Tiny, flat dark spots on the skin that darken upon exposure to sun are referred to as freckles. This word is also commonly used to refer to the dermatological condition of having spotted skin however, freckles are a specific type of skin condition. In the true sense of the word, freckles are known as ephelides where these spots appear and fade or darken and lighten according to the sun exposure patterns. It should not be mistaken with liver spots which are caused by years of sun exposure.
People of all age groups and ethnicities can have freckled skin although it is more commonly observed in fair-skinned people. Two individuals belonging to same ethnic and age groups may show significant differences in the extent of appearance of dark spots. Freckles are usually non-cancerous and therefore, harmless. However, these spots can have psychological effects and may make a person self-conscious.
Freckled skin exhibits spots where the color could range from black, brown, light brown, tan, yellow to red. These spots are usually a millimeter or two, in diameter, although adjacent spots can overlap forming larger patches of pigmented skin. The freckles appear randomly in the sun-exposed areas of the body such as the face, neck, chest, shoulders, upper back and arms.
Freckles may develop into seborrheic keratosis in older subjects. In this condition, brown, itchy lesions grow on the existing dark spot. Freckles may also be a symptom in rare genetic diseases such as xeroderma pigmentosum and neurofibromatosis. A doctor should be consulted if spots of an unusual color or growth are seen and the possibility of a melanoma or basal cell carcinoma to be ruled out.
Freckles is an inherited condition which is aggravated by exposure to sun and influenced by skin type. Identical twins show a remarkable similarity in the density of freckles suggesting a genetic basis for this condition. Skin pigmentation or tanning occurs when skin cells called melanocytes produce the pigment melanin. Melanin production in the skin increases upon sun exposure as a protective mechanism against harmful effects of ultraviolet rays. When melanocytes in only certain regions of the skin produce melanin the pigment is concentrated in small spots and freckles appear.
With freckles, prevention is easier and less expensive than treatment. It cannot be reversed entirely but the degree of the color variance from normal skin color can be reduced. Minimizing exposure to harsh sunlight is extremely beneficial. Sunscreen lotions with a minimum of SPF30 should be applied on the exposed areas of the body, at least 20 minutes before going out into the sun. Using hats, scarves and clothes with long sleeves which cover the freckle-prone regions appropriately is a simple yet effective measure.
A variety of cosmetic treatments are available for reducing or “removing” freckles. Removal is more of a matter of chemically lightening rather than total eradicating the lesions. The dark spots can be lightened by long-term, topical application of prescription creams containing hydroquinone and/or kojic acid. The melanin in the dark spots can be treated to some degree by the use of laser therapy. Chemical peels and tretinoin-ointments cause dermal ablation may also be utilized.
It is important to realize that freckles are a not a skin disease but rather a cosmetic issue. It does not require treatment for medical reasons unless the person wishes to do so.