Marmur Medical Blog

Who is the freckliest of them all?

Thanks to celebrities like Gwyneth Paltrow and Emma Stone, freckles are making a comeback. Even with this great news, my facial freckles are somewhat of a sore point with me, when it comes to my overall complexion and appearance. Though my family tried to alleviate my freckle misgivings by telling me, “They’re cute,” or, “They’ll make you seem younger for longer,” in my formative years, I often wondered what I did in a previous life to deserve freckles. Since entering my twenties, I’ve learned to come to terms with the things I cannot change (or can I?), and accept my “freckle-iness” for what it is, a unique part of me because like fingerprints, no two freckle patterns are the same.

Freckles (a.k.a. ephelis or ephelides) are skin spots where melanin, the dark pigment produced by melanocytes found in the basal layer of skin, is concentrated. Though freckles can be found on anyone, of any race, with any genetic background, more often than not freckles affect those of very fair complexion. The number of freckles and placement of freckles (face, trunk, extremities) is determined genetically and depends on the activation of melanocortin-1 receptor variants. Funny enough, people are not born with freckles. As my baby pictures can attest to, I (as well as many other freckled people) developed my freckles somewhere in childhood . . . and then they never went away.

As all us freckly people know, the darkness and the number of our freckles increases with sunlight. This is because UVB exposure activates our already “mutant” melanocytes to increase their melanin production thus creating darker pigmented areas of skin. It is suggested, to decrease the pigmentation and number of freckles, that areas prone to freckling be kept out of sun exposure, and be protected with sunscreen or sun-protective clothing. Unlike moles (lentigines), freckles do not contain a higher number of melanocytes, which means freckles are not prone to developing into skin cancers like melanoma. However, freckled people are usually of lighter complexion (a decreased amount of melanin overall because it’s being concentrated into those freckles), meaning they have an increased propensity for UV skin damage when exposed to the sun and therefore a higher incidence of skin cancer overall (I’m talking about squamous and basal cell carcinomas, as well as the cancer precursors like actinic keratoses).

So now that we know what freckles are and we know they are pretty much a permanent part of our physical appearance, what do we do from here? Well, if you’re like my aunt or I, you try to get rid of them (because no matter how much I attest to fully accepting my freckles, deep down I still have a longing to have my fresh-faced, freckle-free baby complexion again). Thus far, my only serious attempt at removing my freckles (other than masking them with foundation and concealer) was to experiment with whitening creams. In my experiences, this was unsuccessful. And since I have not worked up the courage, nor money, to laser my freckles into oblivion, I have settled for applying sunscreen like a mad-woman to ensure the freckles I have don’t ferociously multiply.

Unlike myself, my aunt had the money to laser her freckles off. These days in dermatological offices, there are many laser options that can be used to rid your body of freckles. For individual, lightly pigmented freckles a laser such as IPL (intense pulsed light) or YAG (Nd:YAG = neodymium-doped yttrium aluminum garnet) should do the trick. For areas of the body covered in freckles, it is useful to look into treatments such as Fraxel. Though Fraxel leaves you looking a little pink and puffy for a week, it pretty much melts away freckles, sun damage and mild wrinkles after a few treatments. My aunt used Fraxel, and her treatments were very successful. Just remember, even though the freckles have been removed by laser, they are always prone to popping up again with sun exposure. Lasers are not a “get-out-of-jail free card” when it comes to freckles, and sunscreen is a must to ensure freckles do not reappear after treatment.

So freckles are really not that big of a pain after all. There are many options to removing them, and measures to take to keep them at bay. After thinking about it, my interest in dermatology probably comes from a deep-seated root to remove my freckles one day. However, there are a couple freckles that I call “my own” and will probably keep just for remembrance sake. It won’t hurt if they keep me younger-looking for longer.

Written by:
Margit Lai Wun Juhasz
Mount Sinai Medical Student