Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, February 2016.

What is an ephilis?

An ephilis is a freckle, ie, a small, light brown or tan mark on the skin.

The plural of ephilis is ephilides. The can be hundreds or thousands of them on exposed skin.

Who gets ephilides?

Ephilides are particularly common in fair skinned Celtic children. They are not present at birth. People with white skin that cannot tan (Fitzpatrick skin phototype 1) often have red hair and numerous ephilides. Ephilides can also occur in other races that have dark brown or black hair.

What causes ephilides?

Ephilides are an inherited characteristic. People with many ephilides have at least one copy of a variant MC1R gene, which is the same variant that causes red hair. Freckles in non-Caucasians are associated with a different variant of the gene.

The pigment forming cells, melanocytes, produce more pigment than usual in ephilides. The pigment is packaged as melanosomes and distributed to surrounding keratinocytes.

Ephilides increase in number following exposure to ultraviolet radiation in sunlight.

What are the clinical features of ephilides?

Ephilides are found on sun exposed sites, particularly the nose and cheeks.

Complications of ephilides

People with ephilides are often fair skinned. Fair skin is prone to larger, sun-damage freckles called lentigines, as well as other signs of skin ageing including skin cancer.

How is an ephilis diagnosed?

Ephilides are usually diagnosed clinically. However, from time to time, the diagnosis is made by a histopathologist after skin biopsy of a pigmented lesion.

What is the treatment for ephilides?

No treatment is necessary. Occasionally, people seek treatment for ephilides. They can be advised to protect affected areas using broad-spectrum, sun protection factor 50+ sunscreen.

How can ephilides be prevented?

As they are an inherited characteristic, they cannot be prevented. However, the summer darkening can be reduced by careful sun protection.

What is the outlook for ephilides?

Ephilides are particularly prominent in children. They often become less obvious in adult life.

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