Brown spots and freckles
Freckles are small flat brown marks arising on the face and other sun exposed areas. They are most often seen in fair skinned people, especially those with red hair, but they are an inherited characteristic that sometimes affects darker skin types as well.
The medical term for this type of freckle is
ephilides). The colour is due to pigment accumulating in the skin cells (keratinocytes).
Skin pigment (melanin) is made by cells called melanocytes. They don't produce much melanin during the winter months, but produce more when exposed to the sun. The melanin is diffused into the surrounding skin cells, called keratinocytes. The colour of ephilides is due to localised accumulation of melanin in keratinocytes.
Ephilides are more prominent in summer but fade considerably or disappear in winter as the keratinocytes are replaced by new cells.
As the person ages this type of freckle generally become less noticeable. Apart from sun protection, no particular treatment is necessary.
Larger flat brown spots on the face and hands arising in middle age also result from sun damage exposure. Unlike freckles they tend to persist for long periods and don't disappear in the winter (though they may fade). Commonly known as age spots or liver spots, the correct term for a single lesion is
solar lentigo (plural
Lentigines are common in those with fair skin but are also frequently seen in those who tan easily or have naturally dark skin. Lentigines are due to localised proliferation of melanocytes.
It is important to distinguish the harmless solar lentigo from an early malignant melanoma, the
lentigo maligna. If the freckle has arisen recently, is made up of more than one colour or has irregular borders or if you have any doubts, see your dermatologist for advice.
Other brown marks
Treatment of brown marks
Brown marks may fade with careful sun protection, broad spectrum sunscreen applied daily for 9 months of the year. Regular applications of anti-aging or
fading creams may also help. These may contain hydroquinone, or antioxidants such as:
Suitable green-light devices include:
- Flashlamp-pulsed tunable dye laser
- Frequency doubled Q-switched Nd:YAG laser (neodynium:yttrium-aluminium-garnet)
- KTP laser
- Krypton laser
- Copper bromide laser
Suitable red light devices include:
- Q-switched Alexandrite
- Q-switched Ruby
Results are variable but sometimes very impressive with minimal risk of scarring.
With superficial resurfacing techniques, there is minimal discomfort and no down-time but several treatments are often necessary. Unfortunately the treatment occasionally makes the pigmentation worse. Continued careful sun protection is essential, because the pigmentation is likely to recur next summer.
Before (left) and after (right) green laser light
If there is any doubt whether a brown mark may be a cancer, your doctor may choose to observe the lesion (e.g. with mole mapping or photography) or excise it for pathological examination.