What are melasma and dark spots?
There are various types of facial dark spots, each with different causes, appearances, and treatments. It's common for people to mistake melasma for regular dark spots, or to find that their care routine isn't improving their condition, often due to these differences in type. Understanding the type of dark spot you have is the first step toward appropriate treatment.
Types of Dark Spots and How to Identify Them
| Type | Appearance/Characteristics | Main Causes | Common Age of Onset |
|---|---|---|---|
| Melasma | Light brown spots that spread symmetrically across both cheeks, forehead, and around the mouth | Hormonal imbalance, UV radiation, friction | Common in women in their 30s-50s |
| Solar lentigines (age spots) | Brown to black spots with clear borders | Accumulated UV exposure | 40s and older |
| Freckles (ephelides) | Small, scattered brown spots around the nose | Genetics, UV radiation | From childhood |
| Post-inflammatory hyperpigmentation (PIH) | Brown marks left after acne or injuries | Melanin deposition after skin inflammation | Any age |
| Seborrheic keratosis | Raised, brown to black spots | Aging, UV radiation | 50s and older |
Difference between Melasma and Dark Spots
Melasma differs from typical "dark spots" as it is a type of pigmentation strongly influenced by hormonal balance. It is characterized by symmetrical patches that spread across both cheeks, the forehead, and around the mouth, and tends to worsen during periods of significant hormonal fluctuations, such as oral contraceptive use, pregnancy, childbirth, and menopause.
How Melasma Differs from Common Dark Spots
| Comparison Item | Melasma | Solar Lentigines (common dark spots) |
|---|---|---|
| Distribution | Symmetrically spread | Often asymmetrical and scattered |
| Borders | Blurred | Relatively clear |
| Fluctuation | Worsens and improves with hormones, UV, and friction | Progressively darkens in one direction |
| Laser Treatment | May worsen (caution needed) | Often effective |
| Oral Medication | Tranexamic acid is effective | Limited efficacy |
Melasma may worsen with laser treatment
Laser treatment for melasma can sometimes worsen hyperpigmentation due to inflammatory reactions. If melasma is suspected, it is recommended to first try oral treatment with tranexamic acid.
Main Causes of Melasma and Dark Spots
UV Radiation
UV radiation is the biggest external factor promoting melanin production. UVA penetrates to the dermis, destroying collagen, while UVB activates epidermal melanocytes, leading to excessive melanin production. Daily use of sunscreen is the most important preventive measure.
Hormonal Imbalance
Female hormones (estrogen and progesterone) stimulate melanocytes and promote melanin production. Melasma tends to worsen during periods of hormonal fluctuation, such as pregnancy, childbirth, oral contraceptive use, and menopause.
Friction and Irritation
Aggressive rubbing during face washing, strong friction from cleansing, and habitually rubbing the face with a towel can worsen melasma. For those with melasma, minimizing friction during skincare is especially important.
Inflammation
After inflammation from acne, injuries, or atopic dermatitis, excessive melanin production can occur during the repair process, leading to persistent hyperpigmentation (PIH).
Treatments for Melasma and Dark Spots
Tranexamic Acid (Oral)
Tranexamic acid is the only oral medication with evidence for melasma treatment. Originally used as a hemostatic and anti-inflammatory drug, it has been found to improve dark spots and melasma by inhibiting the activity of plasmin, which promotes melanin production.
Melasma is often difficult to improve with topical medications alone, making oral tranexamic acid a cornerstone of treatment.
Topical Medications
| Drug | Action | Target |
|---|---|---|
| Hydroquinone (whitening topical agent) | Inhibits melanin production. High bleaching effect. | All types of dark spots, melasma |
| Retinoic acid (Vitamin A derivative) | Promotes skin cell turnover and expels pigmentation | Solar lentigines, post-inflammatory hyperpigmentation |
| Azelaic acid | Inhibits melanin production, anti-inflammatory effects | Acne scars, melasma |
Laser Treatment (Specialized Clinics)
Q-switched lasers and pico lasers are effective for solar lentigines and freckles. However, lasers can be counterproductive for melasma, so it is crucial for a doctor to confirm whether it is melasma before proceeding.
Chemical Peeling
Peeling with glycolic acid, salicylic acid, etc., promotes epidermal cell turnover and lightens pigmentation. For melasma, it is expected to be more effective when combined with tranexamic acid than when used alone.
About Tranexamic Acid (Transamin)
Mechanism of Action
Tranexamic acid inhibits the action of plasmin, which activates melanocytes (pigment cells), thereby suppressing excessive melanin production. It also has anti-inflammatory properties, making it beneficial for improving rough skin, redness, and post-inflammatory hyperpigmentation.
