Melasma or Sun Spots? How to Tell, and Why It Changes Everything

Two people can walk in with brown patches on their cheeks and need close to opposite treatment plans. Getting this distinction right is the single most important decision in treating pigmentation — and getting it wrong is the most common reason pigmentation gets worse rather than better.

Sun-induced pigmentation

Sun spots and age spots are deposits of pigment caused by cumulative ultraviolet exposure. They tend to have defined borders, appear in scattered rather than symmetrical patterns, and sit relatively superficially. They are common on the cheeks, temples, forearms and backs of the hands.

They generally respond well and fairly predictably to treatment that breaks pigment down.

Melasma

Melasma is not simply deposited pigment — it involves pigment cells that are overactive, driven by hormones, heat and light. It tends to be symmetrical, with soft, blurred edges rather than clean borders, most often across the cheeks, upper lip or forehead. It fluctuates: worse after sun, worse in heat, worse in pregnancy or with certain hormonal changes.

Critically, melasma can rebound and worsen if treated aggressively. Heat alone can provoke it — which means some treatments that work beautifully on sun spots are actively counterproductive here.

Post-inflammatory marks

The third common one. These are the flat brown or reddish marks left after inflammation, most often acne. They are not scars: the skin surface is intact. They fade on their own, just slowly. Treatment accelerates a process that would happen anyway.

The quick self-check

• Symmetrical across both cheeks, blurred edges, worse in the sun and heat — think melasma.
• Scattered spots with clean borders, on sun-exposed areas — think sun-induced.
• Flat marks exactly where spots used to be — think post-inflammatory.

This is a starting point, not a diagnosis. The three can coexist on the same face, which is common and is exactly why an in-person assessment matters.

Why the treatment differs so much

For sun-induced spots, the goal is to break down and clear existing pigment, and results are usually clear-cut.

For melasma, the goal is control rather than removal. Treatment is conservative, spaced out, and combined with strict daily photoprotection and management of triggers. Anyone promising to clear melasma permanently is either misinformed or not being straight with you — it is a chronic condition that is managed, sometimes for years.

The part no device replaces

Daily sun protection. In Singapore's latitude and climate, ultraviolet exposure is constant and ambient heat is a genuine melasma trigger. Without photoprotection, pigmentation returns regardless of what treatment you have had. This is not a disclaimer at the bottom of a page — it is the largest single factor in your result.

What treatment actually looks like for each

For sun-induced spots: treatment that breaks pigment into fragments the body clears. Marks typically darken for several days, then flake away. Often a small number of sessions, with a fairly clear endpoint.

For melasma: conservative settings, longer intervals, and a plan measured in months. The priority is not provoking a rebound. Devices are a supporting player here — daily photoprotection and trigger control do more of the work.

For post-inflammatory marks: often the simplest. Time plus sun protection resolves many of them; treatment shortens the timeline, and is worth doing mainly when the marks are extensive or slow to fade.

Why the same laser helps one and harms another

Energy-based treatment produces heat. For deposited pigment, heat and photomechanical shock break it up and the body clears it. For melasma, where pigment cells are already overactive, heat is itself a trigger — the same session that clears a sun spot can prompt a melasma patch to produce more pigment.

This is not a reason to avoid treating melasma. It is a reason to treat it differently, at lower intensity, with a clinician who has looked at it properly first.

One safety note

Not every pigmented patch is cosmetic. Anything changing in size, shape or colour, or that looks different from everything else on your skin, needs a medical assessment before any aesthetic treatment is considered.