Freckles, freckles, go away

Dear Bobbie,

You, Ron Weasley, and many other folks have at least one thing in common: freckles. Not all freckles are created equal though. There are two types of freckles that vary in color, shape, and size: ephelides and solar lentigines (more on those in a bit). Despite the many freckle fans out there, some people choose to bid them farewell. To answer your question, both freckle removal and prevention is possible. As far as getting rid of your current spots, the appropriate method may be dependent upon the freckle type and its characteristics. Prevention of new freckles is usually as simple as practicing proper sun protection.

Which type of freckle might you have? Time to break down the characteristics of each type:

• Ephelides are small spots, red to light brown in color, are typically hereditary and, usually appear around age two. They will most likely be found on the face, neck, arms, and chest and may fade during the winter when sun exposure is decreased. Interestingly, these freckles also tend to be fickle — they may increase in size or partially disappear with age.
• Solar lentigines, on the other hand, are generally bigger than ephelides and tend to be light yellow to dark brown in color. This type of freckle is usually the result of sun exposure and photodamage to the skin. They appear on sun exposed body parts and remain stable in color year round. As you age, they tend to occur more frequently.

When it comes to removing your spots, most of the research focuses on removal of lentigines. Though there are a number of ways to get rid of these types of freckles, removal usually requires a trip to see a health care provider or dermatologist. Some options for you and your provider to consider include:

• Cryosurgery
• Treatment with laser and non-laser light sources
• Chemical peels using chemicals likes glycolic acid, salicylic acid, or trichloiriacetic acid
• Topical modalities such as retinoids and hydroquinone (to lighten or remove freckles — though they’re considered the least effective treatment)

It’s also good to note that, although freckles are usually considered non-cancerous, they’re often confused with other changes in the skin that could indicate skin cancer. Melanoma (skin cancer) and freckles tend to look similar and have the same risk factors such as excessive sun exposure, fair skin, and aging. As such, if you’ve noticed any changes in the color, shape, or size of your freckles (or moles), making a visit to your health care provider or dermatologist is advised. If there’s a freckle or mole that appears questionable, s/he may perform a biopsy. If the spot in question turns out to be cancerous (or pre-cancerous), surgery, chemotherapy, or radiation therapy may be considered to remove both the freckle and cancer cells.

Whether it’s for cosmetic or health reasons, investigating freckle removal with the help of a medical professional may be your best bet. To further take matters into your own hands, you can also perform a skin self-exam (perhaps while in the bath or shower) to check for any abnormal growths or unusual changes to your freckles. Lastly, since you asked about preventing those spots from forming in the first place, slathering on the sunscreen and limiting your sun exposure can go a long way in keeping unwanted freckles at bay. For even more information on protecting your skin from the sun, check out the related Q&As.