Do you notice flat, reddish-brown, small spots on your skin after exposure to sunlight? These are called freckles. They’re commonly found on sun-exposed areas such as the face, neck, upper chest, back, hands and arms. Freckles often tend to be harmless, but like any other skin lesion, should be checked for changes over time to ensure you haven’t developed skin cancer.
Are you wondering what freckles actually are? Freckles are small patches of extra pigmentation on the skin made up of melanin, a substance produced by responsible for giving your skin its colour. Although usually round and small in size, they can sometimes overlap and run together making them appear in other shapes and larger in size.
This article will thoroughly explain and give an overview of the different types of freckles, their causes, management, and treatment for freckles, and hopefully, answer any questions you may have.
Freckles are very common and aren't considered a threat to your health. They're small flat spots that are more commonly seen or noticed in the summertime. There are two different types of freckles that can be found on the skin: ephelides and solar lentigines. You can also have iris freckles, which appear as a spot of colour on the iris, or a choroidal nevus (plural: nevi), which is a darkly pigmented spot found in the back of the eye.
You are more likely to get freckles if you have a certain skin tone, such as fair skin and blonde or red hair. However, freckles will also appear on darker skin as darker brown spots.
Different types of freckles
Ephelides are the type of freckles that most people imagine when they hear the word ‘freckle’. They are flat and usually red, tan, or brown in colour. Ephelides are mainly caused by sun exposure or sunburns. They typically occur on the areas of skin that get exposed to the most sunlight, the face, neck, upper chest, arms and back. People with pale skin (such as people who are white and of Asian descent) and lighter hair colours are more prone to ephelides. They tend to appear first in children who are exposed to the sun and continue to develop into young adulthood. They can also fade with age.
Solar Lentigines are yellow, red or brown patches of darkened skin. They may also be referred to as actinic lentigines, liver spots or age spots as they tend to develop in adults who are over the age of 40. They result from repeated exposure to ultraviolet (UV) radiation from the sun, which causes the proliferation of melanocytes and accumulation of melanin within the cells of the skin (keratinocytes).1 These types of freckles also appear on areas of skin which are most commonly exposed to sunlight including forearms, back of hands, shoulders, and shins.
What is the difference between ephelides and solar lentigines?
- Size - Ephelides are usually around 1 millimetre (mm) to 2 mm in size, whereas solar lentigines tend to be slightly larger ranging from mm to centimetre (cm) in size
- Colour - Ephelides’ colours are usually enhanced in the summertime and fade in the wintertime, whereas solar lentigines’ colour isn't affected by the seasons
- Borders - The borders of ephelides aren't well defined, however, solar lentigines have clear borders
- Age of appearance - Ephelides develop among younger children whereas solar lentigines occur more commonly in those above 40 years old.
Iris freckles and nevi
Iris freckles will appear in the coloured part of the eye (iris). They are tiny dark brown flecks and like skin freckles, develop from a build-up of melanin pigment.
This type of freckle is located at the back or inner part of your eye. The choroid is the layer of the eye just under the white outer wall (sclera) and above the cornea and includes the iris. Some nevi may appear nonpigmented or amelanotic. Most are amelanotic and appear more yellow than brown. For the most part, choroidal nevi do not cause any symptoms and are usually found during a routine eye examination. However, they can cause blurred vision if situated under the centre of the retina (the macula).¹
Causes of freckles
Freckles are caused when your melanocytes overproduce melanin. Melanin absorbs and reflects ultraviolet (UV) light accordingly to help protect your skin from sun damage.
Sun exposure causes an increase in melanin production that leads to your freckles becoming more pigmented. This is why your freckles may become more noticeable after spending time outside on a sunny day.
Genetics also play a part in who gets freckles. If your family members are prone to freckled skin, then you will likely be too. Nobody is born with freckles, but they will usually start appearing in early childhood and can sometimes disappear as you grow older into adulthood.
Xeroderma pigmentosum is a rare disease that can cause freckles, as it increases your sensitivity to UV light, such as the sun's rays.
Management and treatment for freckles
Freckles are almost always harmless and don't require treatment from a health perspective. However, if you don't like the way your freckles look, it is possible to reduce their appearance (but not completely get rid of them) through the use of topical treatments, such as retinoids, retinol and chemical peels, or lasers and cryotherapy.
How can I prevent freckles?
Due to sun exposure being the main cause of freckles, the best way to prevent them is to protect your skin against the sun's UV rays. Doing this will also help reduce your chances of developing skin cancer.
- Apply sun cream with a high sun protection factor (SPF) or 30 or higher all over your skin before going outside and reapply every two hours (sooner if you’re sweating or swimming)
- Wear hats and sunglasses with UV protection and lightweight long-sleeved clothing to reduce the amount of exposed skin
- Avoid going outside during peak UV hours - 10:00 am - 4:00 pm
- Avoid all forms of tanning, like using sunbeds, instead try a spray-on tanning product1
What’s the difference between freckles and sunspot?
The quickest way to tell the difference between freckles and sunspots is to look at their size. Sunspots are generally larger, typically 0.2 - 2.0 cm. Unlike freckles, sunspots are common with ageing, and may also be referred to as age spots.
What’s the difference between freckles and moles?
Moles, unlike freckles, are raised from the skin's surface. Moles appear when skin cells form a cluster. Freckles can't turn into moles because they have a normal number of pigment-producing cells.
When should I see a doctor?
See your doctor or dermatologist if your freckles or other skin spots:
- Change in size, colour, or shape
- Have a poorly defined border
- Are asymmetrical in shape
- Are painful, itchy or bleed
- Become raised off your skin
- Contain multiple colours or have dark areas
Whilst freckles are extremely common and usually harmless, it is important to, like any other skin discolouration or spot, be aware of them. There are numerous different types of freckles including ephelides, solar lentigines, iris nevi and choroidal nevi. Each type has a common cause - the overproduction of melanin within the skin cells. Due to their non-threatening nature, freckles don’t require any treatment but can be managed in different ways to reduce their appearance. It is important to see your doctor or dermatologist for regular skin checks to ensure any changes are caught early.
- Desai S, Hartman C, Grimes P, Shah S. Topical stabilized cysteamine as a new treatment for hyperpigmentation disorders: melasma, post-inflammatory hyperpigmentation, and lentigines. JDD. 2021 Dec 1 [cited 2023 Mar 30];20(12):1276–9. Available from: https://jddonline.com/articles/dermatology/S1545961621P1276X