Melasma
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Melasma vs Lentigo
Melasma is a soft-edged brown patch with no border you can point to. It covers a broad area and usually matches on both sides of the face. A lentigo is one flat brown spot with a clean edge. Solar lentigo is the medical name for a sun spot, but lentigo is a family of words, and the members do not all mean the same thing.
At a glance
| The difference | Melasma | Lentigo |
|---|---|---|
| What it is | Pigment cells that react too easily | A slight increase in pigment cells |
| What it looks like | A broad patch | A single flat spot |
| What it does over time | Fades and returns | Stays put |
| Treatment | Sun protection first, then fading creams | Cleared one spot at a time |
Lentigo
A slight increase in pigment cells In a lentigo the pigment cells themselves are a little more numerous in that one patch, and they hold on to more pigment.
Side by side
The differences that matter
What it is
Melasma
Pigment cells that react too easily
Sun, heat and hormonal changes push your pigment cells to make extra melanin. The number of cells is normal.
Lentigo
A slight increase in pigment cells
In a lentigo the pigment cells themselves are a little more numerous in that one patch, and they hold on to more pigment.
How it works, illustrated
Melasma
Pigment cells sit spaced out along the base of the top layer of skin, handing an even amount of pigment to the cells around them. Sunlight and heat reach normal skin too. These cells switch on briefly, then settle back down, so the color across a cheek stays even.
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Sunlight, the visible light we can see, and plain heat all land on the skin. This is why a patch darkens on a cloudy day, over a hot stove or through a car window, and it is the step that sun protection is aimed at.
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The pigment cells inside a melasma patch are unusually easy to switch on and slow to switch off, and hormones from pregnancy or the pill keep them primed. That is why the same short walk to the car darkens the patch and does nothing to the skin beside it.
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The switched-on cells make extra melanin and hand it to the skin cells around them. Some of it drops through into the deeper layer of skin, where scavenger cells hold onto it, and that deeper pigment is the gray-brown part creams reach poorly.
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The skin under a patch is not normal skin. Sun damage, extra blood vessels and the supporting layer beneath keep sending growth signals up to the pigment cells, so they stay primed even when the surface looks even. Almost everything on the lists below is pushing on this step.
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What it looks like
Melasma
A broad patch
Fairly even brown across both cheeks, the forehead, the upper lip or the jawline.
Lentigo
A single flat spot
Round or oval, a few millimetres to about a centimetre. Usually there are several, with normal skin in between.
More photographs
Melasma
Appearance
Melasma
Forehead
Symmetrical brown or gray-brown patches across the forehead, nose, upper lip and chin, with soft, blurred edges. It darkens with sun, heat and hormonal change. Daily sun protection does more for it than any single product.
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Cheeks
Patches sitting mainly over the cheekbones on both sides, often in a mirror-image pattern. It is common in pregnancy and with hormonal contraception. It can fade slowly after the hormonal trigger changes, but not always.
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Upper Lip
Patches along the jawline and sides of the face, which tend to appear later in life. This pattern is often more stubborn than the others. Heat and visible light, not only ultraviolet, keep it going.
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Across skin tones
Melasma
Melasma on light skin
On light skin melasma shows as flat tan or light brown patches with soft, blurred edges, usually across the forehead, the cheeks and the upper lip, and usually matching on both sides of the face. It is completely flat. If you can feel it, it is something else. The common mistake here is reading it as freckles or ordinary sun damage and reaching for a scrub, when sunlight, heat and hormone change are what keep it going.
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Melasma on medium skin
Melasma is much more common from medium skin tones onward, and it tends to start earlier and cover more of the face. The patches read mid-brown against a background that is already warm, so the border is softer and it can look like an uneven tan that never evens out. Visible light, the light you can see, drives the pigment here as much as ultraviolet light does, and a clear sunscreen blocks almost none of it. The tint in a mineral sunscreen is the working part, not a cosmetic choice.
