The short version: sun spots are individual, well-defined brown spots that showed up slowly over decades of sun. Melasma is a blotchy, symmetric patch with fuzzy edges, driven by hormones plus light plus heat, that darkens every summer and fades every winter. They look similar enough that patients mix them up constantly, and it matters more than almost any distinction in dermatology, because the laser that erases a sun spot can make melasma dramatically worse.
I am a laser dermatologist. I own the lasers. And one of the most important things I do in a pigment consult is tell people not to laser what they came in to have lasered.
Here is how to tell what you are actually looking at.
Melasma vs. sun spots: the differences that matter
| Melasma | Sun spots (solar lentigines) | |
|---|---|---|
| Shape | Blotchy patches with soft, ill-defined edges | Discrete round or oval spots with clean borders |
| Symmetry | Mirror-image on both sides of the face | Scattered and random |
| Where | Cheeks, forehead, upper lip, jawline | Anywhere sun hits: face, hands, chest, shoulders |
| How it appeared | Over months, often after pregnancy, the pill, or one hard summer | Slowly, over decades |
| Seasonal? | Yes. Darker every summer, lighter every winter | No. It sits there year round |
| Who gets it | Overwhelmingly women, and more common in medium to deep skin tones | Anyone with cumulative sun exposure |
| Driven by | Hormones + UV + visible light + heat | UV, accumulated over years |
| Response to laser | Can rebound and worsen | Usually clears well |
| Curable? | No. Manageable, and manageable very well | Yes, usually in one or two sessions |
The single fastest tell: stand in front of a mirror and cover half your face. Now the other half. If the pattern is close to a mirror image, that is melasma. Sun damage does not distribute itself symmetrically, because the sun does not.
What about hyperpigmentation? And PIH?
“Hyperpigmentation” is not a diagnosis. It is a category, and it means nothing more than “an area darker than the skin around it.” Melasma is hyperpigmentation. Sun spots are hyperpigmentation. So is the third one people miss:
Post-inflammatory hyperpigmentation (PIH) is the mark left behind after the skin was injured or inflamed. A popped pimple, a scratch, eczema, a burn, a bad reaction to a product. The giveaway is location: PIH sits exactly where the injury was, because it is a scar in pigment rather than in texture. It fades on its own over months to a year, and it fades faster with treatment.
This is why “I have hyperpigmentation” is not enough information to treat anyone. It is like saying you have a pain. Where, and from what?
Melasma mustache: why the upper lip is the classic spot
The dark shadow above the lip is the presentation people find most distressing, and the one most likely to be mistaken for facial hair or a stain.
It is melasma, and the upper lip is a favorite location for reasons that stack: the skin there is thin, the area catches direct overhead light, it is densely populated with hormone-responsive pigment cells, and it takes heat from every conversation, every hot drink, and every summer afternoon.
Here is what makes the upper lip specifically difficult: waxing, threading, and hair removal on melasma-prone skin can worsen it. Trauma to the skin is inflammation, and inflammation in someone whose pigment cells are already overactive means more pigment. Patients frequently arrive having spent a year making it worse while trying to make it better.
Upper lip melasma responds to the same approach as melasma anywhere. It just needs more patience, and the discipline to stop irritating it.
What triggers melasma to get worse?
This is where most advice goes wrong, because most people believe melasma is a sun problem. It is broader than that.
- UV light. Obviously, and the one everyone knows.
- Visible light. This is the one almost nobody knows, and it changes everything. High-energy visible light, including the blue light from the sun and from screens, is an independent driver of melasma. Your clear chemical sunscreen does essentially nothing to block it. This is why patients say “I wear sunscreen every day and it still got worse,” and they are telling the truth.
- Heat. Infrared alone can stimulate pigment. Hot yoga, saunas, standing over a stove, a long drive with sun through the window. Melasma is one of the few skin conditions where temperature is a genuine trigger, independent of light.
- Hormones. Pregnancy, oral contraceptives, hormone therapy, and IUDs. Estrogen and progesterone make pigment cells hypersensitive to everything above.
- Inflammation. Aggressive scrubs, harsh acids, waxing, irritation from products you are using to fix it.
- Aggressive lasers and IPL. Covered below, and worth the space.
Best sunscreen for melasma: it has to be tinted
If you take one practical thing from this article, take this.
Your sunscreen needs iron oxides. Iron oxides are the pigments that make a sunscreen tinted, and they are currently the only widely available ingredient that meaningfully blocks visible light. A clear SPF 50 blocks UV and lets the visible light through, and visible light is a primary melasma driver. That gap is why so many diligent patients get worse.
What to look for:
- Tinted mineral sunscreen with iron oxides. If it is clear, it is not doing this job. If the label does not say iron oxides, check the ingredients for CI 77491, 77492, or 77499.
- SPF 30 minimum, broad spectrum, reapplied every two hours outdoors.
- Every single day, indoors included. Melasma does not take winter off, and window glass blocks UVB while letting UVA and visible light straight through. The drive to work counts.
- A wide-brimmed hat is not a substitute, but it is the most underrated tool in melasma management.
Sunscreen is not a supporting player in melasma treatment. It is the treatment. Every other thing on the list below fails without it.
What actually gets rid of melasma?
Straight answer: nothing gets rid of it permanently. Melasma is chronic and relapsing. Anyone promising a cure is either selling something or has not treated enough of it.
What is absolutely achievable: getting it faint enough that you stop thinking about it, and keeping it there. I have patients who have been clear for years. They are clear because they never stopped doing the boring parts.
