💡 At a glance
· Melasma is a blurry, symmetric brown patch across the cheeks and forehead. Freckles are 1~3 mm dots present since childhood. Sunspots (solar lentigines) are sharp-edged brown spots that appear after your 30s.
· The causes differ. Melasma is a chronic condition driven by UV, hormones and sun-aged dermis. Freckles come from genetics (the MC1R gene) plus UV. Sunspots come from years of accumulated UV damage.
· Freckles and sunspots sit in the epidermis, so one or two laser sessions can often clear them. Melasma can darken after an aggressive laser, so the goal is control, not removal.
· Many faces carry two or three of these at once. Telling them apart before treatment decides the result.
Melasma (기미, 肝斑, 黄褐斑), freckles (ephelides, 주근깨, そばかす, 雀斑) and sunspots (solar lentigo, 흑자, 老人性色素斑, 晒斑) are all brown marks caused by extra melanin. They differ in where the pigment sits and why it forms, which is why a laser that helps one can worsen another.
The three spots side by side
| Feature | Melasma | Freckles | Sunspots (solar lentigo) |
|---|---|---|---|
| Shape | Blurry patch that spreads like a map | Many 1~3 mm dots | Round or oval spot with a clear edge, a few mm to a few cm |
| Color | Light brown to gray-brown | Light brown | Brown to dark brown |
| Location | Cheeks, forehead, upper lip, symmetric | Nose and cheeks, scattered | Cheekbones, temples, backs of hands |
| Onset | Late 20s to 40s, often after pregnancy or oral contraceptives | Early childhood to school age | After the 30s or 40s |
| Seasonal change | Darker in summer, recurs easily | Darker in summer, lighter in winter | Almost none |
| Main cause | UV and visible light, female hormones, photoaged dermis | Genetics (MC1R) plus UV | Cumulative UV |
| Pigment depth | Epidermal pigment plus an abnormal dermis | Epidermis | Epidermis |
| Treatment direction | Control with low-fluence toning, medication and sun protection | Removal with an epidermal pigment laser such as 532 nm | Removal with an epidermal pigment laser such as 532 nm |
| Recurrence | Common | Returns with sun exposure | Rare at the treated site, but new spots form |
Melasma: a photoaging disorder, not only a pigment problem
Melasma was long seen as overactive melanocytes. It is now understood as a disorder of sun-aged skin as a whole. Passeron and Picardo (2018, Pigment Cell & Melanoma Research) defined melasma as a photoaging disorder.
The evidence is in the tissue. According to the review by Kwon et al. (2016, International Journal of Molecular Sciences), moderate to severe solar elastosis (sun-damaged elastic fibers in the dermis) was reported in 93% of melasma patients, and basement membrane disruption was seen in 3~95.5% depending on the study. Increased blood vessels and mast cells add to the picture.
This structure is what makes melasma hard to treat.
- The weakened basement membrane lets melanin drop into the dermis.
- Extra vessels and inflammatory cells keep stimulating melanocytes.
- Heat and friction darken it. This is why a strong laser can make melasma worse.
UV is not the only trigger. A 2025 review of melasma pathogenesis in the International Journal of Dermatology also covers visible light and hormonal shifts such as pregnancy and oral contraceptives. Melasma can darken even with a mostly indoor life.
Freckles: set by genes, revealed by the sun
Freckles are an inherited trait. Bastiaens et al. (2001, Human Molecular Genetics) reported that variants of the MC1R gene are the major genetic determinant of freckles. They tend to run in families and show up around kindergarten or primary school.
In a freckle, the number of melanocytes is not increased. The same number of cells make more melanin when exposed to sunlight (Praetorius et al., 2014, Pigment Cell & Melanoma Research). That explains why freckles darken in summer and fade in winter. The pigment stays in the epidermis, so it responds well to laser.
Sunspots: the mark of accumulated UV
Much of what people call age spots is solar lentigo. Unlike freckles, sunspots are absent in childhood, appear one by one after the 30s or 40s, and do not fade with the seasons.
Under the microscope the lower epidermis is elongated and the number of melanocytes itself is increased. If a freckle is an overworked cell, a sunspot is a multiplied one. The clear edge and epidermal depth make it a good target for laser removal.
Spots often mistaken for melasma
- ABNOM (Hori's nevus): clusters of blue-gray to gray-brown dots on both cheekbones. The pigment lies deep in the dermis, so treatment is completely different, and it often coexists with melasma.
- Post-inflammatory hyperpigmentation: brown marks left after acne, injury or a procedure. The shape matches the original lesion.
- Seborrheic keratosis: slightly raised to the touch. It is thickened epidermis, not pigment, and needs to be physically removed.
A quick self-check
- When did it start? Since childhood suggests freckles. After the 30s suggests melasma or sunspots.
- Can you trace the border? If you could outline it with a pen, think freckles or sunspots. If it blurs out, think melasma.
- Does it fade in winter? Clear fading suggests freckles. No change suggests sunspots.
- Is it symmetric? Matching patches on both cheekbones point to melasma.
This is a guide only. A sunspot sitting on melasma, or ABNOM mixed in, is hard to distinguish by eye.
Pigment treatment at DIORE
In DIORE's clinical practice in Korea, sessions are planned differently for each type of pigment.
Melasma, freckles and sunspots each call for a different laser, number of sessions and interval, so we do not group them under one protocol.
Frequently asked questions
Q1. I have both melasma and freckles. Which is treated first?
Melasma first. A strong freckle-removal laser on skin with underlying melasma can darken the melasma. The safer order is to calm melasma with low-fluence toning, medication and sun protection, then remove the remaining freckles.
Q2. Can laser remove melasma completely?
Melasma is a chronic condition managed for control, not cure. Because vessels and basement membrane damage in the dermis are involved, it can return with UV or hormonal change even after it fades. Keeping it light over the long term is the realistic goal.
Q3. Do freckles come back after laser removal?
They can. Freckles reflect an inherited tendency to make more melanin in sunlight, so new ones appear with UV exposure. Consistent sun protection delays their return.
Q4. Will melasma from pregnancy go away after delivery?
It often fades over several months after delivery, but some remains. Medication and procedures are limited during pregnancy and breastfeeding, so sun protection matters most in this period.
Summary
Melasma, freckles and sunspots look alike but differ in cause and pigment depth. Once the type is known, the right laser, the number of sessions and the way to prevent recurrence follow. The next article covers which laser fits each type.
Related reading
- Laser Toning vs Pico Toning vs 532nm for Pigmentation
- How Pigment Lasers Work: Targeting Only Melanin
- UV Rays and Sunscreen: How to Choose and Use Them Right
ℹ️ This content is for general medical information and does not replace an individual consultation. Results vary with each person's skin condition. For an accurate diagnosis, please consult an aesthetic medicine specialist.
References
- Kwon SH, Hwang YJ, Lee SK, Park KC. Heterogeneous Pathology of Melasma and Its Clinical Implications. Int J Mol Sci. 2016;17(6):824. doi:10.3390/ijms17060824
- Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell Melanoma Res. 2018;31(4):461-465. doi:10.1111/pcmr.12684
- Pathogenesis of Melasma Explained. Int J Dermatol. 2025;64(7):1201-1212. doi:10.1111/ijd.17718
- Bastiaens M, ter Huurne J, Gruis N, et al. The melanocortin-1-receptor gene is the major freckle gene. Hum Mol Genet. 2001;10(16):1701-1708.
- Praetorius C, Sturm RA, Steingrimsson E. Sun-induced freckling: ephelides and solar lentigines. Pigment Cell Melanoma Res. 2014;27(3):339-350.