Melasma vs. Hyperpigmentation: How to Tell the Difference, Treatment Options, and Can Tranexamic Acid Help?
目次
June 12, 2026
Difference between Melasma and Age Spots? Identification and Treatment — Can Oral Tranexamic Acid Help?
Learn to differentiate them correctly before incorrect treatment worsens them.
"My spots got worse after laser treatment, which I thought were just age spots." "My brown dullness on my cheeks won't go away even with whitening cosmetics." "Is this melasma or age spots? What's the difference?" — Melasma, commonly seen in women in their 30s and 40s, is often mistaken for regular age spots, and there are countless cases where incorrect treatment exacerbates the condition.
Melasma and common age spots (senile lentigines, solar lentigines) look very similar, yet their causes, aggravating factors, and appropriate treatments are completely different. In particular, it's important to know that "applying laser to melasma can worsen it," otherwise you may regret it.
In this article, a doctor from Mona Aoyama Clinic explains the differences between melasma and age spots, how to identify them, the effectiveness of oral tranexamic acid, and the correct treatment options.
- Online prescription for Tranexamic acid
- Consultations for melasma and age spots via LINE or web questionnaire
- Same-day prescription and shipping (for payments made by 4 PM)
Melasma and Age Spots (Senile Lentigines) — Comparison Table
| Comparison Item | Melasma | Age Spots (Senile Lentigines, Solar Lentigines) |
|---|---|---|
| Cause | Hormonal fluctuations (estrogen) + UV radiation. Female hormones stimulate melanocytes. | Accumulated damage from UV radiation (UV-A, UV-B). |
| Common Age | Women aged 30-50 (common during pregnancy or while on birth control pills) | From 30s onwards (increases with age). Affects both men and women. |
| Appearance | Brown dullness spreading symmetrically on both cheeks. Borders are somewhat unclear. | One to several brown spots. Borders are distinct. |
| Location | Both cheeks, forehead, around the mouth. Characteristically does not appear around the eyes. | Cheeks, forehead, back of hands, and all other sun-exposed areas. |
| Relationship with UV | Tends to worsen rapidly with UV exposure. | Gradually darkens with UV exposure. |
| Relationship with Friction | Worsens with friction (over-rubbing during face washing, massage). | Relatively less affected by friction. |
| Laser Treatment | Can worsen with regular lasers (low-power toning required). | Pico laser, Q-switched laser are effective. |
| Oral Treatment | Tranexamic acid is effective. | Oral treatment has limited effect (weak direct effect on age spots). |
⚠️ Applying lasers of normal intensity to melasma can cause worsening (post-inflammatory hyperpigmentation). Many people who say "my spots darkened after laser treatment, which I thought were just age spots" actually had melasma. Always choose treatment after a diagnosis by a doctor.
Identifying Melasma — Self-Check Points
- Appears symmetrically on both cheeks (if asymmetrical, likely age spots)
- No pigmentation around the eyes (melasma does not appear around the eyes)
- Borders are indistinct (age spots typically have relatively clear borders)
- Appeared or worsened during pregnancy, birth control use, or breastfeeding
- Visibly darkens in summer (period of increased UV)
- Worsens after vigorous face washing or massage
- You are a woman aged 30-50
💡 If several of the above characteristics apply, there is a high possibility of melasma. However, cases where melasma and common age spots coexist are also frequent, so the final diagnosis should be made by a doctor during consultation.
Aggravating Factors for Melasma — Why Summer Requires Special Attention
| Aggravating Factor | Countermeasure |
|---|---|
| UV radiation (biggest aggravating factor) | Use SPF50+・PA++++ sunscreen daily. Also use parasols and hats. |
| Friction (face washing, massage) | Wash gently by enveloping with foam. Do not rub with a towel. | Hormonal fluctuations (birth control, pregnancy) | Consult a doctor if it worsens while on birth control. |
| Lack of sleep, stress | Affects hormone balance. Lifestyle improvements are also important. |
| Inappropriate laser treatment | Choose a laser of appropriate power and type after being diagnosed with melasma. |
What is Oral Tranexamic Acid?
Tranexamic acid (generic name: tranexamic acid) is an oral medication for the treatment of melasma, which is covered by health insurance. Although originally used as a hemostatic agent, it has been found to inhibit melanin production in melasma by suppressing the action of plasmin, a substance that promotes melanin production.
| Item | Content |
|---|---|
| Generic Name | Tranexamic Acid |
| Main Effect | Inhibits and improves melanin production in melasma |
| Dosage/Frequency | Typically 250mg x 3 times a day (as directed by a doctor) |
| Time to Effect | Begins to fade in 1-3 months, clear improvement in 3-6 months |
| Effect on Age Spots | Weak direct effect on common age spots (senile lentigines) |
| Side Effects | Gastrointestinal symptoms (rare). Thrombosis risk (consult doctor if used with birth control pills) |
| Insurance Coverage | Covered by insurance for melasma (can also be prescribed for self-pay patients) |
Treatment for Melasma — Overview of Options
| Treatment Method | Effect | Characteristics |
|---|---|---|
| Oral Tranexamic Acid | ◎ Effective for melasma | Available via online prescription. Continuous use for 3-6 months is necessary. |
| Topical Hydroquinone | ◎ Melanin production inhibition | Representative topical whitening agent. Effects visible in 4-8 weeks. |
| Topical Retinoic Acid | ○ Promotes skin cell turnover | Often used in combination with hydroquinone. |
| Low-Power Toning Laser | ○ Laser treatment for melasma | Irradiated at a weaker power than regular spot lasers. Requires in-person visit. |
| Vitamin C IV Drip/Oral | △〜○ Antioxidant/whitening effect | As a supplementary treatment. |
Mona Aoyama Clinic offers online prescriptions for oral Tranexamic acid and topical hydroquinone. While laser treatment requires an in-person visit, please consult us online if you wish to start with oral/topical treatments.
Frequently Asked Questions
During an online consultation, we can make an initial assessment based on photos you send. If you have brown dullness appearing symmetrically on both cheeks, avoiding the area around the eyes, it is highly likely to be melasma. For an accurate diagnosis, please confirm with a medical examination.
It often takes 3-6 months to see results, and continued use is recommended for maintenance even after improvement. Stopping may lead to recurrence. It is important to combine it with sun protection and lifestyle improvements.
Tranexamic acid has a blood coagulation promoting effect, which may increase the risk of thrombosis. If you are taking birth control pills, please be sure to inform us during your online consultation. We will determine the feasibility of prescription based on your situation.
There is almost no direct effect on common age spots (senile lentigines). Laser treatment and hydroquinone are effective for age spots. It is crucial to first determine whether it is melasma or age spots.
Thorough sun protection is paramount. In addition to using SPF50+ sunscreen, parasols, and hats, continuing oral Tranexamic acid can minimize worsening. Summer is a crucial time for continuous treatment.
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| Clinic Name | Mona Aoyama Clinic |
| Consultation Type | Online Consultation (Nationwide Coverage) / In-person Consultation (Tokyo, Aoyama) |
| Location | 〒107-0062 D Building 3F, 1-10-3 Minami Aoyama, Minato-ku, Tokyo |
| Nearest Station | 5-minute walk from Tokyo Metro "Aoyama-itchome Station" |
| Online Consultation | 24-hour reception・Same-day shipping available (for payments made by 4 PM) |
For Melasma and Tranexamic Acid Prescription, Visit Mona Aoyama Clinic
Online consultations are available nationwide. Send photos for examination and receive same-day prescriptions.