Not every brown patch is a sun spot. A lot of people who come in asking about "these spots" actually have melasma, or a mix of melasma and sun spots on the same face. From across the room they can look alike. Up close, and over time, they behave differently.
That difference shapes every conversation we have about pigment. Something that suits one isn't automatically a fit for the other. So before we talk about IPL, peels, or a home routine, we start with one question: what are we actually looking at?
The short version. Sun spots are usually small, distinct, and scattered where you've had the most sun. Melasma tends to show up as larger, blotchy patches, often on both sides of the face in a matching pattern, and it's tied to hormones as well as sun. Dermatology references caution that light treatments like IPL can make melasma relapse, so the two usually get very different conversations.
First, Get Anything New or Changing Checked
Before any cosmetic treatment, a spot that's new, growing, changing color or shape, raised, itchy, or bleeding should be looked at by a board-certified dermatologist. Some skin cancers can look like an ordinary brown spot at first glance, and that's not something a facial or a peel should be anywhere near. If we see anything during your consultation that we'd want a dermatologist to check first, we'll tell you plainly.
How to Tell Melasma From Sun Spots
Nobody can diagnose your skin from a blog post, us included. A dermatologist is the person who can tell you for sure. These are the general patterns, though, and they'll give you a sense of what to ask about.
| Sun spots | Melasma | |
|---|---|---|
| Look | Small, flat, tan to dark brown, with fairly clear edges | Larger patches with soft, irregular edges, from tan to grayish brown |
| Pattern | Scattered, often more on one side than the other | Often matching on both sides of the face |
| Where | Anywhere that gets sun: face, chest, shoulders, backs of hands | Usually cheeks, forehead, chin, and above the upper lip |
| When it shows up | After years of sun exposure | Often during pregnancy or after starting birth control pills |
| Over time | Fairly stable once they form | Can last for years, and often returns after time in the sun |
The American Academy of Dermatology describes melasma as tan, brown, or grayish brown patches that usually appear on the cheeks, forehead, chin, and even above the upper lip. It notes that many women first see it during pregnancy or when they start taking birth control pills.1 A brownish shadow above the lip, or a patch that showed up during a pregnancy and never fully left, is worth mentioning at your consultation.
Plenty of people have both. You might have a few distinct sun spots on your temples and a blotchy patch across your cheeks. That's common, and it's one reason we look at your whole face before suggesting anything.
What About "Hyperpigmentation"?
Hyperpigmentation is the umbrella term for any skin that's darker than the skin around it. Sun spots are one kind. Melasma is another. So are the dark marks a breakout can leave behind. When someone searches "hyperpigmentation treatment," they could mean any of these, which is why the first step is always figuring out which kind you have.
Why IPL Usually Isn't Where We Start With Melasma
IPL is a light-based service on our menu, and Amy performs it at our North Raleigh office. People usually ask about it for distinct brown spots and redness. Melasma is a different conversation.
DermNet, a dermatology reference written by dermatologists, notes that lasers and IPL carry a high risk of melasma relapsing and becoming harder to treat. It also cautions that peels and lasers carry a risk of worsening melasma or leaving darker marks behind.2 That's why, if there's a real chance your patches are melasma, we'll slow down, talk through the options with you, and sometimes suggest seeing a dermatologist first.
If your spots look like true sun spots, our post on IPL vs. chemical peels for sun spots walks through how people choose between the two.
What to Expect at a Pigment Consultation
Melasma is something people tend to manage over time rather than settle in one appointment. The AAD notes that treatments can't make melasma go away forever, and that it can come back.1 We say that up front so expectations stay realistic.
At your consultation, Amy will usually ask about:
- When it started. A patch that appeared during a pregnancy tells a different story than spots that showed up after a summer at the beach.
- Whether it changes with the seasons. Does it look darker in July than in January?
- Hormonal changes. Pregnancy, nursing, or hormonal birth control. Share only what you're comfortable with.
- What you use now. Your current skincare and any prescriptions. Tell us what you take, and never stop a prescribed medication without your prescriber.
- Your time outdoors. Weekend soccer games, lake days, a daily walk. It all counts.
From there, Amy will talk through which services on our menu might fit, such as a chemical peel or a facial, how they're spaced, and what downtime looks like. The Perfect Derma Peel, for example, is a medium-depth peel with three to five days of visible peeling. With pigment, pacing matters, so she starts conservatively. If something isn't a good fit for your skin, she'll tell you.
Sun Protection Comes First
The AAD notes that it's common for melasma to return when you spend time outdoors without protecting your skin from the sun.1 That's why sun protection comes up in every pigment conversation we have.
A few habits worth building:
- Wear a broad-spectrum sunscreen every day, including cloudy days and the winter months in Raleigh.
- Reapply when you're outside for a while. A morning coat won't last through a soccer game at the park or an afternoon on the patio.
- Pick a sunscreen you'll actually wear. Some people prefer a tinted mineral formula because it skips the white cast.
- Add a hat and shade on long days outside.
Your Home Routine
Amy is happy to look at what you're using now and talk through a simple routine, including how it fits around any in-office appointments. Our skin type quiz is one place to start if you're curious about your skin type. If you're pregnant, nursing, or using prescription skincare, tell us before starting anything new so we can plan around it.
Why Fall Is a Good Time to Ask
Melasma often looks darker after summer, so fall is when a lot of people finally ask about it. You're outdoors less, and it's an easier season to settle into a daily sun-protection habit before spring comes back around.
Not sure if it's melasma or sun spots? Amy will look at your skin, ask when the discoloration started, and talk through what she sees and what she'd suggest next, including whether a dermatologist visit should come first. Consultations are free at our Falls of Neuse Road office in North Raleigh.
For full details and current pricing, see our chemical peels in Raleigh, facials in Raleigh, and IPL photofacial pages.
Frequently Asked Questions
What's the difference between melasma and sun spots?
Sun spots are usually small, distinct brown spots scattered where you've had the most sun. Melasma tends to form larger, blotchy patches, often matching on both sides of the face, and it's linked to hormones as well as sun. A dermatologist can tell you for sure.
Is IPL a good idea for melasma?
It usually isn't where we start. DermNet notes that lasers and IPL carry a high risk of melasma relapsing and becoming harder to treat, so we'll talk through other options and may suggest seeing a dermatologist first.
Does melasma go away?
Sometimes. The AAD notes it may go away on its own, but it can also last for years and often comes back after time in the sun without protection.
Can you have melasma and sun spots at the same time?
Yes, and it's common. At your consultation, we'll look at which areas seem to be which and talk through options for each.
What should I do day to day if I think I have melasma?
Wear a broad-spectrum sunscreen every day, reapply when you're outside for a while, and add a hat and shade on long days outdoors. And mention it at your next dermatologist visit.
Should I see a dermatologist before treating dark spots?
If a spot is new, changing, raised, itchy, or bleeding, yes. Get it checked by a board-certified dermatologist before any cosmetic treatment. We'll also tell you if we see something during your consultation that should be looked at first.
Who handles pigment consultations at Oak City?
Amy, our licensed aesthetician, performs chemical peels, facials, and IPL at our office on Falls of Neuse Road in North Raleigh. Current pricing is on our chemical peels, facials, and IPL pages.
Sources
- American Academy of Dermatology. Melasma: Overview
- DermNet. Melasma (facial pigmentation)