Freckles

In this Article (Index)

• What are Freckles?
• Features of Freckles
• Types: Regular Freckles & Aging Spots
• Ephelides (freckles)
• Lentigines (age spots)
• Prevalence of Freckles
• Characteristics of Freckled Skin
• Melanin
• Types of Melanin
• Genetic Factors Linked to Freckles
• Risks, Care, and Preventive Actions

What are Freckles?

Freckles are benign pigmented spots on the skin that are mostly determined by genes although they may also be triggered by exposure to sunlight.

They are found mostly among Caucasians and Asian people.

Although in Western culture they are considered fashionable and left untouched, among Asians they cause concern because they are considered a "disorder" and "cosmetically disfiguring;" unattractive blemishes that should be removed. This affects the quality of life of freckled people in Asia and leads to the use of different treatments like chemical peeling, cryotherapy, and laser therapy for their removal, all of which have side effects and complications. (1),(5)

The Word Freckle

The medical term for freckle is ephelis (plural: ephelides), from the Latin word ephêlis in turn derived from the ancient Greek word ephelis, which means "ep" = over, upon, "helios" = the sun.

The English word comes from Old Norse freknur, a word of ancient Indo-European origin, and its root means "to scatter." The word is first recorded in English in Geoffrey Chaucer's Canterbury Tales, in the story, (The Knight's Tale): "A fewe frakenes in his face yspreynd" ("A few freckles were sprinkled in his face")

Roman author and naturalist Gaius Plinius Secundus (AD ca23–79), known as Pliny the Elder wrote about how to treat freckles and mentions that some people considered them as a blemish making those with them impure for religious rites:

A he-goat's gall, mixed with cheese, live sulphur, and sponge reduced to ashes, effectually removes freckles, the composition being brought to the consistency of honey before being applied. Some persons, however, prefer using dried gall, and mix with it warm bran, in the proportion of one obolus to four oboli of honey, the spots being rubbed briskly first... I find it stated by certain authors, that persons who have freckles on the skin are looked upon as disqualified from taking any part in the sacrifices prescribed by the magic art. Pliny the Elder The Natural History XXVIII, CHAP. 50. (12.)

Features of Freckles

Types: Regular Freckles & Aging Spots

There are two types of freckles, ephelides and solar lentigines (also known as liver spots, aging spots, actinic lentigines, lentigo senilis, and sunburn freckles). They look similar but have different origins.

Ephelides (freckles)

• Small: 1 to 2 mm (but they can be larger).
• Red to light brown color. They become more pigmented during the Summer as they are exposed to sunlight.
• Located most frequently on the face, neck, arms, and chest.
• They first appear at the age of 2 to 3 years, proliferate during adolescence, and tend to disappear as you age.

Lentigines (age spots)

• Larger than ephelides: from a few millimeters up to over 10 mm in diameter.
• Dark brown color. Pigmentation does not change over the seasons.
• Located on areas that have been overexposed to the sun over the years: face, back of the hands, shoulders, forearm, neck.
• Appear after the age of 50 in chronic sun-exposed skin.

Prevalence of Freckles

A study of Canadian children of Asian and Caucasian background reported that 28% had freckles. (2); another study, using Han Chinese college students in China, found that freckles were present in 19% of them. (3)

It is highly prevalent among the roughly 2% of the world's population that has red hair (4) because the same genetic variant that causes red hair is also linked to giving you freckles.

Characteristics of Freckled Skin

Specialized cells called Melanocytes are located in the "stratum basale", the deepest layer of the outer skin or epidermis. They have dendrites, branches that extend into the skin and contact the surrounding cells known as Keratinocytes, that make up this skin layer. Keratinocytes produce keratin, a protein that forms the skin's protective barrier.
There is roughly 1 melanocyte for every 10 keratinocytes. The face and shins have a higher density of melanocytes almost 1 to 1.

Melanin

Melanocytes produce melanosomes, granules that synthesize and store the pigment known as melanin; they transfer these melanosomes to the surrounding keratinocytes through their dendrites. This group of melanocytes and its surrounding keratinocytes is called a melanin unit. (6)

Melanin gives skin, hair, and eyes their color; it plays a role in vision too, as it forms part of the eye's retina.

The features of melanosomes in freckled people are the following: (5)

• Freckles show an increased pigmentation in comparison to non-freckled areas.
• Freckles contain several large melanosomes, this is a feature shared with dark-skinned people.
• Non-freckled areas contain fewer, smaller, and less pigmented melanosomes.
• Melanocytes in people with red hair tend to be more round and produce more quantity of a pigment called pheomelanin.

Types of Melanin

Melanin is a pigment and a free radical scavenger (antioxidant) with a protective effect against solar radiation. There are five types of melanin, found in all living creatures from fungi, bacteria, worms, and insects to mammals. The latter have two types of melanin: eumelanin with a brownish-black tint, and pheomelanin with a yellow-reddish tint.

Each variety has its specific chemical structure and physical properties. Pheomelanin is less photostable than eumelanin, and when it is exposed to ultraviolet radiation (UV) it undergoes modifications that reduce its protective effect. These modifications increase its pro-oxidative and photosensitizing effects, and this can damage the skin cells. (7),(8)

Pheomelanin is found in people with red or blond hair and has very light-colored skin and freckles. Since pheomelanin has a low protective effect against UV light, people with this type of skin won't tan and have a higher risk of skin damage due to exposure to sunlight.

Genetic Factors Linked to Freckles

The melanocortin-1 receptor gene or MC1R is the main cause of freckles in European-origin people, and this is independent of hair and skin color.(1),(5)

There are other genes linked to freckling below is the full list, including MC1R: (5)

• MC1R. Red hair, fair, pale skin, UV sensitivity, freckles
• IRF4. Blue eyes, brown hair, freckles, sun sensitivity
• ASIP. Red hair, freckling, sun sensitivity
• TYR. Blond hair, blue eyes, freckles
• BNC2. Freckles, skin color saturation

Risks, Care, and Preventive Actions

Freckles are harmless and do not need treatment.

When to see a doctor. Make an appointment with a dermatologist as soon as possible if you see changes in the appearance, size, or surface of an existing freckle or if a new pigmented spot or an unusual-looking one appears. If a spot bleeds, itches, or looks odd.

Sunburn

As mentioned above, the melanin of freckled people isn't as effective as that of non-freckled ones in blocking the UV radiation from the sun. The risk of sunburn is increased in people with freckles.

Sunburn can be painful, causing redness, inflammation, and long-term risk of skin cancer plus premature skin aging.

Protect your skin from sunlight, wear a hat, and glasses, stay in the shade, and use effective SPF30+ sunscreen.

Preventing freckles

Protecting your skin from sunlight can prevent new freckles from forming but won't affect the existing ones.