In older age, the number usually decreases. Ephelides present during childhood as scattered areas of increased pigmentation, mainly limited to body regions above the waist. The macules are asymptomatic, more numerous on sun-exposed areas, and fade and become smaller in the winter. The macules may be discrete or confluent. Sunburn freckles have a similar presentation as simple freckles but are darker, have irregular borders and may appear as large as a few centimeters.
Freckles tend to be inherited as an autosomal dominant trait.
Ephelides are found most commonly in individuals of fair skin with blond or red hair. Freckles are prominent and dark even in heterozygous carriers of this autosomal recessive disease. Excessive freckling in dark-haired individuals should suggest the possibility of this disease. Lab studies are not necessary. Imaging studies are not necessary.