Expected Effects
- Improvement and prevention of melasma
- Improvement of dark spots and freckles
- Improvement of post-inflammatory hyperpigmentation (brown marks from acne scars)
- Suppression of rough skin and redness
- Improvement of skin quality through anti-inflammatory effects
How to Take
Take 1 tablet (500mg) three times a day (morning, noon, evening) with water, without breaking the tablet. If you forget to take a dose, take one dose as usual when you remember.
Time Until Effects Are Seen
| Period | Condition |
|---|---|
| 1-2 months | Many start to feel improvement in skin dullness and redness |
| 2-3 months | Start to notice changes in the lightness of melasma and dark spots |
| 3-6 months | Effects stabilize, clear improvement can be expected |
| 6 months or more | Continued use maintains effects and brings further improvement |
The effects of tranexamic acid are often only realized with continuous use, so we recommend continuing for at least 2 to 3 months.
About Side Effects
Tranexamic acid is a safe drug, but the following side effects may occur:
- Allergic reactions such as itching and rash
- Gastrointestinal symptoms such as loss of appetite, nausea, vomiting, diarrhea, and heartburn
Please consult us if symptoms are severe.
Who cannot take or needs caution when taking this medicine
- Individuals with a history of thrombosis (pulmonary embolism, deep vein thrombosis, etc.)
- Pregnant individuals (please consult your doctor before taking)
- Individuals with blood coagulation disorders
- Individuals with impaired kidney function (dose adjustment may be necessary)
Pricing Plans
| Plan | Quantity | Price |
|---|---|---|
| 1 Month (90 tablets) | Tranexamic Acid 500mg x 90 tablets | ¥2,400 |
| 3 Months (270 tablets) | Tranexamic Acid 500mg x 270 tablets | ¥6,840 |
| 6 Months (540 tablets) | Tranexamic Acid 500mg x 540 tablets | ¥12,960 |
| 12 Months (1080 tablets) | Tranexamic Acid 500mg x 1080 tablets | ¥24,480 |
Daily Care to Prevent Worsening Melasma and Dark Spots
Daily Sunscreen is Essential
UV radiation is the biggest factor that worsens melasma and dark spots. Even on cloudy days or indoors, UV rays are present, so daily sunscreen use is crucial. Choose a product with SPF30 or higher and PA++ or higher.
Minimize Friction
Rubbing hard during face washing, cleansing, or drying your face with a towel can worsen melasma. Wash gently with foam and just blot your face with a towel.
Choosing Skincare Products
- Serums containing vitamin C derivatives (melanin production inhibition)
- Contains niacinamide (suppresses pigment transfer)
- Contains retinol (promotes skin cell turnover)
- Non-comedogenic formula (to prevent hyperpigmentation from acne scars)
Prescription Process at Our Clinic
Step ① Provisional Payment & Pre-consultation Questionnaire
Select your desired plan and place your order. After ordering, please answer the questionnaire sent via LINE or email. Please provide information about the condition of your spots, any medications you are taking, and your medical history.
Step ② Online Consultation
A doctor will provide a prescription via video call. All you need is a smartphone or PC.
Step ③ Same-day Shipping (Earliest)
Orders with video consultations completed by 3:00 PM daily will be shipped the same day. Products are delivered in discreet packaging to protect your privacy.
Frequently Asked Questions
Q1. How do I distinguish between melasma and age spots?
A. Melasma is a light brown patch that spreads symmetrically across both cheeks, forehead, and around the mouth, characterized by fuzzy borders. It often worsens and improves with hormonal fluctuations, differing from common age spots (senile lentigines). If you find it difficult to distinguish, please consult us via online consultation.
Q2. How long does it take for tranexamic acid to show effects?
A. While there are individual differences, many people start to see changes within 2 to 3 months, and it takes 3 to 6 months for the effects to stabilize. Consistency is key.
Q3. Can lasers be used for melasma?
A. Applying lasers to melasma can sometimes worsen it due to inflammatory reactions. It is recommended to try oral tranexamic acid treatment first. If you wish to have laser treatment, be sure to have a doctor confirm whether it is melasma before proceeding.
Q4. I am on birth control pills; can I take tranexamic acid at the same time?
A. Combining birth control pills and tranexamic acid may increase the risk of thrombosis. Do not take them together on your own; always consult a doctor.
Q5. Is it effective for freckles?
A. Tranexamic acid can be expected to have some effect on freckles and post-inflammatory hyperpigmentation. However, for freckles with a strong genetic component, there are limitations, and laser treatment may be more effective in some cases.
Q6. How much does it cost?
A. It costs ¥2,400 per month, ¥6,840 for 3 months, ¥12,960 for 6 months, and ¥24,480 for 12 months. Longer plans offer better value. For more details, please check the pricing page.