Freckles (Ephelides): Where Do They Come From, and Can They Be Made Less Noticeable?

Ephelides are small areas where the cells at the surface of the skin contain more melanin. The cells that produce this pigment are not more numerous: their activity increases with UV rays, which explains the darkening in the sun and the fading in winter.

An inherited predisposition, linked in particular to the MC1R gene, explains their association with red hair. They also occur in people with brown or black hair. Sun protection limits how pronounced they become; camouflage masks their appearance; laser treatment can lighten the pigment, with risks and the possibility that they will come back.

Freckles, called ephelides, are small, flat, beige to brown marks, often found on the nose and cheeks. They are generally a few millimetres across and can be numerous or merge together. They do not form a bump and do not correspond to a thickening of the skin.

On the face, dark spots can also be lentigines, melasma, moles or marks left after inflammation. When they appear, how they are distributed and how they change provide more useful clues than their colour alone.

Melanin is produced by melanocytes, the pigment cells of the skin. It is then passed on to the neighbouring cells at the surface, the keratinocytes. In an ephelis, these surface cells accumulate more pigment, without an increase in the number of melanocytes. The brown spot therefore mainly reflects a difference in the amount of pigment, not a multiplication of pigment cells.

UV rays stimulate this production. The mark becomes more visible when it contains more melanin; it fades when this stimulation decreases, particularly in winter. This is why the same area can appear almost free of spots in the cold season, then show its ephelides again in summer: the appearance varies, but the predisposition has not gone away.

Skin and hair contain two main forms of melanin: eumelanin, which is brown to black, and pheomelanin, which is yellow to red. MC1R helps regulate their production. Certain variants associated with red hair reduce the production of brown-black pigment, so yellow-red pigment makes up a larger proportion. This change helps explain red hair and fair skin; the association of these variants with ephelides also explains why these traits are often found together in a family.

However, not all MC1R variants have the same effects on hair colour. People with brown or black hair can also have ephelides. Hair colour therefore does not confirm what a spot is, and the presence of freckles is not enough, on its own, to infer a genetic profile.

Ephelides are not present at birth. They appear during childhood on exposed areas of skin and can become less visible in adulthood. Their early appearance and their variation with the seasons distinguish them from solar lentigines, which are more often linked to years of cumulative exposure.

A person can have both ephelides and lentigines. In that case, some small marks fade in winter while others remain visible. So do not automatically give all the spots on a face the same name, even when they are a similar colour.

Ephelides are usually small, flat marks, often multiple, that become more pronounced in the sun and fade when exposure decreases. How they have developed since childhood and this seasonal pattern are useful clues.

Solar lentigines are generally more sharply defined and can be larger. They usually persist all year round, even though they can darken in summer. A persistent spot must not be assumed to be an ephelis only because it is brown.

Melasma forms pigmented areas or patches, often on both sides of the face, particularly the cheeks, forehead or above the lip. It can also include small marks and vary with sun exposure. Seasonal variation is therefore not enough, on its own, to distinguish it from ephelides; distribution and context also matter.

Post-inflammatory hyperpigmentation appears where a pimple, irritation or other inflammation occurred, after it has healed. This link with a previous lesion distinguishes it from a group of ephelides present since childhood. The same person can have both types of marks.

A mole corresponds to a local multiplication of pigment cells. It can be flat or raised: “flat” therefore does not necessarily mean “freckle”. These differences explain why a mark needs to be identified before any attempt to make it less noticeable: a technique that targets ephelides is not automatically appropriate for melasma or another pigmented lesion.

Sun protection targets the factor that makes ephelides more pronounced. Shade, clothing that covers the skin and a hat reduce exposure; on uncovered skin, a broad-spectrum, water-resistant sunscreen with SPF 30 or higher adds to these measures. It needs to be reapplied every two hours and after swimming or heavy sweating. Sunscreen is no substitute for the other forms of protection.

Less UV exposure can limit darkening in summer, but does not eliminate the inherited predisposition. Confirmed ephelides do not require medical treatment. Trying to make them less visible is a cosmetic choice, not a requirement for the health of your skin.

Cosmetic camouflage visually covers the marks without changing the melanin in the skin. Its effect lasts as long as the product is on the skin; once it is removed, the ephelides are still there. It therefore offers a reversible change in appearance, whereas sun protection targets the exposure that makes them more pronounced.

A pigment laser emits light that is absorbed by melanin. This energy can damage the structures containing the pigment and thereby lighten the mark. Short pulses aim to concentrate this effect on the target while limiting damage to surrounding tissue. The colour and depth of the pigment influence the result: “laser” does not refer to a single solution for all spots.

The lightening can be temporary. The treatment has an effect on visible pigment, but does not change the predisposition or the skin's future reaction to UV rays. In particular, partial recurrences were observed at a two-year follow-up involving a small group of people who had been treated. This follow-up describes a possible return of the marks; it is not enough to predict an individual's result or to set a universal number of sessions.

The skin may show redness, crusting or a change in colour after the procedure. Darker or lighter marks, and sometimes a scar, can occur. In more pigmented skin, the melanin in the surrounding skin can also absorb the energy: the contrast with the spot and the risk of changing skin tone matter when choosing a technique.

The choice therefore takes into account the nature of the mark, skin colour, the colour and depth of the pigment, as well as possible reactions and care after the procedure. Unlike camouflage, laser treatment involves effects on the skin and a recovery period. There is no guarantee that the marks will disappear permanently without risk.