Ephelides (Freckles) Clinical Presentation

  • Author: Jessica M Scruggs, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

History

Ephelides present during childhood as scattered areas of increased pigmentation, mainly limited to body regions above the waist. The macules are asymptomatic, more numerous on sun-exposed areas, and fade and become smaller in the winter.

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Physical

Simple ephelides are multiple, small, tanned macules, ranging from 1-5 mm in diameter, with uniform pigmentation. They are most commonly found on sun-exposed areas, such as the nose, the cheeks, the shoulders, and the upper part of the back. The macules may be discrete or confluent.

Sunburn freckles present similarly to that of simple freckles, but they are darker, have irregular borders, and may be as large as a few centimeters.[5]

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Causes

Causes are as follows:

  • Genetic: Ephelides (freckles) tend to be inherited as an autosomal dominant trait, and first-degree relatives are at higher risk.[6] Ephelides are most common in individuals with fair skin and/or with blond or red hair. The tendency to develop freckles appears to be closely related to the melanocortin 1 receptor (MC1R) gene polymorphisms.[7]
  • Xeroderma pigmentosum: Freckles are prominent and even dark in heterozygous carriers with this autosomal recessive disease. Excessive freckling in dark-haired individuals suggests the possibility of this disease.
  • Environmental: In individuals who are susceptible, sunlight exposure to both UV-A and UV-B radiation induces freckles by stimulating melanocytes to produce melanin.[8]
  • Neurofibromatosis: Freckles can be found in the folded regions in individuals with this autosomal dominant condition.[9] The Crowe sign is specific for axillary freckling and can be a useful diagnostic aid.[10]
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Contributor Information and Disclosures
Author

Jessica M Scruggs, MD  Resident Physician, Department of Dermatology, Scott and White Memorial Hospital, Texas A&M Health Science Center College of Medicine

Jessica M Scruggs, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, American Medical Women's Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Katherine H Fiala, MD  Assistant Professor, Department of Dermatology, Scott and White Northside Clinic

Katherine H Fiala, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Sungnack Lee, MD  Vice President of Medical Affairs, Professor, Department of Dermatology, Ajou University School of Medicine, Korea

Sungnack Lee, MD is a member of the following medical societies: American Dermatological Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Lorne Hurst, MD, and Shane G. Silver, MD, and previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Azizi E, Lusky A, Kushelevsky AP, Schewach-Millet M. Skin type, hair color, and freckles are predictors of decreased minimal erythema ultraviolet radiation dose. J Am Acad Dermatol. Jul 1988;19(1 Pt 1):32-8. [Medline].

  2. Bastiaens M, Hoefnagel J, Westendorp R, Vermeer BJ, Bouwes Bavinck JN. Solar lentigines are strongly related to sun exposure in contrast to ephelides. Pigment Cell Res. Jun 2004;17(3):225-9. [Medline].

  3. Cockerell CJ, Johnson TM, Swanson NA. Melanocytic nevi. J Cutan Med Surg. 1996;2:1561-3.

  4. Hurwitz S. Clinical Pediatric Dermatology. 2nd ed. Philadelphia, Pa: WB Saunders; 1993:211-2.

  5. Rhodes AR, Albert LS, Barnhill RL, Weinstock MA. Sun-induced freckles in children and young adults. A correlation of clinical and histopathologic features. Cancer. Apr 1 1991;67(7):1990-2001. [Medline].

  6. Yang S, Xu SX, Xiao FL, et al. Prevalence and familial risk of ephelides in Han Chinese adolescents. Arch Dermatol Res. Feb 2008;300(2):87-90. [Medline].

  7. Bastiaens M, ter Huurne J, Gruis N, Bergman W, Westendorp R, Vermeer BJ. The melanocortin-1-receptor gene is the major freckle gene. Hum Mol Genet. Aug 1 2001;10(16):1701-8. [Medline].

  8. Hölzle E. Pigmented lesions as a sign of photodamage. Br J Dermatol. Sep 1992;127 Suppl 41:48-50. [Medline].

  9. McLean DI, Gallagher RP. "Sunburn" freckles, café-au-lait macules, and other pigmented lesions of schoolchildren: the Vancouver Mole Study. J Am Acad Dermatol. Apr 1995;32(4):565-70. [Medline].

  10. Crowe FW. Axillary freckling as a diagnostic aid in neurofibromatosis. Ann Intern Med. Dec 1964;61:1142-3. [Medline].

  11. Kawada A, Shiraishi H, Asai M, et al. Clinical improvement of solar lentigines and ephelides with an intense pulsed light source. Dermatol Surg. Jun 2002;28(6):504-8. [Medline].

  12. Wang CC, Sue YM, Yang CH, Chen CK. A comparison of Q-switched alexandrite laser and intense pulsed light for the treatment of freckles and lentigines in Asian persons: a randomized, physician-blinded, split-face comparative trial. J Am Acad Dermatol. May 2006;54(5):804-10. [Medline].

  13. Vejjabhinanta V, Elsaie ML, Patel SS, Patel A, Caperton C, Nouri K. Comparison of short-pulsed and long-pulsed 532 nm lasers in the removal of freckles. Lasers Med Sci. Nov 2010;25(6):901-6. [Medline].

  14. Bliss JM, Ford D, Swerdlow AJ, et al. Risk of cutaneous melanoma associated with pigmentation characteristics and freckling: systematic overview of 10 case-control studies. The International Melanoma Analysis Group (IMAGE). Int J Cancer. Aug 9 1995;62(4):367-76. [Medline].

  15. Lorincz Al. Disturbances of melanin pigmentation: circumscribed melanoses. Dermatology. 1985;2:1273-7.

  16. Nicholls EM. Genetic susceptibility and somatic mutation in the production of freckles, birthmarks and moles. Lancet. Jan 13 1968;1(7533):71-3. [Medline].

  17. Pavlotsky F, Azizi E, Gurvich R, et al. Prevalence of melanocytic nevi and freckles in young Israeli males. Correlation with melanoma incidence in Jewish migrants: demographic and host factors. Am J Epidemiol. Jul 1 1997;146(1):78-86. [Medline].

  18. Wilson PD, Kligman AM. Do freckles protect the skin from actinic damage?. Br J Dermatol. Jan 1982;106(1):27-32. [Medline].

 
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Numerous ephelides on a fair-skinned, red-haired child. Images courtesy of Ronald Grimwood, MD.
 
 
 
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