When dark spots start to appear on your face in the mirror, it's natural to become concerned. The first question that usually comes to mind is, "Is this melasma, seborrheic keratosis, or lentigo?" Facial pigmentary disorders are not just one type but are divided into several kinds, each with slightly different locations and patterns of occurrence. Accurately distinguishing what they are is the starting point of treatment.
Pigmentary disorders, once they appear, are reported to frequently recur and tend to darken over time. Furthermore, it's not uncommon for melasma, lentigo, and seborrheic keratosis to appear mixed on one person's face, making self-diagnosis difficult. In this article, we will systematically outline the characteristics and differences of easily confused pigmentary disorders, as well as the laser methods used for their treatment.
Why is it important to accurately distinguish pigmentary disorders?
Many people vaguely consider dark spots on their face to be just melasma or freckles. However, the range of pigmentary troubles is wider than expected, and their location and shape vary slightly. To treat them safely, it's crucial to first understand these characteristics.
There are cases where what was thought to be melasma turns out to be another condition after visiting the clinic, and even for the same pigmentary issue, the treatment method may vary depending on its state. Therefore, accurately examining the lesion's pattern is necessary before self-diagnosis.
The criteria we look at when distinguishing common pigmentary disorders are as follows:
- Whether they spread symmetrically on both sides or appear only on one side
- Whether the borders are blurry or distinct
- Whether the surface is flat or slightly raised
- Whether the affected areas are concentrated on exposed parts of the body
Why does lentigo occur?
Lentigo mostly occurs due to the influence of sunlight and UV rays. Therefore, it is prone to appear on frequently exposed areas such as the face, cheekbones, cheeks, as well as the back of the hands and shins. Another characteristic is its strong association with aging, with incidence increasing with age.
However, it does not mean that it never appears in young people in their 20s and 30s, so it is advisable to prepare in advance with thorough skin care, including UV protection.
How do melasma, lentigo, and seborrheic keratosis differ?
Although these three pigmentary disorders may appear similar, a closer look reveals distinguishing characteristics. The key differences are summarized in the table below.
| Category | Melasma | Lentigo | Seborrheic Keratosis |
|---|---|---|---|
| Symmetry | Tends to be symmetrical on both sides | Tends to appear on one side | Various areas |
| Border | Blurry and broad | Relatively distinct | Relatively distinct |
| Surface | Flat | Flat | Thick and raised to the touch |
| Size | Spreads broadly | Approx. 1cm in diameter, over 2cm in large cases | Gradually grows from a spot |
Melasma typically tends to appear symmetrically on both sides. It is characterized by a blurry, broad distribution, spreading like spilled ink, and in some patients, it may appear net-like.
Lentigo is distinguished by its higher tendency to appear only on one side. Compared to melasma, its borders are distinct, and it can appear as coin-sized spots, about 1cm in diameter, or over 2cm in larger cases. Seborrheic keratosis is characterized by a slightly raised form. When touched, the lesion feels thick and elevated, distinguishing it from flat melasma or lentigo. If melasma and blemishes are mixed, forming widespread melasma, blemishes, and hyperpigmentation, the approach will be different.
If you are confused about which form of pigmentary disorder you have, you can easily check by asking about pigment, seborrheic keratosis concerns via chat.
Mishandling can make it darker
Pigmentary disorders usually appear as spots without significant pain, but if treated too aggressively when accompanied by inflammation, the color may darken or recur.
Treatments that cause irritation before accurate assessment can worsen the condition, so caution is needed.
In the consultation room, it's not uncommon for patients to visit after self-treating with strong irritation, only to find their pigmentation has become darker. Therefore, confirming the nature of the lesion is crucial before deciding on the treatment intensity and method.
Laser treatment generally falls into two categories
Laser treatment for pigmentation can broadly be divided into two methods.
The first is a low-energy approach, performed multiple times without creating scabs. It has the advantage of being less irritating, but because the energy is not strong, it has limitations in reaching deep pigmentation, and the increased number of sessions can be a drawback.
Conversely, there is also an approach that increases intensity. Previously, lentigo pigmentation was treated with IPL, Pico, or 755 nm wavelength lasers, which are well-suited for epidermal pigmentation. While relatively fast treatment is possible, the treated area can experience significant irritation, pain, or even new hyperpigmentation, requiring more diligent post-care.
RePott Laser gaining attention for lentigo treatment
Recently, the RePott Laser, used for lentigo treatment, has been attracting attention. It uses a strong wavelength to stimulate the lentigo area on the surface, forming a scab. After about two weeks, new skin grows underneath, the scab naturally falls off, and with it, the pigmentation is expected to lighten.
The RePott Laser utilizes strong wavelengths while simultaneously employing cooling technology. This protects the blood vessels in the treated area from excessive irritation while allowing a scab to form. It is reported to be a highly satisfying method due to reduced pain and minimized hyperpigmentation reactions. If epidermal pigmentation such as blemishes, seborrheic keratosis, or freckles are also present, epidermal pigment removal can be considered alongside.
Important management points to remember after treatment
For pigmentary disorders, post-treatment care is as crucial as the treatment itself in determining the outcome. Please ensure you follow these guidelines:
- Consistently use sunscreen daily.
- If a scab forms, do not forcibly remove it; let it fall off naturally.
- Avoid excessively rubbing or irritating the treated area.
- Maintain the skin barrier with sufficient moisturizing during the recovery period.
- If signs of recurrence appear, seek professional consultation rather than self-treating.
Aggressive treatment without sufficient consultation with a specialist can lead to recurrence, damage to healthy cells, and secondary pigmentation or scarring. To maintain the effects for a long time, it is advisable to continue post-care, including UV protection, after the procedure. If lesions such as moles or seborrheic keratosis are also present, Laser Lesion Removal can also be discussed during consultation.
In conclusion
Today, we've summarized the characteristics and distinctions of easily confused pigmentary disorders, as well as the laser methods used for their treatment. Pigmentary issues are common concerns for many, and treatment methods are becoming increasingly diverse. The important thing is to accurately understand the nature of your lesion and proceed safely after thorough consultation regarding the appropriate method and number of sessions for you.
If you're curious about the right method and number of sessions for your pigmentary disorder, inquire first through Melasma, Lentigo, Seborrheic Keratosis Laser Consultation before making a decision.
Author · Dr. Sang-Joo Lee, Chief Director | Dermatology Specialist As the chief director of Yonsei Star Dermatology Sinchon, he serves as the president of the Korean Dermatological Association in 2026 and has long treated pigmentation and scar conditions as an adjunct professor at the Department of Dermatology, Yonsei University College of Medicine. View Profile First Published 2024-12-30 · Last Reviewed 2026-07-23
This article provides general medical information, and the patterns of pigmentary disorders and treatment responses may vary depending on individual skin conditions. Please consult a dermatology specialist for an accurate diagnosis and treatment plan.