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Ephelides in Adult
Other Resources UpToDate PubMed

Ephelides in Adult

Contributors: Gaurav Singh MD, MPH, Susan Burgin MD
Other Resources UpToDate PubMed


Ephelides, commonly known as freckles, are a frequent finding in children and adolescents on sun-exposed surfaces including the arms, shoulders, and face. They are not present at birth and start to appear during the first 3 years of life. They are usually 1-3 mm in diameter but can be larger. They are usually light brown, darken in the summer, and fade without sun exposure. They may increase in number during childhood and become confluent. Thereafter, they tend to fade, but sometimes, they may persist into adulthood.

The pigment in ephelides occurs due to an increased number of melanized melanosomes and increased transportation of these melanosomes from melanocytes to keratinocytes. The gene encoding for melanocortin-1 receptor plays a role in the development of ephelides. Individuals with light skin phototypes and blond or red hair, and those with a family history of ephelides, are at a higher risk of developing these lesions.

Ephelides are benign and do not undergo malignant transformation. However, they are markers of ultraviolet (UV) damage and therefore may signal an increased risk of UV-induced skin malignancies including melanoma.

Multiple simple lentigines can be seen in genetic conditions such as Carney complex (LAMB / NAME syndromes), LEOPARD syndrome, Laugier-Hunziker syndrome, Bandler syndrome, and Peutz-Jeghers syndrome.


L81.2 – Freckles

403536009 – Ephelis

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Differential Diagnosis & Pitfalls

  • Lentigo simplex
  • Solar lentigo – Solar lentigines are often present at later ages, persist for life, do not change with sun exposure, and are generally larger than 5 mm. Dermoscopy demonstrates diffuse light brown, structureless areas and a reticular pattern with thin lines. Borders can be sharp or moth-eaten.
  • Café au lait spot – Usually solitary, and larger than ephelides.
  • Common acquired nevus are typically darker.
  • Amalgam tattoo
  • Pigmented Actinic keratosis appear later in life and feel rough or gritty on palpation.
  • Seborrheic keratosis appear later in life and are raised.
  • Atypical nevus
  • Melanoma / melanoma in situ (see Lentigo maligna)

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Last Reviewed:09/11/2018
Last Updated:09/11/2018
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Patient Information for Ephelides in Adult
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Ephelides in Adult
A medical illustration showing key findings of Ephelides : Back, Brown color, Face, Sun-exposed distribution, Hyperpigmented macules
Clinical image of Ephelides - imageId=6736522. Click to open in gallery.
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