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lentigo vs freckles ephelides difference dermatology
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Lentigo vs Freckles (Ephelides)
The single most important clinical distinction: A freckle darkens in summer and fades in winter. A lentigo persists year-round regardless of sun exposure.
Freckle (Ephelis)
- Caused by increased melanin production in keratinocytes - melanocyte number is normal
- Strong hereditary basis (MC1R gene variants); common in Fitzpatrick skin types I-II, red/blonde hair
- Appears around age 5, peaks in adolescence, may regress with age
- Small (2-5 mm), light-to-medium brown macules on sun-exposed skin only
- Histology: normal rete ridges; increased melanin in basal layer; each melanocyte has increased dendritic connections
- No malignant potential, but marks a skin phenotype at higher risk of melanoma
Lentigo
- Caused by focal proliferation of melanocytes (increased cell density at the dermoepidermal junction)
- Lentigo simplex: any age, any body site including mucosa, not UV-dependent
- Solar lentigo (liver spot/age spot): appears after age 30-40, driven by cumulative UV exposure, >5 mm, persists year-round
- Lentigo maligna: pre-malignant - may progress to lentigo maligna melanoma; needs excision
- Histology: elongated club-shaped rete ridges, increased melanocytes, melanophages in dermis, solar elastosis
- Associated syndromes: LEOPARD syndrome, Peutz-Jeghers (perioral lentigines), Carney complex
| Feature | Freckle | Lentigo |
|---|---|---|
| Melanocyte number | Normal | Increased |
| Sun fading | Fades in winter | Persists year-round |
| Rete ridges | Normal | Elongated, club-shaped |
| Onset | Childhood | Any age (simplex); >30 yrs (solar) |
| Malignant risk | None | Lentigo maligna is pre-malignant |
| Treatment | Sun protection | Cryotherapy, laser, retinoids |
Sources: Fitzpatrick's Dermatology (9th ed.), Andrews' Diseases of the Skin (13th ed.), Dermatology 2-Volume Set (5th ed.)
Your PDF
Lentigo vs Freckles
PDF Document · PDF
The PDF includes:
- Colour-coded comparison table across 14 clinical features
- Types of lentigo (simplex, solar, maligna, PUVA, ink-spot)
- Histological summary
- "When to worry" clinical guidance
- Quick-reference diagnostic card
- Full references from dermatology textbooks
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