Red freckles, also called cherry angiomas, hemangiomas, senile angiomas and Campbell de Morgan spots, are lesions resulting from a concentrated, high number of dilated blood vessels near the surface of the skin. More specifically, they occur when the number of endothelial cells lining the inside of the blood vessels rapidly grow and divide. Normally occurring on the trunk, they usually are fairly small in size with a flat or slightly raised shape, with a range of colors from bright red to black. It's more common for those who are approaching middle age to get them, with the number often increasing over time. They usually are completely benign and don't need treatment, but removal options are available.
Early on, red freckles are usually very small and are often described as being the size of a pinhead. They can become bigger over time, however, with large ones often reaching up to 0.25 inches (0.635 centimeters) in diameter. The smaller ones typically are flat, while bigger cherry angiomas frequently become raised or dome shaped. Despite their title, the lesions can have a purple or bluish color, or in some cases, brown or even black.
A person can develop a cherry angioma anywhere on the body, but in general, they tend to appear more often on the torso. Areas of the skin with mucus membranes rarely have them, and they aren't very common on the hands or feet. When they appear in a location that someone can't hide easily, such as the face, they often cause some psychological distress, with the person who has them feeling less attractive. Even ones that an individual can cover with clothing can get itchy and bleed when they are scratched, and they can be sensitive to particular types of clothing.
These lesions can show up at any age, but they usually begin to appear after the age of 30. The number of red freckles also tends to go up as a person gets older. In the past, medical professionals referred to them as senile angiomas for these reasons, but this term somewhat has grown out of favor, as the spots generally are not associated with any loss of mental function, and because always pairing senility and aging is a kind of stereotyping.
Research has not found evidence linking any particular race or ethnicity to a higher rate of presentation, and the spots occur relatively equally between men and women. They are generally more noticeable on people with light skin, however, which has led some people to think that they are most commonly associated with those of Caucasian descent.
Medical professionals are not sure exactly what causes red freckles. Some experts believe that there might be genetic links, and they know that a decrease in microRNA 424, a non-coding RNA molecule that plays a role in regulating how genes are expressed, is present in the lesions. People who get them often have a lot of mast cells, which are similar to white blood cells in function. There is some evidence linking the spots to particular chemical compounds, such as mustard gas, as well. It might be that, as with many other medical conditions and traits within someone's phenotype, both genetics and the environment might determine whether they appear.
When to Be Concerned
In most cases, red freckles are completely benign and are nothing to worry about. If they suddenly change significantly in number, color, size or shape, however, or if they become painful, itchy or scaly, it's a good idea to seek medical attention. These shifts sometimes can be symptoms of other serious conditions, and in rare instances, they suggest cancer — this is more commonly associated with brown or black lesions, which usually involve a mass of blood called a hemorrhagic plug within a blood vessel.
Many people want to remove their red freckles, either because they are uncomfortable and bleed too easily, or because they cause problems with general appearance. Depending on the size and prevalence of the red freckles, a dermatologist can often cauterize them using electrodessication, freeze them with cryotherapy or apply laser treatment, which removes the freckle and repairs blood vessels from beneath the skin. These treatments usually take just a few minutes and usually have excellent results, but scarring is possible, especially if the spots are big.
Medical professionals usually do not recommend that someone try to remove red freckles at home, simply because they can bleed so profusely, and because individuals do not always use the right equipment or sterilize it properly. The risk of scarring also is higher for home procedures. Ruling out underlying medical conditions and getting a differential diagnosis is also important.