6-06: Freckles & Lentigines

Freckles (ephelides) and lentigines are flat brown macules, typically between 3 mm and 5 mm in diameter (eFigure 6–4) (eFigure 6–5). Freckles first appear in young children, darken with ultraviolet exposure, and fade with cessation of sun exposure. They are determined by genetic factors. In adults, lentigines gradually appear in sun-exposed areas, particularly the face, dorsal hands, upper back, and upper chest, starting in the fourth to fifth decade of life, and are associated with photoaging as well as estrogen and progesterone use. On the upper back, they may have a very irregular border (inkspot lentigines). They do not fade with cessation of sun exposure. They should be evaluated like all pigmented lesions: if the pigmentation is homogeneous and they are symmetric and flat, they are most likely benign. They can be treated with topical retinoids such as 0.1% tretinoin or 0.1% tazarotene, hydroquinone, laser/light therapy, or cryotherapy.