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