Melasma, freckles and sun spots: the same brown, for different reasons

Pigmentation & Redness

The brown patches in the mirror may look alike, but each has its own character. Here is why telling them apart is the starting point of care.

Brown is a result, not a cause

Skin looks darker mostly because of melanin. Melanin is a protective pigment produced to shield cells from ultraviolet light, so pigmentation is closer to a trace of the skin trying to protect itself. What matters is which stimulus prompted that pigment, and at what depth the pigment has settled.

Different names mean different characters

• Melasma appears mainly on the cheeks, forehead and above the upper lip, roughly symmetrically and with blurred, spreading borders. Ultraviolet light, hormonal changes and genetic predisposition are known to be involved together.
• Freckles appear as small, light brown spots scattered over the skin, with a strong genetic component. They may also show seasonal variation, darkening in summer and fading in winter.
• Solar lentigines, the lesions commonly called sun spots, have relatively clear borders. They are closely related to long-term sun exposure, so they arise not only on the face but also on the backs of the hands and the outer arms.
• Post-inflammatory hyperpigmentation is the mark left where inflammation from acne, a wound or a procedure has subsided. It is less a lesion than a trace of the healing process.

Why the distinction matters

Even with the same brown colour, the course differs depending on whether the pigment stays in the epidermis or has descended into the dermis. Some fade with time, while others change little without care. Repeating strong stimulation on the basis of self-diagnosis can sometimes make the colour deeper instead.

Melasma in particular tends to move back and forth between improving and darkening again, so it is hard to regard it as something to be finished with in one round of care. It is more realistic to have the condition assessed, set a direction and then continue steadily.

What all pigment care has in common

Whatever the type, sun protection is emphasised in common. SPF is an indicator related to UVB and PA to UVA, and it is UVA that is more closely linked to pigmentation and ageing. UVA can have an effect even on cloudy days or indoors near a window.

Also, applying less than the recommended amount makes it hard to expect the protection indicated on the label. On days with long outdoor activity, the habit of reapplying helps.

Have these changes assessed at a consultation

If a spot suddenly darkens, if its shape and border change irregularly, or if it grows quickly, it is safer to have it assessed at a consultation rather than judging for yourself.

This column is general medical information provided to aid understanding. It does not guarantee the results of any specific treatment and does not replace a medical consultation. Treatment results and the course of recovery vary from person to person. Please confirm what is appropriate for your own condition through a consultation.