Freckles - Scientific answer to all your questions

Freckle is mainly formed by exposure to Sunlight more specifically UVB components of it (Apart from visible light, sun-light has different types of ultraviolet lights like UVA , UVB etc)

Solar lentigines and freckles are 2 related almost similar looking conditions. Where lentigines might be more common as people grow older, there is usually no correlation for freckles.
Reference : Bastiaens M, Hoefnagel J, Westendorp R, Vermeer BJ, Bouwes Bavinck JN. Solar lentigines are strongly related to sun exposure in contrast to ephelides. Pigment Cell Res. 2004;17(3):225-229. doi:10.1111/j.1600-0749.2004.00131.x

Yes many times freckles are genetic and run in families. Also sometimes freckle is part of different syndromes which are usually genetic as well. However it does not mean that there is no way to prevent it. Just the chance of getting it increases if it’s there in the family.

You may take the following steps.

1. use of sunscreens with SPF (sun protection factor) of at least 30. Sunscreen needs to be applied liberally and 15-20 minutes before sun exposure.
   Here is a guide to choose the perfect sunscreen for you.
   Here is how you should apply sunscreen.
   
2. use of sun-protective clothing (shirts, long sleeves, long pants),
3. Limit sun-exposure of the peak sun hours of 10 a.m. to 4 p.m.
4. Seek shade and stay indoor as much as possible.

Yes. With procedural treatment like radio-frequency , chemical peel or laser, individual freckle spots can be removed permanently. But unfortunately they tend to come back. So taking preventive steps ( as outlined above ) is very important.

Certain treatments like topical cream take time to act. Chemical peels usually burn (limited burn , nothing to worry ! ) the area and the black spot might remain for a few weeks. Lasers or electrocautery usually remove it instantly.

Some home remedies can lighten the appearance for sure but if you were following all those popular blogs and Youtube channels that claim to have the perfect home remedies for freckles, we have some bad news. Contrary to what you might want to hear, no aloe vera, organic oil or apple cider will remove your freckles. Certain fruit juices like lemon juice however might make it lighter and a good option for maintenance. 

Basically lemon juice contains organic acids (citric acid, ascorbic acid or vitamin C etc) that helps to exfoliate the outer layer of your skin and gives it a lighter appearance. Take one teaspoon of lemon juice and gently massage it over your freckles using your fingertips. Leave it for 5-10 minutes. Keep doing this for a few weeks. If it does not improve, do not forget to consult a dermatologist. The chance is very rare that you would get rid of freckles by this method alone.

Contrary to what you might find in many popular blogs and videos, diet has no proven scientific association with freckles. In general a balanced diet might help to protect your skin from various internal damage but there is no specific relevance for freckles.

When topically applied, Vitamin C ( citric acid) has a skin-rejuvenating effect and also can fade freckles. Actually any fruit juice might do it because of the presence of natural acid. This principle is used in case of treatment with chemical peels where such acids are used in much higher concentration than natural sources. Vitamin pills or vitamin presence in food does not help to prevent freckles.

Your dermatologist might prescribe you an exfoliating cream like glycolic acid cream or retinoid cream. Please note that do not apply retinoid cream should not be taken during pregnancy. Also the efficacy of creams are limited so dermatologists usually prefer certain procedures to remove it.

Freckles can be removed by a number of procedures, the common principle among them is to destroy the black melanin particles in a targeted manner so that surrounding areas bear minimal damage. Most popular procedures are laser treatments, electrocautery and chemical peels.

In India, you might expect the cost of such a procedure to range from few hundred to few thousands depending on location and demands. Charges are usually higher in metro cities like Mumbai and Delhi.

Usually before doing the procedure, the dermatologist or his/her clinic stuff will use some gel to numb the area. If there is still burning sensation , an ice-pack applied over the area will help.

Freckles can be removed by IPL (intense pulse light) and a variety of lasers such as alexandrite , ruby or q-switched laser. As freckles is a benign condition and pigment is very superficial, high-end powerful lasers are not required.
Here is a video to watch to understand the procedure (We do not have any association with the clinic posted the video)

Though technically not a laser, IPL is one of the most effective ways to treat freckles. 

Often freckles are removed effectively in the first session only as the pigmentation is not at all deep. If removal is incomplete or the number of freckles is very high, a second session might be planned after a few weeks.

Though with lasers, the melanin pigments are instantly destroyed, the debris might remain there upto few weeks. Sometime immediately after the procedure it seems darker due to damage to surrounding areas. If the procedure is done correctly, the spots should however fade within a few weeks.

Yes ! No freckle removal procedure is permanent and your chance of getting freckles in the future does not change with treatment of current spots. So after the removal, you should follow the steps or prevention as outlined above (see prevention section).

Chemical peels are an effective and safe treatment for freckles when it is done with proper protocol. As it is applied only over the spots and not on the whole face (like in many other conditions), it is often referred to as spot or touch treatment. Like we call it 88% phenol touch, rather than phenol peel.

Usually medium or deep peels are used in very small amounts such as TCA (tri-chloro-acetic acid) or phenol peels are used. 

Being a very superficial peeling agent, glycolic acid is good for maintenance and gives the surrounding skin a glow. But when it comes to removing the freckle, it is not as effective as TCA or phenol touch.

As the amount needed for treatment is much less compared to other procedures, often it is lower than the IPL or Laser treatment. However in metro cities, it may go up to a few thousand bucks (INR)

Hormonal changes during pregnancy makes existing darker areas even darker and freckles are no exception. But as you might guess, this additional darkening usually will go away after delivery.