Taula de Continguts
Melasma, sun spots and redness can look the same in the mirror, but they are different problems and are not treated the same way: melasma is a chronic pigmentation that can worsen with some treatments, a solar lentigo is a well-defined spot linked to the sun, and redness can have a vascular or inflammatory origin. The Observ 520x helps you see the skin better with different light modes, but the diagnosis is made by the doctor after examining you and learning your history. In this guide we explain how they differ, why that difference changes the plan and what imaging adds to a consultation in Madrid.
Key points
- Melasma, solar lentigo and redness can appear on the same face, and with the naked eye they are not always easy to tell apart.
- The diagnosis of melasma is essentially clinical: the doctor makes it through examination and your history, not a machine.
- The distinction matters because melasma can be triggered or aggravated by procedures that inflame the skin, such as peels or light and laser treatments.
- The Observ 520x offers imaging modes that the manufacturer describes for pigmentation, sub-surface pigmentation and redness; they support the assessment, they are not a diagnosis.
- Any treatment is indicated and performed by the medical team after assessing you, and results vary from one skin to another.
Three problems that get confused in the mirror
It is common to think "I have spots" or "my face is red" without knowing what lies behind it. That makes sense: under normal light, a brown area on the cheekbone can be melasma, a solar lentigo or a mark left after inflammation, and a red cheek can be due to rosacea, irritated skin or other causes.
The medical literature reflects this difficulty. A clinical review on melasma lists freckles, solar lentigo and post-inflammatory hyperpigmentation, among others, as its main differential diagnoses (Handel et al., 2014). The same review describes that dermoscopy of melasma shows a vascular component in a large number of patients. In other words, pigment and redness can coexist in the same area.
On top of that, the three problems share one factor: sun exposure. Melasma appears on sun-exposed areas, solar lentigo develops on exposed skin and sun exposure is listed among the triggers of rosacea. In a city with sunny summers and plenty of outdoor life like Madrid, the same person can have more than one at the same time. That is why the first question is not "which treatment should I have" but "what exactly do I have".
Melasma, solar lentigo and redness: how they differ
Melasma. It is a chronic acquired hypermelanosis: irregular brown patches, with irregular contours and clear limits, usually distributed symmetrically on sun-exposed areas, especially the face. It mainly affects women and more pigmented skin types. The triggering factors cited include the sun, pregnancy, sex hormones, skin inflammation, some cosmetics and photosensitising drugs, and there is a family predisposition (Handel et al., 2014).
Solar lentigo. This is the so-called sun spot or age spot. It appears as flat, well-defined patches of varying colour and size, mainly on the face and the back of the hands. It develops on sun-exposed skin and, unlike a tan, does not go away on its own (Imokawa, 2019).
Redness. Rosacea is one of its best-known causes: a chronic inflammatory disease of the central face that can present with flushing, transient or persistent redness, small visible vessels (telangiectasias), papules and pustules, often with a stinging or burning sensation. The authors of one review stress that the redness must be carefully distinguished from other diseases that also redden the skin (Buddenkotte and Steinhoff, 2018).
| Melasma | Solar lentigo | Redness (for example, rosacea) | |
|---|---|---|---|
| How it usually looks | Irregular brown patches, often symmetrical | Flat, well-defined patches of varying colour and size | Transient or persistent redness, sometimes with visible vessels or spots |
| Where it usually appears | Face and other sun-exposed areas | Face and back of the hands | Central face |
| Associated factors | Sun, pregnancy, hormones, inflammation, some cosmetics and medicines | Accumulated sun exposure | Sun, heat, cold, stress, alcohol, spicy food, depending on the person |
| Observ 520x mode that shows this feature, according to the manufacturer | Pigmentation (uneven pigmentation); True UV (sub-surface pigmentation) | Pigmentation (uneven pigmentation and sun exposure) | Vascularity (areas of redness) |
The table summarises typical features, not rules: there are mixed cases and other causes that the doctor has to rule out.
Why the distinction changes the treatment plan
Confusing these problems is not just a matter of names. Each follows a different logic, and a reasonable treatment for one may not be reasonable for another.
For melasma, the review by Handel et al. notes that it can be triggered or aggravated by cosmetic procedures that inflame the skin, such as peels and light or laser therapies. It also cites a study in which people with subclinical melasma, still barely visible, may worsen with intense pulsed light (IPL) treatments, and its authors proposed using ultraviolet photography before IPL to detect latent melasma (Handel et al., 2014). The same review points out that relapses are frequent and that long-term strategies are usually needed.
A solar lentigo, by contrast, is a well-defined spot that does not go away on its own. In rosacea, the focus is on triggers and on the vascular component; the review by Buddenkotte and Steinhoff mentions sun exposure, heat, cold, stress, alcohol or spicy food as triggers, and recommends avoiding them and using sun protection.
