Melasma vs freckles: What's the difference?

How can you tell them apart?

Feature	Freckles	Melasma
Appearance	Small brown spots, usually less than 3 mm across.	Flat brown or grayish patches, sometimes with freckle like spots.
Pattern	Often across the middle of the face, sometimes more widely.	Often matching areas on both sides of the cheeks, forehead, nose or upper lip.
Usual onset	Early childhood.	Adulthood, commonly between ages 20 and 40.
Who commonly gets them	People with fair skin, especially children with red hair; darker skin can have freckles too.	Women and people with naturally brown skin or skin that tans easily.
Triggers	An inherited tendency, with sunlight increasing pigment.	Sunlight and hormonal changes, including pregnancy and hormonal contraception.
Seasonal changes	Become more noticeable in summer and fade considerably in winter.	Often darken in summer and lighten in winter, but can last for years.

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Both involve melanin, the pigment that gives skin its colour. Sun exposure increases pigment in freckles, while melasma involves excess pigment production with a more complex mix of light, hormonal and individual factors. Winter fading is therefore a clue, not a reliable test for telling them apart.1 3 6 7

What if the spots stay all winter?

Some marks called freckles are actually solar lentigines, often called sun spots. These are generally larger and more clearly outlined than ordinary freckles, commonly appear on the face and hands in middle age, and persist through winter. A lasting brown spot is not automatically melasma.1

What should you do about them?

1Start with sun protection. Apply broad spectrum SPF 50 or higher sunscreen every morning to exposed skin. For melasma, choose a formula containing iron oxides for added protection against visible light.
2Apply sunscreen 15 to 30 minutes before going outdoors. Reapply every two hours outdoors and after swimming or towel drying. Use shade and a wide brimmed hat as well.
3If you suspect melasma, arrange a diagnosis before choosing treatment. A clinician can examine the pattern and sometimes use a Wood's lamp, a light used to assess pigmentation, to help guide treatment.
4Use gentle, fragrance free skincare. Avoid irritating products, and stop using a product that irritates your skin rather than pushing through.

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Ordinary freckles need no treatment beyond sun protection, despite the skincare aisle's preference for turning every mark into a shopping list. If you want to fade brown marks, creams or procedures are options, but procedures can worsen pigmentation and marks can return with sun exposure.1

Melasma treatment usually combines sun protection with creams. Options include azelaic acid and prescription combinations containing hydroquinone, tretinoin and a steroid. Peels and lasers require expert assessment because they can worsen melasma.2 3 7

Will melasma go away?

Melasma can fade over several months after pregnancy or after a triggering hormone medicine is stopped, but it can also persist for years. Treatment is slow, and pigment deeper in the skin responds less well than surface pigment. Creams can fade melasma rather than permanently cure it; sun exposure can bring it back.2 3 4 5

During pregnancy, defer melasma treatment until after delivery and avoid hydroquinone and retinoid creams. If patches appeared after starting hormonal contraception or another medicine, discuss the possible trigger with your prescriber before changing treatment.2 7

When should a doctor check the marks?

Have persistent facial darkening or a changing patch examined rather than assuming it is a freckle. Melasma is not cancerous, but other conditions can resemble it. Typical melasma is flat and neither itchy nor painful. If a nonprescription melasma treatment has not given the results you want within three to six months, see a dermatologist.2 4 5 7

Where this answer comes from

1Brown spots, lentigos and frecklesdermnetnz.org
2Melasma: Overviewaad.org
3Melasma (facial pigmentation)dermnetnz.org
4Melasma: MedlinePlus Medical Encyclopediamedlineplus.gov
5Melasma: Treatment, Causes & Preventionmy.clevelandclinic.org
6Skin Pigmentation Disordersmedlineplus.gov
7Melasmabad.org.uk