Melasma vs. Sun Spots: Why Treating Them the Same Is a Mistake

An esthetician’s guide to understanding two very different forms of hyperpigmentation

Pigment is never one-size-fits-all. And when it comes to melasma vs. sun spots, treating them the same way can do more harm than good.

These two conditions may appear similar at first glance, but their causes, behavior, and treatment strategies are completely different. As skin professionals, knowing how to tell them apart is key to delivering better outcomes and avoiding unintended setbacks.

What Are Sun Spots?

Solar lentigines are the clinical term for what most clients (and even many pros) call sun spots, age spots, or liver spots.

They’re a form of localized hyperpigmentation caused by chronic UV exposure, typically showing up on sun-exposed areas like the cheeks, hands, chest, and shoulders.

For simplicity, we’ll refer to them as sunspots throughout the rest of this blog.

Sun spots are usually:

• Well-defined with clear edges

• Varying in size and intensity depending on sun history

• More responsive to peels, IPL, and laser when properly selected

• Easier to manage with brightening ingredients and consistent SPF use

What Is Melasma?

Melasma is a chronic pigment disorder that often appears as symmetrical patches on the cheeks, upper lip, and forehead.

Unlike sun spots, melasma:

• Has irregular, blurry borders

• It can involve both the epidermis and dermis

• It is triggered by hormones, heat, visible light, and sometimes medications

• It is more common in women, especially Fitzpatrick skin types III–VI

• Tends to relapse and requires long-term management

Melasma is frustrating because it’s:

• Highly reactive

• Easily worsened by the wrong treatments

• Often unpredictable due to hormonal influence

Side-by-Side Comparison

Feature	Sun Spots	Melasma
Clinical Term	Solar Lentigines	Melasma
Triggers	UV exposure	UV, visible light, heat, hormones, and inflammation
Appearance	Small, defined dark spots	Diffuse, symmetrical patches with soft borders
Location	Cheeks, hands, chest	Forehead, cheeks, upper lip
Response to Laser/IPL	Good	Often worsens
Client Type	Any age, cumulative sun damage	Primarily women, hormonally influenced
Treatability	Straightforward with peels and light-based treatments	Complex, requires long-term pigment control and lifestyle awareness

Why Lasers Aren’t Always the Answer

Sun spots typically respond well to laser and IPL when properly indicated. But melasma? That’s a different story.

Because melasma is triggered by heat and inflammation, laser and light treatments can temporarily fade pigment but cause rebound or worsening in the long term.

Even red light therapy, while incredible for many skin conditions, can overstimulate melasma in sensitive clients due to light and heat exposure.

Tinted SPF: A Non-Negotiable for Melasma

Not all sunscreen is created equal - especially when treating melasma.

Visible light (including blue light and LED exposure) can stimulate melanogenesis, particularly in deeper skin tones. That’s why tinted sunscreens with iron oxides are essential for melasma clients.

For sun spots and other forms of hyperpigmentation, non-tinted broad-spectrum SPF may be sufficient.But with melasma, tinted SPF is a daily must - no exceptions.

Pre-Treatment is Critical for Fitz 4–6 (and Melasma)

Before starting microneedling, chemical peels, or any advanced pigment revision on melanin-rich skin, you must pre-treat with melanin inhibitors.

This is especially important for:

• Melasma

• PIH-prone skin

• Fitzpatrick IV–VI clients

Look for ingredients like:

• Arbutin

• Vitamin C

• Mushroom extract

• Tranexamic acid

• Azelaic acid (if tolerated)

• NAD+ – supports repair and reduces inflammation

Pre-treating for 2–4 weeks helps reduce PIH risk, calm melanocytes, and create a safer canvas for treatment.

When Prescription Support Is Needed

In moderate to severe cases of melasma, especially when dermal pigment is present, prescription treatment may be necessary to calm melanocyte activity before esthetic treatments can be effective.

Common prescription options include:

• Hydroquinone – a tyrosinase inhibitor used to suppress melanin production

• Tretinoin – supports cell turnover and enhances ingredient penetration

• Triple combination creams – often include hydroquinone, tretinoin, and a corticosteroid

• Oral tranexamic acid – an off-label option that helps reduce vascular and inflammatory triggers internally

These are very different from non-prescription options, which work more gradually and gently. Prescription interventions tend to act more aggressively and require medical oversight, while professional skincare options are ideal for prepping, maintaining, and managing pigment over time.

Yes, I said hydroquinone.

And yes - I know it’s a controversial ingredient.

This is just for educational purposes, not a recommendation (or a fight in the comments).

I’m not here to debate it, I’m here to keep estheticians informed.

When in Doubt, Refer Out

If you’re dealing with stubborn or recurring melasma, or suspect there’s an underlying trigger like medication or hormonal imbalance, always consider referring the client to a dermatologist.

Working alongside your client’s physician not only supports safer outcomes, it positions you as a credible, collaborative professional.

Final Thoughts: Treat the Condition, Not Just the Color

With sun spots, the approach can be more direct.With melasma, it’s about managing, not erasing, and setting the right expectations from the start.

Know what you’re looking at, plan accordingly, and when necessary, we we partner with your client’s medical provider. That’s how estheticians lead with skill, safety, and confidence.

Want to feel more confident treating all types of pigmentation? Let’s connect.

Follow me on Instagram @slateandserum for real-world education, skin science, and practical tools for estheticians and skincare pros. 

At Slate and Serum, we’re creating a space where pros can grow with confidence, clarity, and evidence-based knowledge that supports real results.

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About the Author 

Karla Pelaez-Barrick is a licensed aesthetic professional, educator, and skincare innovator with over 20 years of experience in the health and beauty industry. Known for her expertise in advanced skin revision techniques, she is dedicated to helping fellow professionals elevate their practice through science-backed treatments and ongoing education. Her work bridges clinical insight with practical application, empowering estheticians to deliver results-driven care with confidence.