Types of freckles

There are two types of Freckles.

1. Ephelides:

These are tiny, flat, tan-coloured spots. They are more visible in summers. In fact, one can see these in people with light skin, reddish hair and bright eyes.

2. Solar lentigines:

These are large pigmented spots. They are isolated. Moreover, one can commonly find them in areas with sunburn. In fact, they are common in older people.

Treatments of freckles

One doesn't need to treat Freckles. In most cases, individuals wish to improve the appearance of freckles for cosmetic purposes. Dermatologists customise treatments based on skin type. 

The same treatment may have different effects on different individuals. 

Freckles often recur with repeated UV exposure. 

• Over-the-counter prevention

These products are creams or ointments. One must apply them to the pigmented area. They work to reduce melanin production. As a result, the hyperpigmentation reduces. 

• Topical creams:

These mainly include skin lightening (bleaching) creams containing hydroquinone, and topical creams containing retinoids. Both may be available with or without prescription 

• Bleaching or fading creams:

Products that contain hydroquinone or kojic acid help lighten freckles, and will also avoid the occurrence of freckles. Hydroquinone suppresses melanin production to lighten darkened areas of skin. Bleaching and fading creams are actually most effective as a combination ensuring avoidance of sun as well as being an effective measure of sun protection.

• Retinoids:

Retinoids absorb the ultraviolet radiation, improve sun-damaged skin, lighten freckles and prevent more from forming. They also accelerate skin cell turnover, destroying the accumulated melanin pigment. 

• Medical procedures

There are various medical procedures. They are safe and effective. Often, dermatologists recommend these procedures in combination with one another. 

1. Chemical peels: 

Chemical peels remove the outermost layer of skin by exfoliating. This reduces the appearance of freckles. New skin generates once the damaged skin peels off. 

Depending on the depth of skin penetrated, the chemical peels come in three different strengths: superficial, medium, and deep. For freckles, medium peels containing chemicals like glycolic acid or trichloroacetic acid that reach up to the middle layers of the skin are used. 

Chemical peels can be used for freckles on face, arms and hands. They may temporarily cause some stinging, redness, irritation, crusting, and swelling. Skin takes about two weeks to heal in case of moderate peels. During this period, it's essential to avoid the sun, take antivirals, and apply a topical ointment daily to promote healing and soothe skin.

2. Cryotherapy:

Cryotherapy uses liquid nitrogen to freeze and destroy abnormal skin cells, causing necrosis (cell death). After being frozen, the freckled lesions whiten. They then scab and fall off within 7-10 days. As a result, this restores the normal pigmentation of skin. 

The procedure is safe, requires no hospitalisation, no anesthesia. The recovery period is also short.  Potential side effects are pain, swelling, blistering, bruising, hypopigmentation, and rarely, infection.  To avoid these, one must follow proper skincare before, after & during the procedure. 

3. Laser therapy:

Lasers target damaged areas of skin using pulses of forced, intense light. It burns the blood vessels underneath the freckles, reduces their appearance, and may also remove them entirely on occasion. Q-switched ND YAG laser is usually effective here. 

Safe, and with low risk of scarring, lasers don't cause any long-term damaging effects, but may temporarily cause itching, swelling, redness, crusting, peeling, infection, etc. 

• Lifestyle changes  

1. Sun protection:

This is a must for preventing new freckles.  A broad-spectrum sunscreen (SPF>30) should be used daily. One must apply it at least 15 minutes before going outdoors. Physical protection is a must too.

2. Vitamin C:

This vitamin prevents melanin production by inhibiting tyrosinase. Tyrosinase is the enzyme for melanin synthesis. Citrus fruits, kiwis, spinach are all rich sources of this vitamin; or you could also take vitamin C supplements.