Freckles (Ephelides and Solar Lentigines)

What are freckles?

Freckles are small flat spots that are usually found on sun-exposed areas of your body. They’re tan, red, light brown or dark brown.

Freckles are extremely common and aren’t a health threat. They’re more often seen in the summer.

You’re more likely to have freckles if you’re lighter-skinned and have blond or red hair. However, freckles can occur in anyone, and appear as darker brown spots if you have darker skin.

How do freckles develop?

Freckles are the result of an overproduction of melanin. Melanin is a pigment that gives your hair, skin and eyes (your “complexion”) its color.

Melanin, produced by skin cells called melanocytes, protects your skin from sun damage by absorbing and reflecting ultraviolet light (UV). If you have a light, or fair complexion, your melanocytes make more melanin when your skin is exposed to the sun. Instead of tanning, you’re more likely to develop freckles.

Are there different types of freckles?

There are two types of freckles: ephelides and solar lentigines.

• Ephelides: Ephelides are flat and usually red or tan-to-brown in color. Ephelides are the freckles that most people think of when they hear the word “freckle.” Sun exposure and sunburns mainly cause them. They typically appear on body areas exposed to the sun: face, arms, upper chest, neck and back. People with lighter hair color and skin color are more prone to ephelides. They’re mainly seen on people who are white and people of Asian descent. Ephelides tend to first appear in young children who are exposed to the sun. Ephelides continue to develop into young adulthood. Ephelides tend to fade with age.
• Solar lentigines: Solar lentigines are yellow to red to brown to dark patches of skin. They’re also called actinic lentigines, liver spots or age spots, as they usually develop in adults over age 40. Repeated sun exposure over time mostly causes them, and they’re found on exposed areas of skin, including your face, forearms, back of your hands, chest, back, shoulders and lower legs.

The differences between ephelides and solar lentigines are summarized in this table.

What causes freckles?

Freckles develop mostly due to exposure to ultraviolet (UV) radiation from the sun. Other causes include:

• Genetics. Several genes are associated with freckling.
• Xeroderma pigmentosum. This is a rare disease that causes increased sensitivity to ultraviolet light, such as the sun.

Do freckles need to be treated?

As freckles are almost always harmless, there’s no need to treat them. As with many skin lesions though, it’s best to avoid the sun as much as possible and use a daily sunscreen. This is especially true if you freckle easily or don’t wish to develop more freckles.

How can I get rid of my freckles?

Freckles can’t be completely removed but can be lightened with topical products, lasers and cryotherapy.

• Acid and chemical peels: Acid and chemical peel products containing alpha hydroxy acid, trichloracetic acid, glycolic acid or phenol can be tried. These products cause the top layer of skin cells to slough off and stimulate the growth of new skin cells.
• Retinoids, retinols: These chemicals encourage skin cells to slough off so new cells are brought to the surface. They also stimulate collagen production.
• Lasers: Lasers remove the top layer of skin.
• Cryotherapy: This procedure uses liquid nitrogen to freeze noncancerous age spots and actinic keratosis. The treated areas become dark and shed in a few days.

Your dermatologist will discuss the best treatment options for you if you wish to fade your freckles.

Can I prevent freckles from developing?

As exposure to the sun mainly causes freckles, the best way to prevent them is to protect your skin from sunlight.

• Always apply a broad-spectrum, water-resistant sunscreen, with a sun protection factor (SPF) of 30 or higher, to all exposed skin before going outside. Use sunscreen every day, even on cloudy days and in the winter. Reapply every two hours or sooner if you’re swimming or sweating.
• Wear a wide-brimmed hat, sunglasses with UV protection and lightweight long-sleeved shirts and pants while outside. Look for clothing with an ultraviolet protection factor label for extra protection.
• Avoid the peak UV hours, usually between 10:00 am and 4:00 pm.
• Avoid all forms of tanning. If you want a tanned look, try a spray-on tanning product.

What are moles?

