Freckles, lentigo and spots

Freckles are round brown spots with sharply defined edges, up to 5 mm in diameter, located in areas that get sun exposure. They most often develop on the cheeks, nose, arms and shoulders, in light-skinned people. When exposed to the sun, the spots get a darker colour, their number increases, and in winter they fade away and are less visible.

Freckles appear on the skin of those people who have a genetic predisposition and due to sun exposure. They are especially present in people with blonde or red hair, light eyes and light skin. The colour of the freckle can vary from light brown to dark brown.

What causes melasma?

Freckles form on sun exposed skin, due to the increased production of melanin pigment in some places. The number of melanocytes – melanin pigment producing cells is not increased when it comes to freckles.
They are usually a consequence of the uneven distribution of melanin in the skin. If creams with protective factors are used and sun exposure is avoided, the appearance of freckles can be significantly reduced.

spots on the face before and after ATV laser treatment
spots on the face before and after ATV laser treatment

What types of freckles exist?

We can distinguish 2 basic types of freckles:
Common freckles – Lentigo simplex – they appear in childhood due to genetic predisposition as clearly defined brown spots.
Age spots – Lentigo solaris – they are spots that form onchronically sun-damaged skin, with irregular edges, darker in colour and larger in diameter.

What are age spots?

Solar lentigo, also called age spots are dark or light brown (hyperpigmented) lesions, 1mm-1cm in diameter, with irregular edges. They are more common in the elderly people due to long-term exposure to the sun, but also in younger people after prolonged use of the tanning beds.
They are most often observed on the hands, back as well as on the face. When it comes to lentigo, there is an increased number of melanocytes in the skin, pigment producing cells.

Seborrheic keratoses are brownish, raised, crust-covered lesions that occur in older people in the same places as lentigo. They cab be different in colour, from light brown to black.
Often, seborrheic keratoses begin as lentigo, gradually growing and rising above the skin.
Keratosis often appear waxy and look like they are “stuck on” to the surface and have normal skin underneath. They can become rough and wart-like over time. Several seborrheic keratoses can be found in every person after the age of 40.

age spots on hand
age spots on hand

What disorders are associated with lentigo?

Genetic predisposition is a very important factor that affects the development of freckles, as well as the skin type. The numerous studies have shown that identical twins have an equal number of freckles, which is not the case in fraternal twins.

In the genetically determined condition of Peutz-Jeghers syndrome, a large number of lentigo spots are present on the skin and mucous membranes, especially on the lips, cheek mucous membrane, tongue. Apart from spots and polyps on the small intestine, patients also have a tendency to develop malignant tumours.

In the hereditary condition of Neurofibromatosis, a large number of café-au-lait macules with irregular sharp edges, measuring a few centimetres in diameter are present at birth.

Do freckles have medical significance?

Freckles are an aesthetic skin problem, they do not tend to turn into malignant tumours.

It is necessary to pay attention to a special form of pigmentation on the face, which gradually expands and is darker in colour.
It is Lentigo malignant-slow-growing superficial skin cancer that occurs on the face of the elderly people, who have been exposed to the sun for a long time.

It is advisable to see a dermatologist and to check all pigmented lesions and spots once a year, because skin cancer and be cured if it is detected in the early stages.


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