All About Freckles - Appalachian Spring Dermatology

Angel Kisses or Sun Damage?

Almost daily I am asked the question, “what are these brown spots on my face?”

Freckles

The earliest brown spots we see on the skin from a young age are FRECKLES. Most people think they are cute, especially when limited in number. However, as a freckly child and adult, I despise them. Why? As a child, they made me different at times in life that I just wanted to blend in. I was told they were angels kisses and a thousand other things to make me feel better about them, but it didn’t work. As an adult and a dermatologist, I know they are a sign of the skin being damaged by the sun. Freckles only occur in heavily sun-damaged areas and rapidly increase in number with each sun exposure. They tend to be small, light brown in color, and number in the hundreds if not thousands. They fade in the winter months only to reappear each spring and summer quickly. Freckles tend to occur most on those with a redheaded complexion or what dermatologists call Type 1 skin.

Genes

“So why do redheads tend to have more freckles? Because both red hair and freckles are usually caused by the same gene, MC1R. The gene perches on melanocytes and controls the pigment balance in both hair and skin. When MC1R is working the way it normally does, it converts any pigment the body produces into eumelanin, which is responsible for black and brown hair and skin colors. When the MC1R gene is “broken,” it allows a rarer type of human pigment, pheomelanin, to build up in the body. Pheomelanin causes reddish hair and the rusty look of most freckles. Variations of the MC1R may also control the number of freckles people have.

But MC1R isn’t the only gene causing freckles. About a decade ago, scientists discovered another gene responsible for freckles in Chinese populations. Other genes may be involved, too—scientists have yet to unravel all of the genetic causes behind freckles, which occur in various ethnic groups. Regardless of the precise genetic mechanism, freckles are always a family affair: Parents pass on the likelihood of freckling, as well as its locations across the body.”

Lentigo

The adult version of a freckle is a LENTIGO. Other common names for a lentigo are a liver spot or an age spot. These tend to be larger than a freckle and more isolated. They also are a sign of sun damage and occur in sun-exposed areas only. They can be seen on all skin types. Lentigines (that’s the plural name) are generally benign, but sometimes a melanoma can occur in a lentigo, called a lentigo maligna. Benign lentigines are often a light brown even color, larger than a traditional freckle, the size of a dime or larger, and sometimes are slightly raised and tend to stay around all year. As compared to freckles and melasma, which result from an overproduction of pigment, lentigines actually are composed of an increased number of pigment cells, melanocytes.

Freckles and lentigines irregular production and retainment of pigment in the skin. As an oversimplification, the pigment cells produce excessive pigment, and that pigment is retained in the outer layer of the skin. In most cases, the pigment is entirely contained in the epidermis, but rarely it is deeper and more stubborn.

I hope that helps you understand more about these brown spots on your skin. Do you love or hate your freckles? Stay tuned for an upcoming blog post on the Top five ways to reduce brown spots on the skin!

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