Topicals that work
- Tranexamic acid — topical or oral. Oral tranexamic acid has become one of the most useful tools we have for stubborn melasma. It requires medical screening (it is not appropriate for everyone, particularly with clotting history), which is precisely why it needs a physician rather than an internet order.
- Hydroquinone — still the benchmark, now prescription-only in the US. Used in cycles, not indefinitely.
- Azelaic acid — inhibits overactive pigment cells while calming inflammation, and it is safe in pregnancy, which matters enormously for the population that gets melasma. One of my favorites for exactly that reason. Azelaic Acid 10 →
- Cysteamine, niacinamide, kojic acid, vitamin C — useful in combination, modest alone.
- Retinoids — helpful, and irritating if pushed. Irritation is a trigger. Go slow.
In-office treatments
- Gentle chemical peels — well tolerated, incremental, safe in the right hands.
- Low-fluence, carefully selected laser — effective, and only as an adjunct to topicals and photoprotection, never as a first move.
The one thing to be careful about
IPL and aggressive resurfacing lasers can make melasma significantly worse. Both deliver heat, and heat is a trigger. You often get a beautiful result for three weeks, then a rebound that is darker and more stubborn than what you started with, and rebound melasma is harder to treat than virgin melasma.
On sun spots, the exact same IPL is excellent. Often one session, gone.
Same device. Same face. Opposite outcomes. That is the entire reason this article exists, and it is why “I’ll just get it lasered off” is the most expensive sentence in pigment.
Melasma in pregnancy (the mask of pregnancy)
Roughly half of pregnant women develop some melasma, called chloasma. It is normal and it is not harmful.
What to do while pregnant: tinted mineral sunscreen, a hat, azelaic acid if you want to treat actively. Hydroquinone and oral tranexamic acid are off the table until after pregnancy and nursing.
It often fades on its own in the months after delivery. When it does not, it is very treatable. Do not spend your third trimester panicking about it, and do not let anyone laser it while your hormones are still in charge.
One thing to rule out
Melasma and sun spots are both benign. But any pigmented spot that is asymmetric, has irregular or notched borders, contains multiple colors, is larger than a pencil eraser, or is changing needs to be examined, not treated cosmetically. A spot that itches, bleeds, or will not heal is not a cosmetic concern.
If you are unsure, that uncertainty is the reason to be seen. This is a two-minute answer in person and an impossible one online.
What to do next
If your pattern is symmetric, blotchy, and worse every August, you have melasma, and the most valuable thing you can do this week costs nothing: get a tinted mineral sunscreen and wear it indoors too.
If your spots are discrete, hard-edged, and scattered across your face, hands, and chest, those are sun spots, and they are one of the more satisfying things we treat because they usually just go.
If you have both, which is extremely common, they have to be treated in the right order. That is the part that requires a real diagnosis.
Melasma treatment in San Diego →
Book a consultation with Dr. Shirazi →
Frequently asked questions
How do I know if I have melasma or sun spots?
Melasma is a blotchy patch with soft edges that appears symmetrically on both sides of the face and darkens in summer. Sun spots are discrete, well-defined individual spots with clean borders, scattered rather than symmetric, and they do not change with the seasons.
What actually gets rid of melasma?
Nothing removes it permanently. Melasma is chronic and relapsing. It is controlled with daily tinted mineral sunscreen containing iron oxides, topicals such as tranexamic acid, hydroquinone, or azelaic acid, and gentle in-office treatment. Most patients can get it faint enough to stop noticing, but it requires ongoing maintenance.
What triggers melasma to worsen?
UV light, visible light including blue light from the sun and screens, heat, hormones such as pregnancy or oral contraceptives, skin inflammation or irritation, and aggressive laser or IPL treatment.
Do sun spots ever go away?
Not on their own. Solar lentigines are permanent until treated. They respond very well to laser, IPL, or cryotherapy, often in one or two sessions.
Can laser make melasma worse?
Yes. IPL and aggressive resurfacing lasers deliver heat, and heat is a melasma trigger. Results often look excellent for a few weeks before rebounding darker and more stubbornly than the original. Only low-fluence, carefully chosen settings should be used, and only alongside topicals and strict photoprotection.
What is the best sunscreen for melasma?
A tinted mineral sunscreen containing iron oxides, SPF 30 or higher. Iron oxides are currently the only widely available ingredient that meaningfully blocks visible light, which is an independent melasma trigger. A clear sunscreen leaves that gap open.
Why do I get melasma on my upper lip?
The skin there is thin, it catches direct overhead light and heat, and its pigment cells are densely hormone-responsive. Waxing and threading can worsen it, since trauma causes inflammation and inflammation drives pigment.
Does melasma go away after pregnancy?
Often it fades in the months after delivery as hormones normalize. When it does not, it responds well to treatment. During pregnancy, tinted mineral sunscreen and azelaic acid are safe options; hydroquinone and oral tranexamic acid are not.
Is melasma the same as hyperpigmentation?
No. Hyperpigmentation is a category, meaning any area darker than the surrounding skin. Melasma is one specific cause of it. Sun spots and post-inflammatory hyperpigmentation are others, and each is treated differently.
Azadeh Shirazi, MD, FAAD, is a board-certified dermatologist and the founder of La Jolla Laser Dermatology. This article is for education and is not a substitute for an in-person evaluation. Pigment conditions can look alike and are treated differently; any changing or irregular spot should be examined.