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Melasma on brown skin
On deeper skin tones the color is often gray, slate or blue-brown rather than plain brown. That shade means more of the pigment has settled into the deeper layer of the skin, and deep pigment clears slowly. Progress is measured in months, and the realistic goal is lighter and more even rather than gone. Sun protection every day is what holds the ground that creams gain.
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Melasma on deep skin
The biggest avoidable risk on deep skin is the treatment itself. Strong peels, high-energy lasers, hair removal lasers used near a patch and hard scrubbing all inflame the skin, and inflamed skin with active pigment cells makes more pigment. That is how a course of treatment can leave a face darker than it started. Creams bought outside a doctor's care do the same: long, unbroken use of high-strength hydroquinone can cause a blue-black discoloration that is far more stubborn than the melasma was. Used properly, in supervised courses, hydroquinone is still one of the most effective treatments there is.
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The edge
Melasma
Soft and blurry
The colour fades out into the skin around it. There is no line where it stops.
Lentigo
Sharp and clean
A defined border. If you can outline it with a fingertip, it is a lentigo rather than melasma.
Where it shows up
Melasma
The face, in a mirrored pattern
Cheeks, forehead, upper lip and jawline. Cover half your face in the mirror. If the two sides broadly match, that points to melasma.
Lentigo
Sun-exposed skin, mostly
Face, backs of the hands, forearms, chest and shoulders. Some kinds turn up anywhere, including on skin the sun never reaches.
Where it appears
Melasma
Cheeks
The most common pattern. The patches sit on the cheekbones and spread out toward the temples, and they are close to symmetric — a patch on one cheek almost always has a match on the other.
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Forehead
A band across the forehead, strongest at the sides and fading up into the hairline. It is easy to mistake for a tan, because it follows the part of the face the sun reaches first.
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Upper lip
A brown band above the lip, shaped like a moustache. This is the one people recognize least, and the one most often blamed on waxing or other hair removal.
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Forearms, neck and upper chest
It can also appear on the forearms, the front of the neck and the upper chest, which are the other places the sun reaches every day. These patches respond more slowly than the ones on the face.
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What it does over time
Melasma
Fades and returns
Lighter through the winter, darker from spring onward. It rarely clears once and stays clear.
Lentigo
Stays put
A solar lentigo does not fade in winter, and more appear while sun exposure continues.
Treatment
Melasma
Sun protection first, then fading creams
Daily broad-spectrum sunscreen matters more than anything else. Hydroquinone, azelaic acid, tranexamic acid and gentle peels fade it. Lasers are used carefully, if at all.
Lentigo
Cleared one spot at a time
Freezing, lasers and intense pulsed light remove a solar lentigo well. Any spot a clinician is unsure about gets examined, and sometimes sampled, before anything is aimed at it.
Melasma
A tinted mineral sunscreen
The single most useful thing on this page, and what makes everything else worth using. Broad spectrum, SPF 30 or higher, mineral and tinted: the iron oxides that give it color are what block visible light, and visible light drives melasma just as ultraviolet light does. A clear sunscreen does almost nothing to that part. A prescription cream worn without this loses ground every summer.
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Azelaic Acid
Calms overactive pigment cells without bleaching the normal skin around them, which is why it can be used for months at a time instead of in short courses. That makes it one of the better options for holding a result after a course of hydroquinone. The over-the-counter strength works slowly, and the prescription strength works better.
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Cysteamine
Put on dry skin, left for about 15 minutes and then washed off rather than left on overnight. It is the over-the-counter option with the most real trial evidence in melasma, and it suits people who want to avoid hydroquinone or need something for the gaps between courses. The smell is the usual reason people give up on it.
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Tranexamic Acid
Works on a different part of melasma from the pigment-blocking creams. It quietens the signals coming from blood vessels and the skin underneath, which is the fourth step and the reason patches keep returning. That makes it a useful addition for stubborn melasma rather than a first treatment on its own. Twice a day, judged at three months.
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Niacinamide
Slows the handover of pigment from pigment cells to the skin cells around them. Modest on its own and not something that will clear a patch, but it is well tolerated and it does not sting, which counts for a lot in a condition where irritation makes things worse. It sits comfortably alongside the stronger treatments.
