Freckles

Freckles:
It is pigmentory condition.
It's also called ephelids.
Freckles are brownish pigmented Macules of various sizes over face.
Other sites: axilla and inguinal regions.
When these sites other than face  are involved then we suspect neurofibromatosis type 1.
Freckles are also present in one genodermatoses  called xeroderma pigmentosa.

Most patients have freckles only over face. In that case it's very easy to treat it.
Diagnosis is solely based on clinical examination.

Treatment:
1) Topical treatment:
A)Use of Depigmenting agents : Kojic acid
B) Phenol 80% over spots

2) lasers:
a)Frequency doubled Nd. YAG 532 nm
b) IPL (500-1000 nm )
c) Q switched ruby laser 694nm
d) 755nm alexandrite laser
e) 532 nm KTP laser

3)chemical peel
Side effects: post inflammatory hyper or hypo pigmentation.

Remember: freckles don't require treatment always.
When cosmetic concern is  there treatment options can be chosen.

Freckles do have 2.5 fold increased  risk of sunburn and poor response to tanning.

Difference between freckles and lentigo:
Freckles.                                Lentigo
1) Darkening on sun exposure No change
2) Presents in early childhood Elderly people
3) No increase in melanocyte Increase in melanocyte number
    Number


Use of sunscreen with spf 30+ is strongly recommended in these patients.

Freckles over cheeks and nose