Brown spots and freckles

Freckles are small flat brown marks arising on the face and other sun exposed areas. They are seen in children and in fair skinned people especially those with red hair who have an inherited predisposition for them. On the face and other areas exposed to the sun they are an inherited characteristic. These small brown marks are most often seen in fair skinned people, especially those with red hair. Known as ephilides, the colour is due to pigment accumulating in the skin cells (keratinocytes). Ephilides are prominent in summer but fade considerably or disappear in winter as the keratinocytes are replaced by new cells. As the person ages this type of freckle generally become less noticeable. Apart from sun protection , no particular treatment is necessary.

Freckled arm	Solar lentigines	Solar lentigines
Solar lentigo	Ephilides	Before (left) and after (right) green laser light

Larger flat brown spots on the face and hands arising in middle age also result from sun damage exposure. Unlike freckles they tend to persist for long periods and don't disappear in the winter (though they may fade). Commonly known as age spots or liver spots, the correct term for a single lesion is benign solar lentigo (plural lentigines ). Lentigines are common in those with fair skin but are frequently seen in those who tan easily or have naturally dark skin. Lentigines are due to accumulated pigment cells (melanocytic hyperplasia).

If the brown marks are scaly, they may be solar keratoses (sun damage) or seborrhoeic keratoses (senile warts). These are usually treated by cryotherapy .

It is important to distinguish the benign solar lentigo from an early malignant melanoma , the lentigo maligna . If the freckle has arisen recently, is made up of more than one colour or has irregular borders or if you have any doubts, see your dermatologist for advice.

Treatment

Benign lentigines can be faded with careful sun protection and regular applications of anti-aging creams containing hydroquinone, or antioxidants such as:

However, they can be removed more effectively by chemical peels , cryotherapy or certain pigment lasers . These may produce a green light, which is absorbed by melanin:

Flashlamp-pulsed tunable dye
Frequency doubled Q-switched Nd:YAG (neodynium:yttrium-aluminium-garnet)
KTP
Krypton
copper bromide laser

Or a red light, also absorbed by melanin:

Q-switched Alexandrite - red light
Q-switched Ruby - red light

Intense pulsed light (Photoderm) has a similar effect. Carbon dioxide and Erbium:YAG lasers vaporise the surface skin thus removing the pigmented lesions.

Results are variable but sometimes very impressive with minimal risk of scarring.

With superficial resurfacing techniques, there is minimal discomfort and no down-time but several treatments are often necessary. Unfortunately the treatment occasionally makes the pigmentation worse. Continued careful sun protection is essential, because the pigmentation is likely to recur next summer.

Unsightly benign skin moles may be removed using traditional surgical techniques ( excision biopsy or with a resurfacing laser .

TOP PAGE