Brown spots and freckles on sun-exposed skin are known as ephelides (singular: ephelis) and lentigines (singular: lentigo). The key difference lies in their behavior: an ephelis fades during the winter months, while a lentigo persists regardless of ultraviolet (UV) exposure.
Freckles, or ephelides, are extra patches of coloring (or pigment) under your skin. Doctors call them ephelides, and they arise on an individual's mid-face and sometimes more widely from early childhood onwards. You have them because of the genes you were born with. Freckles often show up during childhood, and you may continue to get more until you're in your 20s. They're most common in people with fair skin or red hair, but anyone can have them. If you have dark skin, your freckles may appear as darker brown spots.
Another type of spot on your skin is a solar lentigine. Sometimes called age spots, solar lentigines are caused by the sun's rays. They can look tan, brown, or black and are common in people who are 50 or older. You can get them if you're younger, though.
This article delves into the causes and characteristics of freckles, particularly in African Americans, addressing common questions and concerns.
Types of Freckles: Ephelides vs. Solar Lentigines
There are two main types of freckles:
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- Ephelides:
- Are genetic.
- First show up when you’re around 2-3 years old, often after you’ve been in the sun.
- Are usually on your arms, chest, face, and neck.
- Can be red, dark brown, or light brown.
- Can go away as you age.
- May fade during the winter.
- Are usually about 1-2 millimeters in diameter or bigger.
- Have irregular borders that aren’t very defined.
- Solar Lentigines:
- Are sometimes called age spots or liver spots.
- Show up as you age and are common if you’re 50 or older.
- Can be anywhere on your body that gets sun, including areas such as your back, chest, face, forearms, hands, and shins.
- Don’t fade or disappear.
- Can range from light yellow to dark brown in color.
- Show up because of sun exposure and aging.
- Have clear borders.
As the person ages, this type of freckle generally become less noticeable. They are more prominent in summer but fade considerably or disappear in winter. Solar lentigines tend to persist for long periods, and they do not disappear in the winter although they may fade. They vary in size from a few millimeters to several centimeters in diameter.
The Role of Melanin and Genetics
An ephelis is brown because of the pigment melanin. Melanin is made by melanocytes and diffused into keratinocytes. The colour is due to the localised accumulation of melanin in keratinocytes. Melanin production by melanocytes decreases during the winter months and increases when the skin is exposed to the UV radiation in sunlight.
Ephelides are very common in fair-skinned people, especially in children with red hair, where the MC1R gene is thought to be the main gene involved.
In order to have freckles, you must have a variation of the MC1R gene. The variation of the MC1R gene that causes freckles is passed down genetically. People of Celtic heritage, who typically have very fair hair and skin, are more likely to have this genetic mutation than other groups. However, people of African, Mediterranean, Asian, and Hispanic descent can also have freckles.
Key Genes Involved in Freckle Formation
Several genes play a role in the development of freckles:
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- Melanocortin-1 Receptor (MC1R) Gene: Responsible for producing proteins that regulate eumelanin and pheomelanin production. A variant of this gene is associated with red hair and freckles.
- Interferon Regulatory Factor 4 (IRF4) Gene: A variant of this gene contributes to inhibiting the production of an enzyme that causes melanin synthesis, resulting in light pigmentation, freckles, blue eyes, and brown hair.
- Oculocutaneous Albinism Type 2 (OCA2): A rare form of albinism where freckling is common after sun exposure.
- Basonuclin 2 (BNC2): Associated with skin color saturation; SNPs in this gene have been linked with freckling.
The science of skin color - Angela Koine Flynn
Dermatosis Papulosa Nigra (DPN): "Black Girl Freckles"
Dermatosis Papulosa Nigra (DPN) refers to small lesions that are similar to freckles but aren’t flat on the skin. The lesions are more raised and are seen as a variant of seborrheic keratosis (a non-cancerous skin growth) and can be the same colour as the skin but are often darker. These skin lesions are most prominent in Black, Asian and Indigenous skin types, and most notably are the distinguishable features of actor Morgan Freeman.
