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For more information, see CMDT Part 6-06: Freckles & Lentigines

Key Features

  • Freckles (ephelides) and lentigines are flat brown macules, typically between 3 mm and 5 mm in diameter

Clinical Findings

  • Freckles

    • First appear in young children

    • Darken with ultraviolet exposure

    • Fade with cessation of sun exposure

    • Determined by genetic factors

  • Lentigines

    • Start to appear in the fourth to fifth decade of life

    • Gradually appear in sun-exposed areas, particularly the face, dorsal hands, upper back, and upper chest

    • Are associated with photoaging as well as estrogen and progesterone use

    • May have a very irregular border (inkspot lentigines)

    • Do not fade with cessation of sun exposure

Diagnosis

  • They should be evaluated like all pigmented lesions: if the pigmentation is homogeneous and they are symmetric and flat, they are most likely benign

Treatment

  • Topical retinoids such as 0.1% tretinoin or 0.1% adapalene

  • Hydroquinone

  • Laser/light therapy

  • Cryotherapy

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