Dark spots on your face don’t always mean the same thing. Two of the most common causes-melasma and sun damage-look similar but behave completely differently. One is triggered by hormones and light, the other by years of sun exposure. Treat one the same way as the other, and you could make it worse. If you’ve tried creams, lasers, or sunscreens without lasting results, you’re not alone. Most people don’t realize they’re treating the wrong problem.

What’s Really Causing Your Dark Patches?

Melasma shows up as large, blurry patches on the cheeks, forehead, or upper lip. It’s not just a sun spot. It’s a reaction to hormones, heat, and visible light-not just UV. Up to 90% of cases occur in women, especially during pregnancy, while on birth control, or after menopause. People with medium to dark skin tones (Fitzpatrick III-VI) are 3 to 5 times more likely to develop it. That’s why it’s so common in Black, Asian, and Hispanic populations.

Sun damage, or solar lentigines, looks different. These are small, crisp, brown spots on the nose, hands, shoulders, or chest. They show up slowly over time. By age 60, about 90% of fair-skinned people have them. They’re caused by direct UV exposure damaging melanocytes-the cells that make pigment. Unlike melasma, they don’t respond to hormones. They’re purely a result of accumulated sun exposure.

Here’s the key difference: melasma is a chronic condition. Sun damage is a visible sign of past harm. One can be managed. The other can be reversed.

Why Most Sunscreens Don’t Work for Melasma

You’ve probably been told to wear SPF 30 or higher. That’s good advice-for sunburn and skin cancer. But for melasma? It’s not enough.

Visible light (the blue and green wavelengths you see) and infrared heat can trigger melasma just as much as UV rays. Regular sunscreens block UV but let most visible light through. That’s why many people with melasma still get worse-even with sunscreen.

Studies show visible light contributes to 25-30% of melasma cases. The solution? Mineral sunscreens with iron oxides. Zinc oxide and titanium dioxide block UV, but iron oxides block visible light. Look for tinted sunscreens labeled “broad-spectrum with iron oxide.” They’re not just for cosmetics-they’re medical-grade protection.

And don’t forget: UV and visible light come through windows. If you sit near a window at home or in your car, you’re still exposed. Daily SPF 50+ with iron oxide isn’t optional-it’s the foundation of every successful melasma treatment.

Topical Treatments: What Actually Works

Not all creams are created equal. Here’s what dermatologists use for each condition:

• Hydroquinone (4%): The gold standard for melasma. It blocks the enzyme that makes melanin. Used alone, it helps about 30% of people. But when combined with tretinoin and a corticosteroid (a triple combo), improvement jumps to 50-70% in 12 weeks. Limit use to 3 months at a time-longer increases the risk of ochronosis, a rare but permanent darkening.
• Tretinoin (0.025-0.1%): This retinoid speeds up skin cell turnover. It doesn’t lighten pigment directly, but it helps flush it out. Use it every other night to avoid irritation. Start low-your skin needs time to adjust.
• Vitamin C (10-20% L-ascorbic acid): A powerful antioxidant. It reduces existing melanin and stops new pigment from forming. Use it in the morning under sunscreen. It also helps protect against pollution and blue light.
• Tranexamic acid (5%): An emerging option. Originally a blood thinner, it’s now used topically to block signals that trigger melanin production. Studies show 45% improvement in melasma after 12 weeks with no major side effects.
• Kojic acid, niacinamide, azelaic acid: Good alternatives if you can’t use hydroquinone. Niacinamide (5%) reduces pigment transfer to skin cells. Azelaic acid (15-20%) works well for both melasma and post-inflammatory spots.

For sun damage? Hydroquinone helps, but it’s not the best. Lasers work faster and more predictably.

Laser and Light Therapies: When to Use Them

IPL (Intense Pulsed Light) is great for sun spots. It targets brown pigment with light energy. The spots darken, then flake off in 3-5 days. Most people need 1-2 sessions. Results last years-if you keep wearing sunscreen.

But IPL is dangerous for melasma. Heat from the light can trigger more pigment. Up to 40% of melasma patients get worse after IPL. Dermatologists won’t even consider it until the skin has been suppressed with topical treatment for 8-12 weeks. That’s called a “melanocyte rest.”

For melasma, safer options include low-energy Q-switched lasers, fractional non-ablative lasers, or chemical peels (like glycolic or lactic acid). But even these require caution. Darker skin types (Fitzpatrick IV-VI) have a higher risk of post-inflammatory hyperpigmentation from any procedure. That’s why 40% of hyperpigmentation cases are in these skin tones-and why treatment must be personalized.

Why Melasma Comes Back-Even After Success

If your melasma improved but returned after a few months, you’re not failing. You’re normal.

Studies show over 80% of melasma patients relapse within a year if they stop treatment. That’s because the triggers-hormones, light, heat-are always there. Melasma isn’t cured. It’s managed.

Think of it like high blood pressure. You don’t stop taking the pill just because your numbers are normal. Same here. Maintenance is non-negotiable.

Successful long-term control means:

• Daily SPF 50+ with iron oxide (even indoors)
• Evening use of tretinoin or tranexamic acid
• Occasional chemical peels every 3-6 months
• Avoiding heat: hot yoga, saunas, steam rooms
• Replacing hormonal birth control if possible

And here’s the hard truth: 65% of patients don’t use their prescriptions consistently. They skip days. They use too little sunscreen. They think “I’m indoors, so I’m safe.” That’s why most treatments fail-not because they don’t work, but because they’re not used right.

What Not to Do

Here are the biggest mistakes people make:

• Using hydroquinone for more than 3 months straight-risk of ochronosis increases.
• Starting lasers without pre-treating melasma first-can make it worse.
• Using chemical peels on dark skin without a dermatologist-high risk of PIH.
• Believing OTC creams (like “brightening” serums) will fix melasma-they rarely do.
• Skipping sunscreen on cloudy days-up to 80% of UV penetrates clouds.

And don’t assume all dark spots are the same. Post-inflammatory hyperpigmentation (PIH) from acne or eczema looks similar but appears where there was inflammation-not necessarily sun-exposed areas. It responds poorly to lasers and needs different topicals like azelaic acid or niacinamide.

The Future of Treatment

Research is moving fast. Cysteamine cream (10%) showed 60% improvement in melasma with minimal irritation in recent trials. Tranexamic acid pills are now being studied for severe cases. Some dermatologists are testing genetic tests to predict who responds best to which treatment.

But the biggest breakthrough isn’t a new cream-it’s awareness. More people now know that sunscreen isn’t optional for melasma. More dermatologists are prescribing triple combos upfront. More patients are learning that consistency beats quick fixes.

The global market for hyperpigmentation treatments is growing fast-$12.7 billion in 2022 and climbing. But money doesn’t fix this. Knowledge does.

What to Do Today

If you’re dealing with dark spots:

1. Take a photo of your spots. Note where they are and when they appeared.
2. Check if they’re symmetrical (melasma) or scattered (sun damage).
3. Start using a mineral sunscreen with iron oxide every morning. Use a quarter teaspoon for your face.
4. Stop using harsh scrubs or DIY remedies. They irritate and worsen pigmentation.
5. See a dermatologist. Don’t wait. The sooner you get the right diagnosis, the sooner you’ll see results.

There’s no magic bullet. But with the right approach, melasma can fade. Sun damage can vanish. And you don’t need to spend hundreds a month to make progress. Just be consistent. Be patient. And protect your skin like your life depends on it-because for your skin, it does.