Melasma & Dark Spots: Diagnosis and Treatment in Myeongdong & Jongno, Seoul

What causes melasma and dark spots?

Skin colour comes from melanin, made by pigment cells called melanocytes in the base of the epidermis. Dark spots appear when melanin is produced in excess in one area, when melanocytes cluster, or when pigment drops into the deeper dermis. The trigger and the depth determine how a mark looks and, more importantly, how it responds to treatment.

Melasma is thought to be a light-driven disorder in genetically predisposed people. UV, visible light and heat stimulate melanocytes; hormones such as oestrogen and progesterone add fuel, which is why melasma often starts in pregnancy (the 'mask of pregnancy') or with hormonal contraception. Around 60% of patients have family members with melasma. It is much more common in women and in medium skin tones, including many East Asian, South Asian, Middle Eastern and Latin American patients.

Other dark spots have simpler stories. Solar lentigines (sun or age spots) are flat, well-defined brown marks caused by years of UV. Freckles are small, genetically determined spots that darken in summer. Post-inflammatory hyperpigmentation (PIH) is the brown mark left behind after acne, eczema, burns or an over-aggressive treatment, and it is especially common in darker skin.

How a doctor tells melasma apart from other dark spots

Many visitors arrive with several types of pigment on the same face: melasma across the cheeks, a few sun spots near the temples and some post-acne marks on the jaw. Each needs a different setting, so diagnosis comes first. Your doctor examines the pattern, colour and edges, uses dermoscopy to look below the surface, and reviews Mark-Vu skin analysis images that separate surface pigment from deeper brown and highlight UV damage that is not yet visible.

A Wood's lamp can help classify melasma: epidermal pigment looks more obvious under it, dermal pigment does not. A biopsy is rarely needed but may be suggested if a lesion is unusual. The table below shows the look-alikes our doctors consider most often.

• Hyperpigmentation
• Skin Whitening
• Acne & Breakouts

Which skin layers are involved

Most freckles, sun spots and many cases of melasma sit mainly in the epidermis, within roughly a tenth of a millimetre of the surface. Pigment here can be shed as the skin renews and responds to topical treatment and lasers relatively quickly. That is why a typical sun spot often clears after one or two targeted sessions.

In dermal and mixed melasma, melanin has dropped below the epidermis into the dermis, where it is taken up by scavenger cells and cleared slowly. Research also suggests that melasma skin shows changes in small blood vessels and the basement membrane, and signs of chronic light damage, which may explain why it keeps coming back. Deeper pigment such as Hori's naevus needs higher energy aimed deeper, but with careful spacing to avoid post-inflammatory darkening.

The figure below summarises how a pigment assessment and plan typically run. Session counts are guides; your doctor adjusts them to how your skin responds.

Treatment options for melasma and dark spots compared

Melasma is managed rather than cured. Dermatology guidance from the AAD and DermNet places sun protection and topical treatment first: a combination of hydroquinone, a retinoid and a mild steroid is among the most successful regimens, with tranexamic acid (cream or tablets) used when others are not enough. Laser and light treatments can improve results when combined with these, but the AAD stresses that they should be performed by experienced doctors.

In Korea, low-fluence Q-switched Nd:YAG and picosecond laser toning are widely used for melasma in Asian skin. Studies show useful improvement over a series, but also highlight relapse after stopping and, if energy or frequency is too high, mottled white spots (hypopigmentation) or rebound darkening. Our doctors therefore use conservative settings, space sessions thoughtfully and combine toning with home care rather than relying on the laser alone.

• Hyperpigmentation
• Pico Fraxel
• Skin Whitening
• Lip Brightening

Is it melasma, or a spot to check first?

Melasma and sun spots are harmless, but some skin cancers, including melanoma, can start as a brown mark. Any spot that is new and growing, changes shape or colour, has irregular edges, bleeds or does not heal should be examined before cosmetic treatment. Lasers must never be used on a lesion that has not been assessed, because they can mask warning signs.

Some pigment has medical causes, such as certain medicines, thyroid problems or, rarely, adrenal conditions that cause general darkening with tiredness and low blood pressure. If your dark patches came with other symptoms, or after starting a new medicine, tell us. We may suggest blood tests at home or referral to a dermatologist or endocrinologist.