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Vitamin C (L-Ascorbic Acid)
Lightens surface pigment a little and helps sunscreen do its job during the day. It is a reasonable thing to try in the three months before asking for a prescription, and a reasonable thing to keep for maintenance afterwards. On its own it rarely shifts an established patch, and it does not replace sun protection.
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Alpha Arbutin
A gentler relative of hydroquinone that releases a small amount of it slowly in the skin. It suits people who want a lightening step running between supervised courses of the prescription version. The effect is milder and slower, and the studies behind it in melasma are small.
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Kojic Acid
Blocks the same pigment-making enzyme hydroquinone does, more weakly. It is nearly always sold combined with other lightening ingredients, and the studies showing it work are studies of those combinations rather than of kojic acid alone. It stings some people, and stinging on a melasma patch tends to darken it.
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Licorice Root Extract
A common ingredient in brightening products, resting mainly on laboratory work rather than trials in people with melasma. It is gentle and unlikely to cause trouble, and it is also unlikely to be the thing that clears a patch. If a routine only has room for one active, this is not the one to pick.
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Chemical Peel
Light peels, spaced out, speed up the clearing of surface pigment when they are added to creams and sun protection. They are an addition and never a replacement. Depth is the whole issue: a peel strong enough to leave the skin red and peeling can inflame it and leave the patch darker than it started, which is one of the commonest ways melasma gets worse.
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Nd:YAG Laser
Used at low energy over several sessions to break up pigment that creams reach poorly. It can lighten stubborn patches, and the improvement often fades over the following months if creams and daily sun protection are not carrying on behind it. Pushed too hard it causes patchy loss of color or rebound darkening, so settings stay low and a test patch first is sensible.
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Picosecond Laser
A newer laser that delivers very short pulses at low energy, aimed at the deeper pigment creams struggle with. The melasma studies so far are small and cautiously encouraging. Like every device used here it is an addition to creams and sun protection rather than a shortcut past them, and results still fade without them.
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Microneedling
Fine needles make temporary channels that help tranexamic acid or other treatments reach deeper, and that combination is where the evidence sits — not needling on its own. It has to be done gently. Aggressive needling inflames the skin, and inflamed skin with active pigment cells makes more pigment, not less.
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IPL (Intense Pulsed Light)
Often offered for facial pigment, and often the wrong choice for melasma. It can lighten patches briefly and then bring them back darker within weeks, because the heat it delivers is itself a trigger for pigment cells. It works far better on sun spots, which is part of why telling the two apart matters before booking anything.
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Fractional CO2 Laser
An ablative resurfacing laser with a real risk of making melasma worse, particularly on medium and deep skin tones. Any benefit tends to be short-lived and the rebound darkening can last a long time. If a clinic is offering aggressive resurfacing as the answer to melasma, that is a reason to get a second opinion.
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Oral tranexamic acid
A low-dose tablet, usually taken for a few months, for melasma that has not answered creams and daily sun protection. It works on the blood vessel and signalling side of the condition rather than by bleaching, and the trials behind it are reasonable. It is not for everyone: a history of blood clots or certain other risks rules it out, so it comes after a proper history. Melasma usually returns once it is stopped, so sun protection carries on.
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A review of hormonal contraception
The combined pill, the patch, the implant and menopausal hormone therapy can all set melasma off or keep it dark. Stopping sometimes helps and sometimes does not, and it can take many months to show. Never stop a prescribed hormone on your own. Ask the prescriber whether a different method makes sense, and weigh that against what the contraception is doing for you.
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Triple combination cream
Hydroquinone, a retinoid and a mild steroid in one cream, used at night on the patches. It is the most effective topical treatment for melasma and the one with the best trial evidence, given as a course of a few months rather than indefinitely. It is also the one that most needs a doctor watching it, because the steroid thins skin with long use and the hydroquinone is meant to be stopped and restarted.
