Freckles (Ephelides and Solar Lentigines) ICD-10: L81.2

Pigmentation / Benign skin lesion

Often searched as: freckles on face, brown spots from sun, age spots on skin, sun spots on hands, liver spots, dark spots from sun damage, freckles that won't go away, new brown spots on skin…

Clinical urgency level

lowmediumhigh

Systems Affected

skin

Severity Levels

mild

Few stable freckles on sun-exposed areas, consistent in appearance, no changes over time — entirely benign, no treatment needed.

moderate

Numerous or darkening freckles with increased sun exposure, or solar lentigines appearing in adulthood — cosmetically significant, sun protection recommended.

severe

Any freckle or lentigo showing rapid change in size, shape, color, or texture — requires dermatological evaluation to rule out lentigo maligna or early melanoma.

Red Flags

A freckle or spot that grows noticeably larger over weeks or months
Uneven or multiple colors within a single spot
A spot with blurry or irregular borders
A spot that starts to itch, bleed, or crust
A new dark spot appearing after age 50 — especially if it looks different from others
A spot that looks like a freckle but doesn't fade in winter (possible lentigo maligna)

Clinical Presentation

Classic ephelides (freckles) on fair skin face

Source: Wikimedia Commons (CC BY-SA 3.0 )

Solar lentigines (age spots) on the back of the hand

Source: Wikimedia Commons (CC BY-SA 3.0 )

When to See a Doctor

Freckles and age spots are almost always harmless and require no treatment. See a dermatologist if any spot changes in size, shape, or color, starts to itch or bleed, or if a new dark spot appears that looks different from the rest. People with many sun spots and significant UV exposure history benefit from annual skin checks.

Differential Diagnosis

Lentigo maligna (early melanoma in situ — larger, irregular, slow-growing)
Seborrheic keratosis (raised, waxy, 'stuck-on' appearance)
Melanocytic nevus (mole — usually raised)
Café-au-lait macule (larger, uniform light-brown patch)
Post-inflammatory hyperpigmentation
Actinic keratosis (rough, scaly — precancerous)

Comorbidities

Xeroderma pigmentosum (rare — extreme UV sensitivity with many pigmented lesions)
LEOPARD syndrome / Noonan syndrome with lentigines (multiple lentigines + cardiac abnormalities)
Increased melanoma risk in people with many solar lentigines and fair skin

Prognosis

Freckles (ephelides) are entirely benign and often fade with age and reduced sun exposure. Solar lentigines (age spots) are also benign but persistent — they do not fade on their own and accumulate with lifetime UV exposure. Neither type requires treatment unless desired for cosmetic reasons, in which case options include topical retinoids, laser, cryotherapy, and chemical peels. The main clinical importance is distinguishing them from early melanocytic malignancy.

Detailed Overview

Causes, Symptoms, and When to Take Action Freckles are small, usually harmless spots on the skin that become darker with sun exposure. They're common in people with light skin, blond or red hair, but anyone can have them. How It Looks Texture: Flat spots on skin, no elevation Color: Tan, light brown, or dark brown; some may appear reddish depending on skin tone Shape: Round or oval, often multiple and scattered Location: Areas exposed to sun — face, neck, shoulders, arms, upper chest, back of hands There are two types: Ephelides — classic freckles that tend to appear in childhood, become more pronounced with sun exposure, and may fade in winter. Solar lentigines — also called age spots or liver spots, appear later in life, tend to be larger, persist through seasons, and increase with accumulated sun exposure. Why Does It Appear? Melanocytes (pigment-making cells) produce more melanin in response to ultraviolet (UV) light. Genetic factors make some people more prone (light skin, families with freckles). Repeated sun exposure over time increases number and darkness of spots. Should You Be Concerned? Freckles are almost always harmless and not a health threat. Still, you should watch for: Changes in size, shape, or color of a spot Spots that become raised, bleed, or itch Any spot that looks different from your other freckles or moles If you notice unusual changes, a healthcare provider or dermatologist can take a look. Can You Prevent It? Limit sun exposure, especially during peak hours Use sun protection (clothing, hats, shade) Avoid tanning beds and intense UV sources Monitor skin for new freckles or changes in existing spots 👉 How Piel AI Can Help Piel AI lets you take photos of freckles over time and compare. While it doesn't diagnose, it helps you notice developments or changes to share with a professional. Summary Freckles are flat spots caused by increased pigment from sun exposure. Two main types: ephelides (younger onset, seasonal) and solar lentigines (age-related, persistent). Generally harmless, but changes should be monitored. Preventive measures include sun protection and skin checks.

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