The London-based medical aesthetician has DPN herself and explains that the harmless skin conditions tend to run in families. The exact cause of DPN is unknown but there is thought to be a hereditary component. Around 50% of patients seeking treatment have a family history of the skin condition. Lesions typically begin to appear around adolescence and can increase in size and number as one gets older.
Morgan Freeman, known for his prominent DPN
Treatment Options for DPN
There are a number of treatments available to remove DPN, including laser treatment, cryotherapy (using liquid nitrogen to freeze off the lesions), electrocautery (using an electric current) to cauterize the lesion, and curettage (scraping) to remove the lesions.
It's worth noting that both the latter can cause hyperpigmentation (dark patches) or hypopigmentation (lighter patches), which can take up to six months to resolve. Like DPN, hyperpigmentation is also more common in those with darker skin tones so the best to consult an experienced skin specialist before going about a route of treatment.
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Sunspots
Sunspots are caused by too much pigment stuck together in one area of your skin. This can happen after many years of spending a lot of time in the sun. Tanning beds can cause sunspots, too.
If you have sunspots, you could also see: More spots on parts of your body that get sunlight (like your hands, feet, face, and shoulders). Spots as large as a half-inch across.
Moles vs. Freckles
You might mistake moles for freckles, but they're something different. Also called "nevi," moles form when a bunch of your skin cells clump together. You can find moles anywhere on your body. Almost everyone has at least a few moles. Even having dozens is normal. You're more likely to have moles if you have light skin. They often appear when you're a child.
If you notice any changes to a mole, or if it gets itchy or starts to bleed, get it checked by a dermatologist. These can be early signs of skin cancer.
Prevention and Management
Not all brown marks on the skin can be prevented. However, careful sun protection will reduce the number of new solar lentigines. Staying out of the sun and using sun-protective clothing is much more effective than using sunscreens alone.
Sun Protection Tips
- Apply a broad-spectrum sunscreen daily.
- Seek shade during peak sun hours.
- Wear sun-protective clothing, such as hats and long sleeves.
When to See a Doctor
Almost all freckles are harmless, and cancerous freckles are rare. You should see a doctor if your freckles:
- Have jagged borders.
- Aren’t symmetrical.
- Are sore.
- Have a diameter of more than 6 millimeters (about the size of a pencil eraser).
- Become raised above your skin.
- Have dark patches or multiple colors.
- Start to grow or change size or colors.
Most ephelides and lentigines can easily be diagnosed clinically by a health practitioner trained in examining the skin. It is important to distinguish a harmless but atypical solar lentigo from an early melanoma and its subtypes, lentigo maligna and lentiginous melanoma.
Treatment Options for Freckles
Natural freckles don't need treatment, as they don't indicate a skin problem. If you don't like how your freckles look, treatments can help fade them. Brown marks may fade with careful sun protection, such as applying a broad-spectrum sunscreen daily.
Brown marks may be removed more rapidly and effectively by:
- Chemical peels
- Cryotherapy (skin freezing)
- Laser treatments
- Creams such as retinol, a form of vitamin A
A dermatologist can help you decide which treatment is best for you. With superficial resurfacing techniques, there is minimal discomfort and no down time but several treatments are often necessary. Treatment occasionally makes the pigmentation worse by causing postinflammatory pigmentation.
Table: Comparison of Freckles, Sunspots, and Moles
| Feature | Freckles (Ephelides) | Sunspots (Solar Lentigines) | Moles (Nevi) |
|---|---|---|---|
| Cause | Genetics, sun exposure | Sun exposure, aging | Clustering of skin cells |
| Appearance | Small, flat, irregular borders | Larger, defined borders | Raised or flat, various colors |
| Seasonality | Fade in winter | Persistent | Persistent |
| Risk | Harmless, monitor for changes | Harmless, monitor for changes | Monitor for changes, potential for skin cancer |
