2026-07-03
Melasma vs. Lentigo: The Biggest Differences
Learn the key differences between melasma and lentigo, their distinct characteristics, and why proper diagnosis and treatment order are crucial for clear skin.
✔ Melasma
Caused by UV rays, pregnancy, hormones, aging, etc.
Melanin pigment is deposited in the epidermis and dermis, appearing as uneven, varied spots.
The pigment is located deepest in the dermal layer, and the borders often appear blurred and indistinct to the naked eye.
Most common on the cheekbones and under the eyes / Most prevalent in women in their 30s and 40s.
Spreads symmetrically on both sides of the face.
Blurred borders.
Brown to grayish-brown tone.
Sensitive to sunlight, hormones, and skin irritation.
Prone to recurrence.
👉 The core issue is a weakened skin foundation rather than the pigment itself.
✔ Lentigo
Large spots commonly referred to as blemishes or age spots.
The surface is not raised; only the color is present.
Unlike melasma, the pigment is only in the epidermis, so it can be improved in 1-2 sessions with treatments that form scabs.
You must leave the scabs alone until they fall off naturally. If you pick at them, it will lead to scarring and hyperpigmentation! Managing with hydrocolloid patches for one to two weeks is essential.
Round and distinct borders.
Appears locally like a mole.
Dark brown to black.
Increases in number one by one as you age.
Fast response to laser treatments.
👉 The pigment cluster itself is the problem.
cf. Seborrheic Keratosis
Unlike lentigo, these spots have a raised surface.
Requires an ablative laser that can shave down the surface.
Seborrheic keratosis must be carefully differentiated from skin cancer!
The treatment approaches are completely different.
Core of Melasma Treatment
Removing only the pigment ❌
Building a strong skin foundation ⭕
Therefore,
👉 Stabilize the skin foundation with Thermage + collagen boosters,
👉 and then combine it with low-irritation pigment treatments.
This speeds up the process and reduces recurrence.
Core of Lentigo Treatment
Accurate target removal (scab-forming treatment using a 532nm laser).
Can be improved with just one or two laser sessions.
However,
for lentigo that appears on melasma-prone skin,
👉 irritation management is much more important than for typical lentigo.
The problem is ‘when lentigo is layered over melasma.’
In actual clinical practice,
✔ Melasma + Lentigo
✔ Lentigo that looks like melasma
✔ Melasma that looks like lentigo
It is mostly a mix of these conditions.
In this state,
if you only focus on the lentigo and use a strong laser,
👉 it can create a vicious cycle where the melasma becomes even darker.
That is why diagnosis and the order of treatment are important.
1️⃣ First, stabilize the melasma-prone skin.
2️⃣ After the skin foundation has recovered,
3️⃣ accurately remove the lentigo.
Following this order
will clear up your skin tone and lower the risk of recurrence.
Final Summary
Melasma and lentigo are ‘completely different pigments even if they look similar.’ Properly distinguishing them and following the correct treatment order will change the results.