Freckles or Sun spots?

The beauty standards of this world fuelled by unrealistic expectations through social media has made the slightest blemishes on the skin an un-welcomed sight.

The world is more forgiving towards skin blemishes now, luxury brands are embracing models with vitiligo, freckles have made their way into instagram filters and I personally love seeing this change.

I’m hoping this post will help individuals understand why freckles occur and hopefully help one embrace them.

What are freckles?

Ephelides the medical term for freckles are small unform light brown pigmented areas (maucles) usually occurring on sun exposed skin such as the cheeks, bridge of nose or over the hands.

They are commonly seen in fair skinned individuals with red hair and blue eyes. Freckles can also occur in Asian and Indian skin type though with lesser prevalence.

In an Indian study of pigmentation disorders in Indian skin type, melasma was the commonest cause and freckles only contributed to ~7% of the study population.

Freckles usually start appearing in childhood & adolescence period.

What causes freckles?

Genetics plays a huge role, mutation of a gene encoding for melanocortin receptors have been found especially in red haired individuals. A positive family history of freckles is usually present.

UV radiation stimulates the melanocytes to produce more melanin (the pigment of our skin) and it also increases the transfer of the melanin to the keratinocytes (cells of the upper layers of our skin) and is responsible for the pigmenation.

Image source: http://droualb.faculty.mjc.edu/Lecture%20Notes/Unit%201/FG04_06.jpg

The number of melanocytes (specialised cells in the skin that makes the pigment melanin) are not increased but there is an increase activity of these melanocytes.

For an individual who is genetically predisposed, UVR (sun exposure) can cause the development of freckles

How to differentiate freckles from sun spots?

  • Freckles/ Ephelids
Image source

Freckles appear at early childhood (2-3 years) over the cheeks, nose or the hands.

They are light brown, 1-5 mm in size, round to oval, regular & well defined patches. Freckles are mostly uniform in size, colour and distribution.

They become darker on sun exposure and fade with strict sun protection. Hence they tend to be more prominent in summer and lighter in winter.

They may even fade with age.

  • Solar lentigens / Sun spots
Image credit : DermNetNZ

Starts appearing in adulthood 20-30 years.

Light -dark brown patches on the sun exposed areas such as face, upper neck, hands. They are larger & more irregular than freckles.

Can occur both in light and dark coloured skin.

Caused by prolonged sun exposure over time.

They become darker with more sun exposure and do not fade in winter. They are persistent throughout life and no not fade with time. They may even increase in number with age.

When to worry about freckles?

A child with multiple freckles and a severe intolerance to sunlight

If the child develops severe sun burns even with minimal sun exposure, a detailed medical examination may be required to rule out genetic disorders such as xeroderma pigmentosa where the cells fail to repair the DNA damaged by UV radiation.

Are freckles harmful?

Freckles are completely harmless unless if its associated with the above mentioned condition.

How to fade freckles?

Freckles respond well to strict sun protection either in the form of sunscreens or physical protection.

I’ve mentioned in my previous blog posts on how to achieve a good level of sun protection.

Other form of treatments are topical creams such as hydroquinone or retinoids. However these tend to give an uneven result.

Chemical peels have shown good results, such as spot TCA or Phenol peels. In these procedures, a high strength alpha hydroxy acid (glycolic acid, mandelic acid etc) or caustic acid (TCA)are applied by a dermatologist using a toothpick or cotton buds to the freckles. These areas then forms a scab with falls off in 7-10 days and heals with a normal pigmented skin.

LASERS have been widely used successfully for fading the freckles as well.

All the above procedures do come with certain side effects such as irritation, redness, pigmentation (especially in dark skinned individuals). Therefore always find a dermatologist experienced in this field to perform such procedures.

Recurrence of the freckles or sun spots can occur hence strict sun protection must be maintained even when the freckles have faded.

My advised is, start loving your sunscreen, use it judiciously for best results.

Try the other treatment options if you are very concerned about the freckles but in my opinion, every blemish, or scar or mole adds character to your face, learn to embrace it.