Freckles or Melasma. Can You Spot the Difference?

freckles, melasma, sun damage, hyperpigmentation

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:

Freckles Indian Woman

Freckles on african american woman

Red head with freckles

Freckles on asian woman

Freckles on caucasian woman

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?



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  • Reply
    January 28, 2013 at 7:56 PM

    My melasma cropped up with pregnancy too- unfortunately, in my case, I don’t think anyone would mistake it for freckles. If nothing else, I’ve certainly been much better about protecting my skin from the sun than I would have been had it not developed. I, too, love Dr. Irwin’s site and use many of the things she recommends- Retin-A and Skinceuticals sunscreen. Phloretic CF is supposed to help with hyperpigmentation too- I use it but I still have some areas on the apples of my cheeks from years of thinking a baseball cap would shield my skin and instead the sides of my face were fried- really dumb, I know, but I couldn’t bring myself to wear a big floppy hat in my 30’s and now I’m paying for it. I’m tempted by the fraxel. Dr. Irwin also recommends a Dermaquest sunscreen that comes in a tinted version like the physical fusion. Have you tried that? The other things I’m tempted by are the TNS and Neocutis lines with growth factors, but the more research I do, the more questions I have.

    • Reply
      January 29, 2013 at 6:23 AM

      Hi Amy – I’m sorry to hear about your melasma, it really sucks, I know! I also tried to skirt by with a baseball cap, but whamo-o, more melasma. Honestly, I only wear big floppy hat when I know I’m going to be in the sun all day, like at soccer games, the beach, walking all day long, but I hear you, it’s a style bitch:) I haven’t used Dermaquest, but if Dr. I recommends it, I would certainly try it. I used and liked Neocutis in the past, but not for sun, only for eyes and I’ve heard great things about TNS, but never tried it myself. One thing I forgot to mention is that everyday I use Skinceuticals C&E Ferulic which has been a lifesaver for aging and hyperpigmentation. I put it on under my moisturizer and sunscreen. There are two other formulas that are great for hyperpigmentation and those are Skinceuticals Floretin CF Gel and Floretin CF Serum (I use the C&E because my skin is dryer and a little sensitive).

      Aside from the Fraxel laser, have you tried professional chemical peels? I’ve never looked back since I started doing them almost 8 years ago.


  • Reply
    February 3, 2013 at 9:06 AM

    Hyperpigmentation is my enemy. While I have always had a problem with the brown spots left from acne, I noticed a very large brown overcast on my facial skin in my late twenties. It was someone else who pointed it out to me. It has mostly overtaken my face except for the area around my EYES which still has my natural skintone.

    It is very frustrating to treat this. However, I am very afraid of pointing a laser at my face and I have done laser hair removal (PAINFUL). I stay away from anything that indiscriminately kills pigment (HQ) but focus on those that gradually lift it). Differin is a topical retinoid that has been shown to treat melasma over time, which I use. I miss my old skintone but I have adjusted by wearing darker foundations so a rando can’t tell.

    • Reply
      February 6, 2013 at 10:48 PM

      You know it’s funny, I too didn’t really notice mine until someone else pointed it out (a derm of course). You’re right to be wary of lasers for melasma though. Fraxel is supposed to be helpful in some cases, but it’s still not a silver bullet. I haven’t tried Differin but will check it out.


  • Reply
    February 7, 2013 at 7:47 PM

    I experienced it shortly after taking the birth control pill in my late twenties. Even more unfortuanately, it was on my upper lip which made me look as if I had a mustache. Reason enough to get off the pill. I kept it under control with zinc sunscreen and, then, eventually, a few years after I had stopped the pill, it went away.

    • Reply
      February 10, 2013 at 11:22 AM

      I wiah birth control pills weren’t pushed so indiscriminately on women without a full disclosure of side effects. It’s like they are not a big deal.

  • Reply
    That Peelin' Feeling: 10 Things You Need to Know About Chemical Peels - NARCISSISTA.ME | NARCISSISTA.ME
    February 13, 2013 at 10:00 AM

    […] why; only your derm can tell the difference between a sun spot, a freckle, melasma or something more sinister, like skin cancer.  They’ll evaluate your Fitzpatrick skin type, […]

  • Reply
    Pabitra kumal
    July 14, 2015 at 4:52 PM

    Since I used antibaby pils i am suffering by malasma have around my chek ,around forehead it’s make me uncomfortable i hope this tretment tips help me out from malasma.

  • Reply
    November 20, 2015 at 9:32 AM

    […] plastic surgeon. Only a trained physician can effectively spot the difference between a sun spot, freckle, melasma, or even skin cancer. Your doctor must then determine the ideal combination of peel […]

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    David McIntyre
    March 4, 2016 at 1:58 PM

    I’m a Kiwi guy with slight facial malasma who finds any girl with freckles or malasma etc incredibly beautiful! Features over perfection anyday!

  • Reply
    Sobia younas
    October 27, 2016 at 10:48 AM

    Sir i also have melasma which is continously growing … i use cream Melaneez recomended by my physician but dont get of rid… please guide me wt to do

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