The Santé Madrid catalogue includes laser for pigmentation, laser for melasma and laser for rosacea, as well as peels and cosmeceuticals. The fact that these options exist does not mean they are all suitable for you: the medical team decides whether any treatment is considered, which one and with what precautions, after assessing you. Results vary from one skin to another.
What the Observ 520x adds and what it does not
The Observ 520x by Sylton is a facial imaging system with ten light modes. According to the manufacturer, the Pigmentation mode shows variations in skin tone and areas of uneven pigmentation and sun exposure; the Vascularity mode highlights areas of redness; the True UV mode uncovers sub-surface pigmentation, and the Cross Polarised mode reduces shine to give a clearer view of the deeper skin layers (Sylton, Observ 520x). The manufacturer also describes a face positioning system designed to repeat images under the same conditions over time.
The idea of using ultraviolet light to study pigmentation is not new. A review of the Wood's lamp describes it as a tool used for more than a century to help diagnose, among other things, pigmentary disorders, always interpreted by a trained eye (Dyer and Foy, 2022). In melasma, the review by Handel et al. shows how Wood's light highlights the limits of the patches compared with visible-light photography (Handel et al., 2014).
What the Observ 520x does not do is diagnose. The review by Handel et al. reminds us that the diagnosis of melasma is essentially clinical (Handel et al., 2014). An image with more contrast can make visible a pigment or redness you did not see, but it does not tell you on its own whether it is melasma, a lentigo or something else. The doctor reaches that conclusion by combining the image with the examination, your history (pregnancies, contraceptives, medication, sun exposure, how the spot has changed) and, if needed, other tests or a referral to dermatology. The image can also help you understand what the doctor explains and allow your skin to be compared at later reviews under the same capture conditions.
When a medical assessment comes first
Not every spot or patch of redness on the face is a purely aesthetic problem. Before thinking about any aesthetic treatment, there are situations in which the priority is for a doctor to look at the lesion and, if appropriate, refer you to dermatology. The American Academy of Dermatology recommends seeing a doctor if a spot is new, different from the others, or changes in size, shape or colour, itches or bleeds, and sums up the warning signs in the ABCDE rule: asymmetry, irregular border, varied colour, diameter and evolution (American Academy of Dermatology).
In these cases, imaging does not replace the examination. In the medical consultation we assess the lesion and tell you whether it is better to wait, monitor it or see a dermatologist.
How we work at Santé Madrid
Santé Clinics Madrid is at C. de Amador de los Ríos, 1, Chamberí, 28010 Madrid. We are open Monday to Friday from 9:00 to 21:00 and on Saturdays from 10:00 to 15:00; the clinic is closed on Sundays.
If you do not know what you have and want some guidance, you can start with a free aesthetic consultation with a Beauty Coach, who reviews your skin and your routine with you. When melasma, lentigo or redness need to be told apart, or there is medication, pregnancy or a changing lesion, the right step is the medical consultation, which costs €50.
At the clinic we have the Observ 520x, which can be used to support that assessment. The Santé Madrid medical team examines you, reviews the images with you if they have been taken, asks about your history and explains what they see and what they do not. With that, they propose, if indicated, a plan that may combine sun protection, home care and an in-clinic treatment, or they recommend waiting or seeing a dermatologist.
We make no promises about results: results vary from one skin to another, and with problems such as melasma we talk about long-term control rather than definitive solutions.
Frequently asked questions
How do I know whether my spot is melasma or a sun spot?
With the naked eye it is not always possible. Melasma usually forms irregular, symmetrical patches, and solar lentigo flat, well-defined patches. The diagnosis is made by the doctor through examination and your history, and imaging can provide support.
Does the Observ 520x diagnose melasma?
No. It is an imaging system that, according to the manufacturer, shows pigmentation, sub-surface pigmentation or redness with different light modes. The diagnosis is made by the doctor by interpreting those images together with the examination.
Can I have melasma and rosacea at the same time?
Yes, they can coexist. In addition, the literature describes a vascular component in many people with melasma, which is why it makes sense to assess pigment and redness together before deciding on a treatment.
Why don't you just laser the spot straight away?
Because melasma can be aggravated by procedures that inflame the skin, such as some light or laser treatments. First we need to know what the spot is; the medical team decides whether a treatment is indicated and with what precautions.
Is facial redness always rosacea?
No. Rosacea is a well-known cause, but there are other causes of redness that the doctor must distinguish. If the redness comes with other symptoms, a medical assessment comes first.
Which consultation should I book if I don't know what I have?
For guidance you can start with the free aesthetic consultation with a Beauty Coach. To tell melasma, lentigo or redness apart, or if a lesion is changing, the right step is the medical consultation, which costs €50.
Do sun spots go away on their own?
A solar lentigo, unlike a tan, does not usually go away on its own. Sun protection remains the basis of care, and any treatment is assessed in consultation.
If you have spots or redness and do not know what they are, an assessment at Santé Madrid will help you put a name to them before choosing anything. We will calmly explain what we see, what we do not and which options make sense to consider in your case.