Moles can appear anywhere on your body. Moles can be of various shapes and sizes. They’re usually larger than freckles. Moles range in color from pink to tan to blue to black to even skin-toned or colorless. Moles can be flat or slightly raised. Most aren’t cancerous (benign), but they can grow and change color and shape. Some can turn cancerous.

Moles tend to appear in early childhood during the first 20 years of life. Some moles appear later in life. Most people have at least a few moles.

Moles of concern are those that look different from other existing moles or those that first appear after the age of 20. Most moles don’t need to be treated. However, if you notice changes in a mole’s color, height, size or shape, get it checked by a dermatologist.

What’s a melanoma?

Melanoma is the most dangerous type of skin cancer. It grows quickly and can spread to any organ. Most melanomas are black or brown, but some are pink, red, purple or skin-colored. About 30% of melanomas begin in existing moles, but the rest start in normal skin. This makes it especially important to pay attention to changes in your skin.

What should I look for during a self-exam of freckles, moles or other skin spots?

According to the American Cancer Society and the American Academy of Dermatology, knowing your ABCs is a useful guide to assess your skin spots.

• A is for Asymmetry: This means that if you draw an imaginary line through the center of the spot, neither side would match the other.
• B is for Border: The spot has a ragged, blurred, notched or irregular border.
• C is for Color: The color of the spot isn’t the same all over and may contain shades of black, brown or tan or even patches of red, white, blue or pink.
• D is for Diameter: The diameter across the spot is about 1/4-inch or larger (the size of a pencil eraser).
• E is for Evolving: The spot has changed its size, shape and color.

If you notice any of these signs, make an appointment to see your healthcare provider or dermatologist right away. Also, know that some spots don’t follow this guide. Other warning signs include:

• Changes in a new spot or growths that are different from the rest of your spots.
• A sore that doesn’t heal.
• Redness or swelling beyond the border.
• The color of the spot spreads beyond the border of the spot into the surrounding skin.
• The spot now itches, is painful or tender.
• The surface of the spot has changed and is oozing, bleeding or scaling or has developed a lump or bump.

Why would I get a freckle on my lip? Is it something to worry about?

Freckles can develop anywhere on your body, including your lips. The skin on your lips is part of your epidermis, the outermost layer of all of your skin. In most cases, having freckles on your lips is harmless. But you should always watch your spots and see your dermatologist if you notice any changes.

Freckles on your lips might resemble other lesions, including moles or a lesion associated with Peutz-Jeghers syndrome. This is an inherited condition in which one of the symptoms is dark-colored spots on various parts of your body, including your lips.

What are white freckles on my skin?

The white spots, called idiopathic guttate hypomelanosis, are thought to be related to long-term sun exposure. Like other types of freckles, they’re most commonly seen in people who are fair-skinned but can also be seen in people who are older and dark-skinned. The areas most affected are legs, arms, upper back and face.

The white spots are due to a decrease in melanin in your skin. Idiopathic guttate hypomelanosis isn’t a harmful condition. Treatment options (if you desire treatment) include topical steroids, tretinoin, pimecrolimus and dermabrasion.

When should I see a dermatologist?

See your healthcare professional or dermatologist if your freckles or other skin spots:

• Change in size, shape or color.
• Have a border that’s jagged or not well defined.
• Are asymmetrical in shape (if divided in half, neither half of the spot matches the other).
• Are sore, itchy or bleed.
• Become raised off your skin.
• Have dark areas or contain multiple colors.

A note from Cleveland Clinic

Freckles are a common skin discoloration. They’re almost always harmless. However, like any other skin spot or skin discoloration, be aware of all the spots on your skin. You may want to take annual pictures of all areas of your skin so you can see all your spots, bumps and skin discolorations over time. This will help you see any changes more easily. If you do see any changes in a mole, freckle or other spots, see your healthcare provider or dermatologist for follow-up. Even if you don’t notice changes, you should see a dermatologist for regular skin checks by a medical professional.