Melasma vs Sun Spots
Melasma is a soft-edged brown patch, and the two sides of your face roughly match. It darkens through the summer and fades over the winter. Sun spots are separate brown spots with a sharp edge, and you can count them. Each one marks a place the sun landed year after year, and they do not fade.
What it is
Your skin has the usual number of pigment cells. They react too readily to sun, heat and hormonal changes, and lay down extra melanin.
Each spot is a small area where repeated ultraviolet light has left the pigment cells permanently overproducing.
What it looks like
Large areas of fairly even brown across both cheeks, the forehead, the upper lip or the jawline.
Round or oval, from a few millimetres to about a centimetre, with normal skin in between them.
The edge
The colour fades out into normal skin. There is no line where the patch stops.
Each spot has a border you could trace with a pen.
Where it shows up
Cheeks, forehead, upper lip and jawline, sometimes the neck and forearms. Cover half your face in the mirror. If the two sides broadly match, that points to melasma.
Face, backs of the hands, forearms, chest and shoulders. The pattern follows exposure, so drivers often have more on one side.
What makes it worse
Heat counts on its own, so saunas, hot kitchens and a sunny car window all set it off. Hormonal changes, including from hormonal birth control, push it too.
Nothing else adds spots. Each unprotected summer adds to a running total.
What it does over time
It lightens in winter and with treatment, then comes back with sun, heat or a hormonal change. It rarely clears once and stays clear.
Spots do not fade in winter and do not clear on their own. New ones keep arriving while the exposure continues.
How it is treated
Daily broad-spectrum sunscreen matters more than anything else, and a tinted one with iron oxides also blocks the visible light that drives it. Hydroquinone, azelaic acid, tranexamic acid and gentle peels fade it. Lasers are used carefully, if at all.
Cryotherapy, lasers and intense pulsed light clear individual spots well, often in one or two sessions. Creams fade them more slowly. Sunscreen stops new ones forming.
Three tests you can do in the mirror
Look at the edge first: A sun spot stops cleanly, like a large freckle drawn with a pen. Melasma soaks out into the skin around it with no border at all.
Then check for symmetry: Cover one half of your face. If the pattern on the left broadly mirrors the pattern on the right, that points to melasma. Sun spots land where the light landed, so the two sides rarely match.
Then think back to February: Melasma is lighter in winter and darker by August. A sun spot in January looks the same as it did in July.
Sun spot, age spot, liver spot, solar lentigo
All four names describe the same mark: Doctors write solar lentigo. Everyone else says sun spot, age spot or liver spot, and none of those words changes what it is.
Two of the names mislead people: The spots are not caused by ageing itself. They build up with total sun over a lifetime, which is why they appear on the backs of the hands and not on the stomach. And they have nothing to do with the liver — that name is old and comes from the colour.
Both often sit on the same face
Plenty of people have both at once: Sharp spots on the temples and cheekbones, a soft patch of melasma across the upper cheeks. One face, two problems, two plans.
The treatments are not interchangeable: Heat and light remove a sun spot quickly, and the same heat and light can set melasma back months. Dermatologists usually treat them in separate steps even in one appointment.
Sunscreen is the step that helps both: It fades neither on its own. It stops new sun spots forming, and it is the single most effective thing anyone does for melasma.
See a doctor if
One spot is changing in shape, colour or size
One spot looks clearly different from all the others
A dark spot bleeds, itches, crusts or will not heal
A flat brown patch is slowly widening with a ragged edge
A brown patch keeps spreading despite daily sunscreen
You want laser or intense pulsed light and are not sure which one you have
