What are freckles?

Freckles are harmless tan, brown or black flat spots that appear on areas of skin that have been exposed to the sun. Freckles are more common in those with lighter skin, red or blond hair, and in those who sunburn easily. Unlike age spots, freckles are common in childhood and fade in the winter.

What causes freckles?

Freckles are commonly found on the face and hands, and any other part of the body that has been overexposed to the sun. Freckles are among the many signs of photoaging. Photoaging occurs when excessive sun exposure speeds the skin's natural aging process.

What are the symptoms of freckles?

Freckles have no associated symptoms. However, if you notice that your freckles are changing or getting bigger, they may need further evaluation by your physician. If you have freckles, you have a higher risk of skin cancer than a person who doesn’t have freckles.

What do freckles look like?

Freckles are usually round, brown or tan small flat spots found on sun exposed areas (face, upper back, forearms, etc).

How is the diagnosis of freckles made?

Your physician can usually distiguish freckles from other kinds of lesions based upon the appearance of your skin.

What treatment options are available?

The best treatment for freckles is prevention. The key to preventing freckles is sun avoidance and daily sunscreen use. However, for most of us, it is too late for prevention, and there are a number of treatment options available.

Bleaching Creams

• What they are:

There are many over the counter and prescription medications that may be used to treat freckles. One popular over-the-counter medication contains 2 percent hydroquinone, a bleaching agent. Prescription creams may use single agents, such as Retin-A (tretinoin) or combinations of medications such as hydroquinone with tretinoin plus a cortisone cream.

• What are the risks?

Over the counter bleaching creams are usually well tolerated and may gradually lighten freckles over a couple of months. However, they are not very effective. Sometimes bleaching agents can lighten the skin around the freckle. Prescription formulations are often more effective but may have more side effects (such as redness, drying, and peeling) and are expensive. Your physician may treat your freckles with liquid nitrogen freezing. Topical treatments and creams may not work for everyone and the risks and benefits need to be discussed with your physician.

Chemical Peels

• What are they?

Your physician can administer a peel using a variety of different chemicals to remove age spots, freckles, discoloration, wrinkles and fine lines. Chemical peels may smooth and firm the skin and may lighten freckles gradually. The superficial peels, such as a glycolic acid peel can be done during your lunch hour, and there is no recovery time. Deeper peels are more effective but require longer recovery. See more details under discussion chemical peels.

• What are the risks?

Different kinds of peels carry different risks. Superficial peels are usually quite safe. However, you may need a series of superficial peels (done approximately once a month) before you'll notice improvement. Costs can add up if you choose a series of peels. The risks and benefits vary depending on the kind of peel and need to be discussed in detail with your physician.

Laser Resurfacing

• What is it?

An in-office treatment where freckles, melasma, age spots wrinkles and fine lines are “burned” off with a laser. Laser resurfacing can effectively treat freckles, melasma, most age spots, and wrinkles, often in just one treatment.

• What are the risks?

Lasers actually remove the outer portion of the skin- called the epidermis. Because of this, you may experience some pain as well as redness and peeling. You may even form scabs in the days after the procedure. Expect recovery time of at least a week. Rarely, laser therapy can cause scarring. Laser therapy is also expensive. One treatment can cost anywhere from $1,000 to $5,000, depending on how much of your face is treated. On the other hand, the CO2 laser is the most effective way to rejuvenate your skin. With good sun protection, the effects can last up to five years. The risks and benefits of laser resurfacing need to be discussed in detail with your physician.

Intense Pulsed Light Therapy (IPL)

• What is it?

IPL is one of the newer forms of facial rejuvenation. Unlike lasers, which use intense, focused light, IPL is intense broadband light. Although IPL delivers energy to both the superficial (epidermis) and deep (dermis) layers of the skin, the epidermis is spared from damage. Thus, there is virtually no recovery time. In the studies to date, IPL can improve the texture of the skin and fade freckles, age spots, melasma, and even visible blood vessels. Benefits usually last for about a year with good sun protection.

What are the risks?

IPL is safer than laser therapy because IPL does not damage the epidermis. There may be some pain during the procedure but there is no recovery time. Unlike laser therapy, however, multiple treatments (4-6, at three weeks intervals) are often needed to get the full benefit. The cost is variable, but is usually more expensive than peels and less expensive than lasers. The risks and benefits of IPL therapy need to be discussed in detail with your physician.

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