They are benign macules that appear following an increased production of melanin by skin melanocytes, the same cells responsible for tanning or moles. Do we need to treat them in some way? What precautions should we take when exposing our little ones to the sun?
The parents of Mara, 2 years old, observe their little girl playing with other children at the park. When the little girl comes over to drink, the mother notices something on her cheeks. «What are these specks?…», he asks. Mara’s father also has the opportunity to observe them closely, they are really small pigmented spots on the skin, brown in colour, which were not there before. “They look like freckles,” he then comments.
What are freckles and why do they appear? Do we need to treat them in some way? Do we need to observe certain precautions regarding sun exposure?
What are freckles
What are freckles? Let’s start by saying that having freckles on your skin is not a pathology at all. In fact, these are benign macules that appear following an increased production of melanin by skin melanocytes, the same cells responsible for tanning or nevi (or moles).
Is there a difference between freckles and freckles? Although very similar, these are completely different conditions. In fact, freckles are small freckle-like spots that often appear in children with a light complexion. They are caused by exposure to the sun and disappear when the exposure ends. They therefore have a “seasonality”: they are highlighted in the hot seasons and in areas that are exposed to the sun and disappear as soon as the cold weather arrives (it is no coincidence that in common jargon they are called “summer freckles”).
Types of freckles
Freckles are very similar to lentils: clearly circumscribed, circular to oval, uniformly brown or tending towards black and do not exceed 5 mm in diameter.
But are they all the same? No, they are differentiated both by their distribution on the different areas of the body and by their characteristics.
The appearance of freckles on the body usually occurs during childhood. Generally, these are a few lesions that occur in various locations on the skin (from the face to the lips, from the breasts to the back) with no predilection for areas exposed to the sun.
As regards the location, there is a very particular type of freckle that appears on the mucous membranes, the cutaneous melanotic macula. Similar to freckles on the face, it is concentrated in the mucosal portion of the lower lip, but can sometimes also appear on the genitals. The cutaneous melanotic macule usually does not exceed 1 cm in diameter, is blackish-brown and is benign (with some exceptions for cases of multiple perioral and oral macules in some congenital syndromes).
The so-called solar freckles appear in photoexposed areas, generally their diameter is greater than 1 cm, they can have irregular margins and have a light brown (sometimes brick or red) or dark brown color. They occur above all in places that undergo massive exposure to rays, i.e. on the face, on the back of the hands, on the forearm, on the upper portion of the trunk. These spots can also appear on the backs of the feet and legs. Children exposed excessively to the sun can develop these lesions.
As mentioned, what has just been described should not be confused with freckles, which look like light freckles, appear in photoexposed areas due to the stimulus following exposure to sunlight itself, but disappear when exposure ceases, unlike solar freckles which instead remain.
Since solar freckles (also known as sunspots) increase directly proportional to exposure over time, they are more frequent in the elderly, so much so that in common jargon they are specifically referred to as “senile solar freckles”.
Causes and risk factors of freckles
The cause of the appearance of freckles is not single. In fact, we speak of a multifactorial etiology (origin) (due to many factors). Genetic and hereditary factors are certainly important. In particular, children with a light phototype (skin color) and red or blond hair are more predisposed.
An important role is played by melanin and pigmentation. A gene associated with their appearance has been identified, MC1R, which influences the synthesis of melanin, a pigment that has a protective role against UV rays.
If the gene that protects us from the sun is responsible for the predisposition to freckles, it is easy to imagine how exposure to the sun and UV rays can weigh on the innate tendency of each of us: if we expose ourselves to the sun excessively, in the hours of greatest risk and without any protection, we stimulate the synthesis of melanin and the formation of freckles. This happens even more evidently if, as they grow up, adolescents also expose themselves to other massive sources of light, such as sunbeds: increasing exposure in this way over the years increases the possibility of developing senile solar freckles, which is why freckles can also appear in adults.
Diagnosis and evaluation
How is freckles diagnosed? Firstly through anamnesis and clinical evaluation. A visual examination is carried out, in the first instance with the family paediatrician. The latter observes the distribution and characteristics of freckles, identifying shape, size, color and distribution on the skin layer and identifying any signs of atypicality.
The pediatrician will then ask if the child’s freckles have ever bled, if they have changed color or shape or if they have grown rapidly in size, also using the support of old photos of the child. At the same time, he will ask the parents for some information on the family history (anamnesis), looking for any family history of skin diseases such as melanomas, which require greater attention and specialist observation.
The dermatologist specialist will be able to carry out an accurate examination also using dermoscopy, a non-invasive examination that allows you to examine the epidermis, dermis and other parts of the skin. Thanks to the dermatoscope it will be possible to differentiate freckles from other lesions that have similar color and pigmentation. Rarely, you will need to carry out a biopsy in case of diagnostic doubt, which is nothing more than the removal of a small portion of skin for analysis under the microscope.
Treatments
Do freckles go away? If we notice solar freckles appearing on the skin of our little ones, how can we eliminate them? Let’s stop for a moment and ask ourselves first of all a very important question: why on earth do we want to remove them?
It is certainly good to take care of the skin and resort to adequate prevention and protection (as we will see in the next paragraph), but the possible need to remove freckles is purely aesthetic and not medical in nature, therefore it is not dictated by health reasons. And also from an aesthetic point of view, the uniqueness of freckles should be underlined as a peculiar characteristic of each individual who has them, and not as a defect.
However, if you want to proceed with removal, there are some treatments that can be used. That is to say:
- laser treatment with intense pulsed light, which reduces the number of hyperpigmented melanocytes that cause freckles;
- outpatient medical treatments such as peels and other techniques.
- cryotherapy, which freezes excess melanin with liquid nitrogen;
- chemical peeling, with creams and topical treatments such as retinoic acid that exfoliate the superficial layers of the skin, reducing the visibility of freckles.
Freckles and tumors: prevention and advice
However, it must be remembered that cryotherapy can only be used after the age of 6, retinoic acid after the age of 12 and laser treatment after the age of 18 and always with expert and dedicated staff.
Although, as mentioned, the appearance of freckles in no way represents a potentially malignant pathology, solar lentigines are a sign of photodamage that indicates an increased risk of skin cancers during adulthood. How can we prevent this risk, taking care of our skin and that of our little ones?
It is best to avoid exposing your child to the sun during the hottest hours, and expose him gradually and in a well-protected way (we use hats, sunglasses, and use the umbrella or pergolas to spend more time in the shade). We use sunscreen with a protection factor (SPF) of at least 30 or higher, if possible even on sunny days outside the summer season.
The skin also needs to be nourished and hydrated, which is why it is necessary to favor a varied diet, which above all includes local and seasonal products (fruit and vegetables in particular, as they contain vitamins and antioxidants), and it is necessary to drink a lot of water.
In children with solar lentigines, an annual skin evaluation by the family pediatrician is recommended. If there are signs of atypicality (recognized by the doctor during the clinical evaluation) or a family history of melanoma, it is right to bring the little ones to the attention of a dermatologist specialist for monitoring and possible early diagnosis.
Once again it should be underlined that freckles, although sometimes perceived as imperfections, should be considered as a distinctive appearance. If it is right to take care of our body and our skin so that it is not damaged, it is also true that it is important to recognize and appreciate the natural beauty of these dots, making them a unique and unrepeatable feature.
