Ephelides (Freckles)

Author: Jessica M Scruggs, MD; Chief Editor: Dirk M Elston, MD more...

Updated: Jan 25, 2012

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Background
Pathophysiology
Epidemiology
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Background

Ephelides (freckles) are tanned macules found on the skin. Ephelides are usually multiple in number. Although ephelides are predominantly benign, they may be seen in association with systemic disease.^[1]Ephelides are associated with fair skin and red or blonde hair. In contrast to solar lentigines, ephelides are not strongly associated with age.^[2]Note the image below.

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

Pathophysiology

Individuals who are genetically susceptible to ephelides may have somatic mutations in epidermal melanocytes that promote increased melanogenesis. Melanocytes are not increased in number, and they may even be decreased in number. With UV-A and UV-B exposure, the dopa reaction is increased, leading to the production of larger melanosomes, which produce the clinical picture.^[3]

Frequency

International

Worldwide, ephelides may be found in varying degrees in most, if not all, individuals. Ephelides are more pronounced in individuals living in temperate climates.

Mortality/Morbidity

Ephelides have an impact on cosmesis but are not associated with increased mortality. Mortality may be increased in diseases associated with ephelides, such as xeroderma pigmentosum.

Race

Ephelides are more common in fair-skinned and red- or blond-haired white persons than in individuals of other races.^[4]

Sex

Ephelides are distributed equally between the sexes.

Age

Commonly, ephelides first appear at age 2 years and increase in number into young adulthood. In older ages, the number usually decreases.

Proceed to Clinical Presentation

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

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