Ephelides, more commonly known as freckles, are benign, small, well-demarcated, brown macules found on the sun-exposed skin of blond, light brown, and red-haired individuals. They present in early childhood and decrease in older age. They can be distinguished from lentigines in that they darken in times of high sun exposure and fade during periods of limited sun exposure.
Incidence: very common, particularly in fair-skinned patients
Race: more common in Caucasians, but also seen in Asians
Precipitating factors: individuals with light hair and complexion such as blonds and redheads
The brown pigmentation associated with ephelides results from increased production of melanin in sun-exposed areas of the skin.
Keratinocytes display an increase in melanin especially in the basal layer, but there is no substantial increase in the number of melanocytes in ephelides.
Ephelides are well-demarcated light brown to dark brown macules of several millimeters diameter that present in sun-exposed areas of the skin.
The differential diagnosis includes other benign lesions such as lentigines and junctional nevi.
They present in early childhood. They darken in periods of high sun exposure and lighten during periods of limited sun exposure.
KEY CONSULTATIVE QUESTIONS
There is no medical indication to treat ephelides. The cosmetic appearance, however, may displease some individuals. Sun avoidance and sunscreens protect against darkening of ephelides. Bleaching creams, such as hydroquinone, and topical retinoids can produce lightening. Cryotherapy and laser treatment are also effective. Recurrence is frequent, particularly with sun exposure.
Topical bleaching creams may provide some lightening. Multiple formulations are available differing in their product contents and strengths.