How does melasma differ from lentigo?
| Difference | Melasma | Solar lentigo |
|---|---|---|
| What the name means | A pigmentation disorder that commonly affects the face. | A particular form of lentigo; not every lentigo is a solar lentigo. |
| Appearance and identification | Usually flat, blotchy patches on both sides of the face, sometimes with freckle like spots. | Can resemble melasma and needs to be distinguished from it during assessment. |
Melasma commonly affects the cheeks, forehead, nose, chin and skin above the upper lip. Its colour can be tan, brown, grayish brown or bluish gray. Pregnancy or starting birth control pills can coincide with its appearance. These clues help a dermatologist assess the pattern; they do not make every facial brown spot melasma.34
The label "dark spot" covers more than one diagnosis, which is convenient for packaging and less useful for choosing treatment, giving two words a suspiciously large department to run.2
When should you get the pigmentation checked?
See a dermatologist if you are unsure whether you have melasma, a lentigo or another pigmented lesion, particularly before starting treatment. Melasma is not cancerous, but some skin cancers can mimic it. Other possible causes of pigmentation include moles and pigmentation left after inflammation. A dermatologist examines the skin and can use a Wood lamp, a special light, or a dermatoscope, a magnifying instrument. Occasionally, a biopsy is needed to clarify the diagnosis.123
What should you do if melasma is confirmed?
- Protect your skin from the sun every day. Use shade, protective clothing and a wide brimmed hat alongside sunscreen.
- Choose a tinted, broad spectrum sunscreen containing iron oxides. SPF 50+ is a practical choice for melasma; iron oxides also help protect against visible light, which can worsen the pigmentation.
- Reapply sunscreen every two hours outdoors, or sooner after swimming or sweating.
- Choose gentle skincare and makeup without fragrance. Stop using a product that burns or stings, because irritation can make dark spots darker.
Melasma often needs several measures together. A dermatologist can discuss creams such as a combination of hydroquinone, tretinoin and a topical steroid, or other options such as azelaic acid. Chemical peels and lasers need particular caution: they can worsen melasma or cause pigmentation after inflammation. Treating darker skin tones requires care because irritation can make melasma darker.14
Makeup can make melasma less noticeable while treatment takes time.5
Will melasma fade, and what changes during pregnancy?
Melasma can fade on its own, including after pregnancy, but it can also persist for years. Treatment is slow, especially when pigmentation has been present a long time. Creams can fade the colour without permanently preventing its return; sun exposure can bring it back. If a treatment bought without a prescription has not given the results you want within three to six months, see a dermatologist rather than continuing indefinitely.14
If you are pregnant, wait until after birth to start melasma treatment and focus on sun protection. Treatments sold without a prescription are not automatically safe during pregnancy. If pigmentation appeared while using hormonal contraception, discuss that connection with your prescriber before changing contraception.14
Where this answer comes from
- 1Melasma (facial pigmentation)dermnetnz.org
- 2Pigmented skin lesionsdermnetnz.org
- 3Melasma: Treatment, Causes & Preventionmy.clevelandclinic.org
- 4Melasma: Overviewaad.org
- 5How to make melasma less noticeableaad.org
