Freckles are flat, beige, brown circular spots that typically are the size of the head of a common nail. The spots are multiple and may develop on sun-exposed skin after repeated exposure to sunlight. These are particularly common in people with red hair and a fair complexion. They may appear on people as young as 1 or 2 years of age.
Most freckles are uniform in color. On different people, freckles may vary somewhat in color — they may be reddish, yellow, tan, light brown, brown, or black — but they are basically slightly darker than the surrounding skin. They may become darker and more apparent after sun exposure and lighten in the winter months. Freckles are due to an increase in the amount of dark pigment called melanin and an increase in the total number of pigment-producing cells called melanocytes.
Freckles are rarely treated. Several safe but expensive methods are available to help lighten or reduce the appearance of freckles. Frequently, multiple or a combination of treatments may be required for best results.
- Bleaching or fading creams: Products containing hydroquinone and kojic acid can be purchased with and without a prescription. Higher concentrations of hydroquinone (over 2%) require a prescription. These products can help lighten freckles if they are applied consistently over a period of months. Bleaching or fading creams are most effective in combination with sun avoidance and sun protection.
- Retinoids: Sometimes used in conjunction with other bleaching creams, tretinoin (vitamin A acid, Retin-A), tazarotene (Tazorac), and adapalene (Differin) also may help lighten freckles when applied consistently over a period of several months.
- Cryosurgery: A light freeze with liquid nitrogen in the physician’s office can be used to treat some types of freckles. Not all spots respond to this form of therapy.
- Laser treatment: Multiple types of lasers may help lighten and decrease the appearance of freckles safely and effectively. Like cryosurgery, this is a simple and safe procedure with a high success rate and a low risk of scarring or skin discoloration.
- Photofacials or Intense Pulsed Light treatments are another method to lighten and remove freckles. This is not a true laser technique but an intense light source.
- Chemical peels can also help lighten freckles and improve irregular pigmentation.