freckles are found in the form of tanned macules, which are small-sized, discolored spots.

Freckles are extremely common and fairly harmless. Most of the time freckles do not pose a health issue, but in some incidences they are associated with systemic diseases. Freckles are usually occur as multiple blemishes on the skin rather than a single spot. It is more common in light-skinned individuals with red or blonde hair and are more likely to be prominent in the summer.


Freckles can be of two types :

  1. simple freckles
  2. sunburn freckles

Simple Freckles

The signs and symptoms of simple freckles are:

  • Small blemishes usually 1 to 5 millimeter in diameter.
  • Flat brown, tanned spots known as macules.
  • Pigmentation pattern is uniform.
  • Most commonly appear on skin areas exposed to sun, like the cheeks, the nose, the shoulders, and the upper back.
  • Macules may be present as individual units or may blend into each other.

Sunburn Freckles

The symptoms of sunburn freckles are:

  • Darker compared to simple freckles.
  • Larger than simple freckles and might measure in centimeters.
  • Irregular borders.


Genetic factors and exposure to the sun play the main roles in development of freckles. However, there are other factors that contribute to freckles as well.

  • Genetics. Freckles run into families. They are linked with genes responsible for fair skin and/or with red or blonde hair. The polymorphism (appearance in more than two forms) of a gene, melanocortin 1 receptor (MC1R), is closely related to the development of freckles.
  • Biological changes. In people who are genetically susceptible to freckles, there may be genetic changes in the melanin-producing cells (melanocytes). These changes may promote increased production of melanin even when the number of melanocytes may remain same or decreases. This results in formation of bigger melanin-storage cells (melanosomes) which gives the appearance.
  • Skin diseases. Some diseases like xeroderma pigmentosum are associated with freckling in dark-haired individuals.
  • Neurofibromatosis is a genetic disorder of the nervous system, also presents freckles in the folded regions of the body.
  • Environmental factors. In freckles-susceptible individuals, exposure to both UV-A and UV-B radiation of sunlight stimulates melanocytes. This results in increased production of melanin.


Treatment is not needed for freckles. If desired, the following measures can be taken to reduce or remove the appearance of freckles:

  • Avoiding the sun prevents the appearance and severity of freckles.
  • Makeup can be used for cosmetic appearances.
  • Sunscreens may help during sun exposure and prevent enhancement of the freckling.
  • Chemical peels can help in fading the freckles and improving the appearance.
  • Cryotherapy using liquid nitrogen can be used to eliminate freckles.
  • Non-invasive laser treatment can remove freckles.

Avoiding sunlight is the best preventive measure. In unavoidable situations, use of sun block lotions with high SPF value should be followed.

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