Freckle Removal Prepared by Dr. Fathia Gazem Al-Awadi Assistant professor of dermatology and cosmetics Al-Razi University- Yemen What are Freckles? Freckles are melanocytic lesions frequently seen on the face with red or blond hair. Most common sites are nose, malar area, and forehead. Facial freckles are a really cosmetic concern to especially young females. Freckles, can be used for ephelides and lentigines, are important pigmentation characteristics of localized face and upper extremities. Ephelides are largely genetically determined but induced by sunlight, whereas lentigines are induced by sun exposure and photo damage of the skin. However, despite being commonly observed, we know very little about them. Freckles may vary somewhat in color—they may be reddish, yellow, tan, light brown, brown, or black but they are basically slightly darker than the surrounding skin. Most freckles on a skin are usually uniform in color. They tend to become darker and more apparent after sun exposure and lighten in the winter months. Freckles are caused by an increase in melanin pigment in the melanocytes especially on sun-exposed area in young people with fair skin. Freckles are due to an increase in the amount of dark pigment called melanin and are not due to an increase in the total number of pigment producing cells called melanocytes. Unlike solar lentigines, freckles usually present in early childhood. Solar lentigines are considered as a sign of photodamage while ephelides are associated with fair skin type and red hair. The FASI is used to evaluate the severity of the freckles, based on the three important features of the freckles. These parameters based on the darkness of the freckles, the extension and distribution of the macules, and density of the freckles. Freckle Removal Treatment The treatment of the freckles is a challenge and also may be requested for cosmetic reasons. Many treatment modalities have been used for the freckles but post inflammatory hyperpigmentation still remain a main problem after the therapy. But, in the past decade, freckles have been lightened and cleared with different types of lasers and IPL system. Four different types of laser were used for the treatment of the freckles such as long pulsed dye laser, alexandrite laser, Q-switched Nd:YAG laser, and potassium-titanyl-phosphate (KTP) laser. They found that long pulsed dye laser, Q-switched Nd:YAG laser, and KTP laser were effective in the treatment of the freckles. But no significant improvement was found after alexandrite laser treatment. Carbon dioxide laser was applied for freckles as a single session in Egyptian patients. It was found to be an effective and safe treatment option in skin phototypes II–IV. IPL was found an effective and safe method with relatively few adverse effects and high satisfaction levels for face in Asian skin. Freckles showed good response almost completely to all types of therapies including laser and IPL. But, pain, postoperative punctate bleeding, purpura, and post inflammatory hyperpigmentation were reported as adverse effects. Bottom of Form IPL stands for intense pulse light. This treatment is suitable for those that are wanting to remove freckles or reduce excessive freckling of the skin, want an even skin tone or would like to target a specific age spot. This is a quick procedure that is very easy for a skin specialist to perform. Often times it will take between 30 to 90 minutes to perform, based on where the treatment is being done at. Many times a single freckle removal treatment will be needed to remove the freckles, however, it is not uncommon to have a few more sessions after the initial one for the best possible results. If multiple freckle removal treatments are used, three to six weeks will be needed between each treatment. The intense pulse light will target the areas on the skin that have excess pigment, breaking down the excess melanin. Eye pads or glasses will be used to protect the eyes, and a cooling gel can be placed on the skin. Short bursts of light that has been filtered will be absorbed by the high concentration of melanin that is found in the freckles. The melanin will then be heated by this process, which in turn will eradicate the melanin rich cells. After the freckle removal treatment, the cooling gel will be wiped off, and a moisturiser with sunscreen will be applied. Anywhere between a few days and up until 2 weeks after treatment, the freckles will darken, but then will fade away as the excessive melanin is shed. This treatment is not recommended for persons with very dark or tanned skin complexions, nor for those that are pregnant. How does IPL work for Freckle Removal? Upon receiving IPL, there will be a light tingling sensation that feels warm. It can be an uncomfortable process, with the skin being red after the procedure is finished. Some skin specialists will use topical anesthetics. However, not everyone that has this treatment done finds pain associated with it there could be mild swelling after the treatment, which should subside within a few hours to a few days. Small blisters could form, but this is very rare. Benefits to using IPL for Freckle Removal There are many benefits to having IPL done on the skin: · First off, it is non-invasive. This means there will be no surgery involved, and patients can often return to their normal daily activities as soon as the procedure is done. · Secondly, it is quick on the skin. Often times, after one treatment, skin tone will be noticeable more even.