How Obliv plans a pigment treatment

Our Skin Architecture approach treats pigment by type and depth. The doctor marks melasma zones, discrete sun spots and post-inflammatory marks on a face map. Melasma zones receive low-energy laser toning; isolated sun spots outside those zones can receive a targeted pico or Q-switched pulse; texture with scattered pigment may suit Pico Fraxel later.

Home care is half the plan. We set up a routine with a tinted mineral sunscreen containing iron oxides, which also blocks visible light, and, where appropriate, a brightening cream or oral tranexamic acid prescribed after checking your history. Patients with a history of blood clots, some heart conditions or who are pregnant are not prescribed tranexamic acid tablets.

Every setting and every photo is stored in your Skin Library, which is particularly useful for melasma: if a session leads to darkening, the next doctor knows exactly which energy and interval to avoid. For dark lips or a dull overall tone, related programmes include lip brightening and our skin brightening plan.

A typical treatment plan and timeline

Pigment treatment rewards patience. The AAD notes that melasma results usually take three to twelve months. Toning sessions are typically one to two weeks apart, and the most visible change often comes in the second and third month. Sun spots treated with a targeted laser darken, form tiny scabs and flake off within about a week, leaving pink skin that settles over a few weeks.

Short-stay visitors can usually have the assessment, a first toning session and any sun-spot treatment during one trip, then continue creams at home. Our guide can pigmentation be treated in three days? explains what is realistic, and the best season for pigmentation laser in Seoul covers timing.

Home care for melasma and dark spots

Sun protection is not optional with melasma. UV and visible light can darken existing patches within days and trigger new ones, and most relapses happen in summer. Use a broad-spectrum sunscreen of SPF 30 or higher (SPF 50 in Seoul's summer) every morning, reapply during outdoor days, and add a wide-brimmed hat and shade. Tinted sunscreens with iron oxides add protection against visible light.

Be gentle. Rubbing, scrubbing, waxing the face and harsh peels inflame the skin and can deepen pigment, especially in darker skin tones. Heat matters too: saunas and hot yoga worsen melasma for some people.

• Tinted mineral sunscreen with iron oxides, SPF 30–50, every day, even indoors near windows.
• Brightening ingredients such as azelaic acid, niacinamide or vitamin C if your doctor agrees.
• Avoid perfumed products on the face, which can cause phototoxic pigment.
• Do not pick acne spots; treat breakouts early to prevent post-inflammatory marks.
• Discuss hormonal contraception with your own doctor if melasma started with it.

• Korean Laser for Asian Pigmentation in Seoul
• Hyperpigmentation After Acne Treatment Korea

Pigment treatment for travellers in Seoul

Laser toning has almost no downtime, so it fits easily between shopping in Myeongdong and sightseeing around Jongno. Spot treatments leave small dark scabs for about a week, which can be covered with a patch or make-up after the first day. If you are heading to a beach holiday after Seoul, consider treating spots at the end of the season instead.

Before you travel, send photos taken in daylight without make-up and a list of the creams you use. If you are pregnant or breastfeeding, tell us: some medicines are avoided, and many doctors prefer to wait, because pregnancy melasma often fades after delivery. Read melasma treatment near Myeongdong shopping street and dark spot removal during a Korea vacation for more planning tips.

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• Prices & Payment

When to see a dermatologist or another specialist

Any suspicious or changing spot belongs with a dermatologist for examination and, if needed, a biopsy. Pigment that appears together with general symptoms needs a medical work-up. Very extensive dermal melasma that has not responded to months of combined care may need specialist medical dermatology review, sometimes with newer oral treatments.

For most people, though, a careful, combined plan brings clearly more even skin. The key is honest expectations: melasma can be calmed and kept faint, but it is a chronic tendency that needs ongoing protection. Treatment cost depends on the number of sessions and areas; see prices and payment.

Frequently asked questions

Related treatments and guides

From the Obliv Skin Journal

• Melasma Treatment Near Myeongdong Shopping Street
• Korean Laser for Asian Pigmentation in Seoul
• Best Season for Pigmentation Laser in Seoul
• Can Pigmentation Be Treated in Three Days?
• Best Laser for Sun Spots in Myeongdong
• Pigmentation Packages for Tourists

Sources and further reading

1. American Academy of Dermatology – Melasma: Diagnosis and treatment
2. DermNet – Melasma
3. Cleveland Clinic – Melasma: Treatment, Causes & Prevention
4. The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review (PMC)