Does freckle removal have side-effects? A Singapore doctor explains

People are not born with freckles, but those living in tropical areas such as Singapore are likely to develop them if they are often exposing their skin to the UV radiation of the sun.

These often unwanted pigmentations are caused by spending significant amounts of time outside without sunscreen or other protection such as hats or umbrellas.

There are many skin conditions involving pigmentation, and freckles are just one type. They appear more often on Westerners, and many celebrities proudly wear them as a signature look (Lindsay Lohan, for example). Some of my patients tell me they enjoy having a freckled look, some dislike them and want an unblemished complexion; there isn’t a right answer and we should always have the final say on what our ideal skin looks like.

What are the different types of freckles?

Freckles come in two forms, Ephelides and Lentigines freckles. Ephelides freckles are light brown dots that are most obvious on light-skinned people. These will fade naturally when exposure to the sun is reduced or removed. They usually appear darker in the summer and lighter in the winter, according to how much sun exposure the individual gets and how harsh the sunlight is. Lentigines are also called age spots or liver spots, and these freckles house excessive amounts of melanocyte cells, which create pigmentation in the skin.

What is the difference between freckles and other skin pigmentation flaws?

skin with freckles

Many skin conditions involve excess pigments in various layers of the skin. Freckles are easy to identify based on their colour and shape. Freckles are small, flat, and circular spots on the skin. They are 1mm to 2mm in diameter and they appear in large groups as if these tiny dots have been peppered across an area skin.

Freckles are uniform in colour for each individual, but the colour can vary from person to person, especially on people of different skin tones. People of Asian descent often have dark brown freckles, whereas people with fair skin and red hair often have light brown or red-tinted freckles. I’ve seen patients with freckles that have been yellow, tan, varying shades of brown, or even black. Freckles are always darker than the normal complexion of the individual sporting them, making them stand out against the surrounding skin.

What causes freckles?

Some people are genetically predisposed to developing freckles, and others develop them by prolonged exposure to UV radiation. Hereditary freckles are more common for those with fair skin, blond or red hair, and light (green or blue) eyes. Women are more likely to get freckles than men, and those with very dark skin do not get freckles.

How do freckles develop?

The important takeaway is that freckle development is triggered by exposure to UV radiation. The UV rays penetrate layers of skin and cause cells to overproduce melanin or skin pigments. Too many melanocyte cells result in the appearance of darker spots, or freckles, on the skin. This can be the result of exposure to any form of UV radiation. I commonly advise patients who don’t want freckles to develop to avoid any form of tanning equipment.

Where can freckles develop on the body?

Freckles can develop on any area of skin exposed to UV rays, but they are most common on the cheekbones and nose.

At what age do freckles usually develop?

Freckles can develop at any age, and even children as young as one year old can get freckles. They are most likely to develop after any prolonged time in the sun, so many adolescents who spend their summers outdoors will develop freckles.

Are freckles cancerous?

Many patients ask me this question after reading online that moles and certain skin blemishes may lead to cancer. Relax, there are no medical implications if you have freckles; most freckles are harmless, and are purely an aesthetic issue.

Can I prevent freckles from developing?

apply sunscreen

Yes, freckles can be prevented, and prevention is often much easier than having freckles removed after they have developed. Freckle removal can be a time-consuming and expensive process, and it may not always work completely.

The best way to prevent freckles is to use sun protection when outdoors, specifically by wearing sunscreen and using hats and umbrellas to shield skin from the sun’s rays.

My recommendation is to use a sunscreen with at least SPF 30 and broad-spectrum coverage (protecting against both UV A and UV B radiation) is recommended, even on cloudy days and in the winter months. Wide-brimmed hats, umbrellas, and long-sleeved shirts are recommended to further shield the skin from the sun. Avoid direct sunlight during peak hours, from 10 am to 4 pm.

How can I remove freckles that have already developed?

There are several treatments to reduce or remove freckles once they have developed, including:

  1. Bleaching Creams
  2. Chemical peels
  3. Cryosurgery
  4. Intense Pulsed Light (IPL)
  5. Lasers
  6. Retinoids

These treatments can be used in combination with each other to achieve the best results. Here is a bit more detail about each treatment.

Bleaching Creams. Topical lightening creams with hydroquinone or kojic acid will lighten the pigmentation of freckles over time with the continual application.

Chemical peels. This involves applying gentle acids like glycolic, lactic, and salicylic acids to the freckled skin that will remove the outermost layer of skin as well as the pigments, so that new skin forms without the pigmentation that causes freckles.

Cryosurgery. One procedure that is commonly inquired about is cryosurgery. In cryosurgery, liquid nitrogen is used to get rid of freckles. This does not always work, and some people do not respond to this treatment well.

Intense Pulsed Light (IPL). Pulsed light therapy uses beams of light (energy) to reduce the appearance of and get rid of freckles.

Lasers. A laser called the Q-switched Nd: Yag laser sends packets of energy through the skin to break up pigments into tiny pieces that the body can then dispose of. These treatments are more intense and require a few days of recovery post-procedure for the skin to heal and restore itself.

Retinoids. Topical retinoid creams such as tretinoin, adapalene, and tazarotene reduce pigmentation and lighten up the appearance of freckles, allowing them to blend into the surrounding skin better. These can be used in conjunction with bleaching creams.

Is it possible to permanently eliminate freckles?

There is no way to permanently cure freckles, as any treated areas will re-develop freckles when exposed to the sun again. The best way to prevent the reappearance of freckles is to take adequate protection against harmful UV-rays.

Which treatment is the best for me?

The only way to know which treatment is right for you is to consult with an experienced dermatologist. They will be able to assess the type and severity of your freckles and determine the best course of action to eliminate them.

Do note that certain treatments such as lasers and IPL will be more expensive, but you might see results faster than with topical creams. Make sure your doctor is experienced in administering these more intense treatments before the procedure. It’s a good idea to ask to see before and after photos of a doctor’s previous patients to make sure you can get your desired results.

Always make sure your doctor is qualified and experienced with the treatment method you decide on. Listen to their instructions for aftercare and stay out of the sun as much as possible to prevent your freckles from reappearing.