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I love my freckly skin, but should I?

Skin, Sun and freckles, is there a risk? When we are younger and have fair skin, we all love our freckles as they look attractive. However, as we get older and are exposed to more UV rays our freckles enlarge, coalesce, form blotches and dyschromia. This can be in people classified as Fitzpatrick Type I to IV, but it also occurs in Fitzpatrick IV to VI. Skin dyschromia and lentigines can be treated with laser, chemical peels or Hydroquinone.
I recommend Tretinoin cream treatment for my patient’s as it is something that they can do themselves at home regularly and at night. It acts when they are asleep and is combined with sun protection cream during the day, thereby additionally reminding them of the need for good skin care and protection against the sun. Tretinoin 0.05% is often the starter concentration used at night on dried, cleaned skin three times a week working up to six or seven times a week.
Tretinoin should be applied very lightly, or it can act as a chemical peel if put onto heavily and then becomes associated with annoying erythema and peeling which the patient may not want. It is still effective in the higher dose, but the erythema can be associated with irritation, redness and then a subsequent peel which can be exceedingly effective, but visible to other people. Hence it’s used initially in a staged fashion in a very thin layer that is recommended so that all the Tretinoin is absorbed into the skin and works to lift up the lentigines and even out the skin. During the day an SPF-50 is recommended such as Anthelios by La Roche-Posay.
Other chemical peels include TCA peel, which is a medium depth peel, but care has to be taken in skin types IV to VI using TCA as there can be post inflammatory hyperpigmentation. It is important to pre-treat the patient with a tyrosinase inhibitor to block excessive production of melanin.
Hydroquinone is helpful to patients with skin dyspigmentation and melasma used as a skin lightening cream. It can be used by itself or in conjunction with Tretinoin 0.1% in a product called Pigmanorm. Using the right protocol of Hydroquinone is a fantastic treatment for photodamage. Again there has to be sun protection cream applied during the day to prevent further photodamage.

Maintenance

Once maintenance has been reached, and the skin pigmentation has improved with less dyspigmentation, melasma and lentigines, maintenance treatment is required using sun cream during the day, active topical serums and between one and three times weekly Tretinoin 0.05%.
At Clinica London, we also see patients with skin hyperpigmentation. Dr Jennifer Crawley is a dermatologist who sees pigmentations with troublesome skin pigmentation and possible skin pigmented tumours. She does mole assessment and assesses pigmented lesions using the
dermatoscope and biopsy if required.
Jennifer Crawley is a Consultant Dermatologist at Clinica London with a special interest in dermatology. She is an expert in both adult and paediatric dermatology and has particular interests in research, teaching and leading audit projects.

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