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Hydroquinone 4%
The most established single prescription cream for melasma, applied thinly at night to the patches only. It is used in courses of about three to four months with breaks in between, not continuously for years — unbroken long-term use at high strength is what causes the blue-black discoloration people have heard about. Expect the first month to look like nothing is happening.
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Tretinoin
Speeds up how quickly pigmented skin cells are shed, and helps the other creams get in, which is why it is more often part of a combination than used alone. Used by itself it works slowly and it can irritate, and irritation darkens melasma, so it is started at a low strength a few nights a week. Ask your doctor about it if you are pregnant or trying to become pregnant.
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A steroid cream on its own
Steroid creams do fade pigment for a while, which is why they turn up in unregulated lightening products, but they are not a melasma treatment. Used on the face for months they thin the skin, bring up broken vessels and can cause a rash around the mouth, and the pigment comes back when they stop. In melasma a steroid belongs only inside a supervised combination cream.
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Lentigo is a family of words, not one diagnosis
Lentigo
Solar lentigo is the common one. It is a harmless flat brown spot built by years of sun. Sun spot, age spot and liver spot are the everyday names for exactly this. Most people who look up "lentigo" have one of these.
Lentigo simplex appears in childhood. It is a small dark spot that is not caused by sun and can show up anywhere on the body, including skin that stays covered. It is harmless.
Lentigo maligna is a different matter. It is an early melanoma that grows slowly on skin with heavy long-term sun exposure, usually the face, neck or scalp, usually in older adults. It can look very like a solar lentigo, and that resemblance is why it gets missed.
See a doctor if
Related topic illustrations
Melasma
Post-Inflammatory Hyperpigmentation
Melasma is the condition where pushing hard backfires most often. A strong peel, a high-energy laser or an irritating cream can inflame the skin and leave it more pigmented than it began, and that extra pigment can take many months to settle. It is the reason melasma is treated gently and slowly, and the reason a test patch is worth doing before any device is used across the whole face.
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Living with it day to day
Melasma does not hurt and is not dangerous, which is exactly why its effect gets underestimated. People describe avoiding photographs, spending time and money on makeup that only half covers it, and feeling worse every summer as it darkens. It is a reasonable thing to ask for treatment for, and saying it out loud in the appointment usually changes what gets offered.
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Post-Inflammatory Hyperpigmentation
Both are flat brown marks on the face and both show up more on deeper skin tones. The difference is the shape. Marks left by inflammation copy whatever came first, so they sit as separate spots where acne spots were, or in the outline of a rash, and they are rarely symmetric. Melasma is a spreading patch with soft edges that mirrors itself on both sides of the face. Plenty of people have both at the same time, and they are treated differently.
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Tinea Versicolor
A common yeast overgrowth that leaves flat patches which can be light brown, pink or paler than the skin around them, so it gets read as uneven pigment. It usually sits on the chest, back, shoulders and neck rather than the cheeks, it is not symmetric, and the patches show a fine dusty scale when they are scraped. It clears with an antifungal, which does nothing at all for melasma.
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Common questions
Questions Patients Ask
What is the difference between melasma and a lentigo?
A lentigo is a single flat spot with a clean edge. Melasma is a broad patch with no border, usually spread symmetrically across the cheeks, forehead or upper lip.
Is a lentigo the same as a sun spot?
A solar lentigo is. Sun spot, age spot and liver spot are all everyday names for a solar lentigo. Lentigo on its own is a wider term that covers a few different spots.
Can a lentigo turn into melasma?
No. They are separate things with separate causes, and one does not become the other. Many people have both on the same face.
Is lentigo dangerous?
A solar lentigo and a lentigo simplex are harmless. Lentigo maligna is an early melanoma that can look similar, which is why a spot that changes or stands out from the others is worth having examined.
Which is easier to get rid of?
A solar lentigo. Freezing, lasers and intense pulsed light usually clear one in a session or two. Melasma is managed over time and comes back without daily sun protection.
Why did my dermatologist write "lentigines" on my notes?
Lentigines is simply the plural of lentigo. It means you have more than one of these flat brown spots.