The Differences Between Melasma, Sun Spots, and Other Skin Spots
What's that brown spot? Here's how to ID your skin markings and know when they require a visit to a dermatologist.
Brown spots on our skin
It's not uncommon to have mysterious brown spots on your skin. In some cases you can be born with them or develop them through the years. Still, it's important to be on top of all of your skin markings so you can determine whether they're pregnancy-related melasma, sun spots, or possibly a sign of skin cancer. We asked top dermatologists to give us the 411 on the most common splotches to monitor on your skin in between checkups.
Caused by (you guessed it) exposure to the sun, these brown spots usually look like freckles. However, they tend to be larger. "After time in the sun, our cells' melanin production goes into overdrive trying to combat UV/UB damage," explains Dendy Engelman, MD, a dermatologist and cosmetic surgeon based in New York, NY. "When a cell overproduces melanin, it causes the area to look darker, thus forming a sun spot." The first step in treating sun spots starts with prevention. The Centers for Disease Control and Prevention (CDC) recommends simple skin-saving steps like spending more time in the shade and wearing a wide-brimmed hat. You should also use a broad-spectrum sunscreen with SPF 50 or more. Chemical peels or lasers at your dermatologist's office may also help fade the spots.
Most of us have at least one or two moles, which can vary in size and shape. "Moles can range from a birthmark to a growth that can either be completely benign or ranging from benign to malignant (cancerous)," explains Joel Schlessinger, MD, a dermatologist in Omaha, NE. There is no surefire way to determine the status of moles without visiting a dermatologist, but many recommend using the ABCDE rule. Moles that are a cause for concern are typically asymmetric and have irregular borders, Dr. Schlessinger notes. They also tend to be dark in color or larger than the size of a pencil eraser in diameter. Finally, he explains that another red flag is a mole that's evolving, or changing in some way. Treatment will depend on the area and whether or not the mole tests as benign or malignant. "Often, a dermatologist will biopsy or remove a mole if there are any concerns."
Melasma is the result of hormonal changes within your body. According to the American Academy of Dermatology, when it is caused by pregnancy, it's referred to as "the mask of pregnancy." This is because of the rather large splotches or areas of darker pigmentation that crop up on the face (typically the forehead), nose bridge, and chin. "Generally, it appears in women in their 20s, but can appear at any age and affect men as well," says Dr. Schlessinger. In fact, information published in a 2018 issue of The Journal of Clinical and Aesthetic Dermatology explains that melasma in men is common and is usually visible on their cheeks. If you're concerned about your melasma, make an appointment with your dermatologist. There, you can get a treatment plan that suits your skin-care needs.
You're probably the most familiar with this type of brown spot. It usually shows up at birth or develops within the first few weeks of life. Dr. Schlessinger explains that birthmarks are a collective term that includes a range of spots. For example, they may be moles or vascular growths like port wine stains or hemangiomas. Birthmarks may also be congenital nevi, which are larger, more serious moles. Treatment depends on the type. Port wine stains, for example, can be treated with a laser, while hemangiomas can be treated with either a drug called propranolol, or rarely, steroids. Darker spots, such as nevi or congenital nevi, are treated depending on the area, size, color, and family history. If you're not sure whether a mark is a birthmark or mole, ask your dermatologist at your next checkup. Dr. Schlessinger adds that moles which are present at birth can become concerning when there are changes over time. Therefore, he says it's important to observe and even photograph which ones are present at birth (or shortly thereafter). This helps provide accurate documentation.
Many people consider freckles to be a natural skin variation. However, these tiny spots are as worth observing as melasma, birthmarks, or other skin markings. "Freckles are most commonly found on children and teens, likely because of their high degree of sun exposure, and they tend to crop up on sun-exposed areas of the face, decolletage, shoulders, and body," explains Lara Devgan, MD, a plastic and reconstructive surgeon based in New York, NY. While freckles are usually harmless, they can become precancerous when exposed to too much sun. If you are trying to get rid of existing freckles, Dr. Devgan recommends starting with topical skin products, specifically retinoid creams and high-potency vitamin C serum. "Lasers can also help, but a medical grade skin-care regimen is both less invasive and less expensive, so that would be my first line approach."
Similar to freckles, age spots appear on sun-exposed skin as a result of age plus UVB exposure. Often called "liver spots," Dr. Devgan points out that they actually have no relationship to the abdominal organ. "Age spots are generally benign, but because of their variable appearance, they can sometimes make skin cancers more challenging to detect," she says. "Treatment options for age spots include topical hydroquinone, azelaic acid, vitamin C, and retinoids." Dr. Devgan adds that more invasive options like laser therapy and cryosurgery can also work. The best way to treat age spots is to do your best to avoid getting them in the first place. Do this by minimizing sun exposure and always wearing a high-quality sunscreen; here's how dermatologists treat age spots.
This skin disorder is the exact opposite of most skin spots. Vitiligo is not brown, but rather white, or lacking in pigment. It is more common in young individuals, but it can appear at almost any age; here's the deal with those white spots on your skin. Usually, it appears on areas of the hands, feet, and face first. "There aren't many lookalikes to this condition, though some conditions such as a fungus infection can mimic it," explains Dr. Schlessinger. "If there are spots that range from a half-inch to an inch or so and don't have pigment, this is likely to be the cause." While there are many treatments available, most do very little to truly treat the problem. Lasers such as excimer can help.
- Dendy Engelman, MD, dermatologist and cosmetic surgeon at Medical Dermatology & Cosmetic Surgery, New York, NY.
- American Academy of Dermatology:"Melasma: Overview."
- Joel Schlessinger, MD, dermatologist in Omaha, NE.
- Lara Devgan, MD, plastic and reconstructive surgeon, New York, NY.
- The Journal of Clinical and Aesthetic Dermatology: "Melasma in Men: A Review of Clinical, Etiological, and Management Issues."
- Centers for Disease Control and Prevention: "#SunSafeSelfie."