Melasma, Freckles or Sun Spots? Why Diagnosis Comes First

Why do different brown marks need different treatment?

All of these marks come from melanin, the pigment that colours skin. What differs is why the pigment is there, how deep it sits, and how the pigment cells react when they are disturbed. Sun spots and freckles are mostly stable pigment near the surface, so they tend to respond well to light-based treatment. Melasma comes from overactive pigment cells that are easily triggered, so the same energy that clears a sun spot can provoke more pigment.

The mark you see is the end result; the treatment has to fit the cause. That is why a photo alone is a starting point, and an in-person look under good light is part of the consultation.

How do you recognise melasma?

• Shape: patches with soft, blurred edges rather than distinct dots.
• Pattern: often symmetrical, on both cheeks, the forehead, the upper lip or along the jaw.
• Triggers: pregnancy, hormonal contraception, sunlight, visible light and heat. It often appears in the late 20s to 40s.
• Who: much more common in women and in medium to darker skin tones, including many East Asian and Southeast Asian skin types.
• Behaviour: it fades and returns. Even after good improvement it can come back with sun or hormonal change.

How do you recognise freckles?

• Shape: small, flat, light brown dots, often many of them.
• Onset: they usually appear in childhood and are partly inherited.
• Behaviour: they darken in summer and lighten in winter.
• Where: the nose, cheeks and shoulders, and anywhere that sees sun.

How do you recognise sun spots?

• Shape: flat brown marks with clear edges, usually larger than a freckle.
• Onset: they appear in adult life after years of sun, often from the 30s onwards.
• Behaviour: they do not fade in winter, and they slowly increase in number.
• Where: cheeks, temples, the backs of the hands and the chest.

What else can look like these?

Several other marks are often mistaken for melasma or sun spots, and each has its own approach.

• Hori’s nevus: grey-brown or bluish spots on both cheeks, common in East Asian women and often confused with melasma. The pigment sits deeper in the skin.
• Post-inflammatory pigmentation: brown marks left after acne, a rash, a burn or a too-strong treatment. These usually fade slowly on their own with sun protection.
• Raised brown spots: marks that feel rough or raised are not flat pigment and need a different approach.
• Mixed pictures: many people have more than one type at once, such as melasma with sun spots on top.

When should a spot be checked first?

Some brown marks need a medical check before any cosmetic treatment. See a doctor about a spot that is new and growing, changing in shape or colour, has an irregular edge or several colours, bleeds, itches, or looks different from your other spots. Cosmetic lasers are not used on a mark that has not been assessed.

How does the diagnosis change the treatment?

Without going into protocols, the broad direction differs by type:

• Sun spots and freckles often respond to targeted pigment treatment or intense pulsed light, such as the Stellar M22 IPL. Spots usually darken for a few days before they flake away. Freckles can return with sun.
• Melasma needs a gentle, patient approach. Strong heat and aggressive settings can make it worse. Our guide to laser toning for melasma explains when it helps and when it backfires.
• Mixed pigment is usually treated in stages, starting with the more stable marks and keeping melasma calm.

For how a course of toning is structured, see laser toning sessions. Whatever the type, daily broad-spectrum sunscreen is part of the plan, because sunlight drives all three.

What you can do before your visit

• Use sunscreen every day, including on cloudy days and indoors near windows, and reapply when you are outside. For melasma, a tinted sunscreen that also helps block visible light can be useful.
• Avoid picking or scrubbing the marks, which adds inflammation and more pigment.
• Note what you have used: creams, peels or previous laser treatments, and how the skin reacted. This helps the doctor judge the type and the risk.
• Take dated photos in the same daylight, so you can see whether the marks change with the season.

Planning pigment treatment on a trip

Pigment work often needs more than one session, and treated spots can look darker for about a week. If you are in Seoul for a short stay, a doctor may suggest starting with the marks most likely to respond and planning the rest. The cost depends on the type of pigment, the area and the number of sessions, and you get a clear quote after the consultation.

FAQ

Plan a visit: send a clear photo of the marks in daylight on WhatsApp, LINE, or KakaoTalk, and we will explain what they look like and what the next step could be, in English, before you land.