Freckles or Melasma. Can You Spot the Difference?
Thanks to multiple childhood summers spent at the Jersey Shore (Stone Harbor, no Snookie) and genetics, I’ve been permanently stamped with a liberal sprinkling of freckles across the bridge of my nose and the apples of my cheeks.
While no stranger to insecurity, for most of my life the freckles didn’t bother me because there wasn’t much I could do about them, just like being short or having brown eyes. Besides, it made me a little…unique.
Until my last trimester of pregnancy when my freckles unionized against me into one nasty uni-splotch on either cheek. On top of my 55 lbs of baby weight gain, I now had the complexion of an appaloosa.
Most of my melasma faded post-partum, but faint patches creep up on now and then, especially if I’ve been outdoors (even though I’m a sunscreen-wearing-wide-brimmed-hat person). Complicating this is that because I’ve had a lifetime of freckles, it’s tough to tell the difference between where the freckle ends and the melasma begins. Add to that the errant age spot.
What I didn’t know at the time, is that some of the treatments used to get rid of freckles can actually make melasma worse. Further, melasma tends to get worse overtime, especially if you’re not in the habit of smothering yourself in sunscreen. This is why it’s important to see a board certified dermatologist for a correct diagnosis. Often, the difference can only be detected by a Woods Lamp, that blue light the dermatologist scans your body with during skin checks.
Until you get to your dermatologist though, here are the crib notes on what you need to know:
First, all freckles, age spots, brown spots left from acne and melasma fall under the dermatological umbrella of hyperpigmentation, which is doctor speak for spots of abnormal darkening of the skin caused by excess melanin. Too much sun plays a role in all hyperpigmentation, but hormones are the culprits with melasma, either from pregnancy, birth control pills or if you’re in menopause hormone replacement therapy (HRT).
Freckles are small, brown flat dots. Most if the time they’re caused by both genes and too much sun. On the upside, these are pretty easy to treat because they’re closer to the surface of the dermis. They’re more apt to look like evenly distributed sprinkles and if they bother you, they can be easily treated with lasers, peels, and some skin care products. Here are some examples of what freckles look like:
Melasma on the other hand looks like concentrated patches of brown that congregate around your cheeks, forehead, upper lip or jaw. While sunlight stimulates melasma, the root cause are the hormones mentioned above. Also, women with darker skin tones (Hispanic, African American, Latin, Asian, Mediterranean, Middle Eastern, Indian, etc) tend to be more vulnerable to melasma. Here’s what melasma looks like:
Treating melasma is tough because unlike the freckle, the pigment is down deeper into the dermis so a lot of the topical creams won’t reach it. But there is hope beginning with a trip to a board certified cosmetic dermatologist who has an arsenal of weapons to treat. Dr. Brandith Irwin of Skin Tour says:
“Sunscreens, hydroquinones, antioxidants, and other topicals are still the mainstay of treatments, often combined with light peels or microdermabrasion. Lasers often make melasma worse”.
Here are some of the treatment options you and your doctor might discuss:
- Sunscreen all the time. You can do this right now! I know that a big brimmed hat might cramp your style, but managing your melasma is serious business. This means religious application of sunscreen with zinc, titanium or mexoryl plus a coating of some of the mineral formulas on top of your make-up (Jane Iredale, Color Science and Peter Thomas Roth make nice formulas).
- Hydroquinone. Available over the counter at 2% or by prescription at 4%. The prescription brands on the radar are TriLuma, EpiQuin Micro, Solange and Lustra. However, there’s been some concern over the safety of hydroquinone and a potential link to cancer. In fact, in the US, TriLuma is indicated only for use 8 weeks at a time. Alternatives include Vitamin A, Vitamin C and kojic acid, but the trade-off is that they aren’t as targeted or effective.
- Series of light chemical peels and/or microdermabrasion. Theses can be a terrific solution that doesn’t require a lot of downtime and leaves your skin instantly glowy. But promise me you won’t be lured into the DIY versions off the internet or the med spa dangling a Groupon. Even though light peels and microdermabrasion are more superficial treatments, in the wrong hands they can scar and leave a mark, especially if you have darker or Asian skin.
- Deeper TCA peels. Dermatologists generally like TCA peels for more severe cases of melasma because of their effectiveness and long track record of good results. There’s some downtime involved (as in a few days of flaky redness like a sunburn), but the real watch out here is to make sure you’re being treated by a board certified dermatologist or plastic surgeon. Careless application can mean possible blistering or lifelong scarring.
- Fraxel laser. This is where only a board certified medical professional should be touching your face as some lasers make melasma worse. Fraxel however, is FDA approved for melasma, but only your doctor can tell you if this is the best treatment for your particular case. While Fraxel is effective, there is some downtime (think 2-4 days hiding from the general public) and it’s expensive at around $1000 each treatment, with most cases requiring anywhere from 2-6.
As for me, I’ve kept my melasma under control with a cocktail of sunscreen (I like Skin Ceuticals Total Fusion Physical Defense SPF 50), a wide brimmed Eric Javitz sunhat, sunglasses, prescription Retinol 1% during the winter and chemical peels every 6-8 weeks, alternating between Vitalize and Bx-Lift in the summer, and heavier peels like TCA or Vi Peel in the winter.
Coming up later this week, chemical peels in depth.
Do you have hyper-pigmentation of any kind, and if so where is it on your beauty pain scale and how do you treat it?
Sources and Related articles
- Melasma (American Academy of Dermatology)
- The Relationship Between Melasma and Freckles (Livestrong)
- Melasma Treatments (Real Self)
- Understanding Pigment Problems (Skin Tour)
- Melasma; Is It A Freckle? (SkinFitnessFacts)