Post-Holiday Melasma Flare or Sun Spots? How a Dermatologist Tells Them Apart Before Choosing a Laser

Melasma flare after holiday

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By Dr Hiba Injibar | Consultant Dermatologist, Dermasurge Harley Street

September is one of the busiest months in a London dermatology clinic. Patients come back from two weeks in Greece, Italy or Dubai, unpack, look in the bathroom mirror under honest daylight, and find pigmentation that was not there in June. The assumption is almost always the same: sun damage. Sometimes that is correct. Often it is not.

The distinction matters more than most people realise, because a melasma flare after holiday and a crop of solar lentigines (the medical term for sun spots or age spots) respond to opposite treatment logic. Solar lentigines can often be cleared efficiently with the right laser or light-based device. Melasma can be made visibly worse by that same energy. A patient who books a pigmentation laser on the assumption that all brown patches are the same problem can leave with darker, more stubborn skin than they arrived with.

This article explains how a consultant dermatologist separates the two, what the assessment actually involves, and why the diagnosis determines whether laser is used at all.

Why autumn is peak season for pigmentation consultations

Pigmentation after summer in London follows a predictable pattern. Ultraviolet exposure over the holiday period stimulates melanocytes, the pigment-producing cells in the epidermis. That stimulation does not show its full effect immediately. Tan fades over four to eight weeks, and as the diffuse background colour drops away, focal pigment that was previously camouflaged becomes obvious.

So the pigmentation you notice in late August or September may have been developing since May. Two different processes are commonly at work:

• Solar lentigines: discrete, well-defined brown marks caused by cumulative UV-driven proliferation of melanocytes. Photodamage, in short.
• Melasma: a chronic, relapsing pigmentary disorder driven by a combination of hormonal influence, UV and visible light exposure, heat, and genetic predisposition. UV is a trigger rather than the sole cause.

A significant number of patients have both at once. That is one of the reasons self-diagnosis from a phone photo is unreliable.

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Melasma vs sun spots: the clinical differences

Pattern and border

Solar lentigines are individual lesions. They have a defined edge, sit separately from one another, and vary in size from a few millimetres upwards. They tend to accumulate on the areas that take the most direct sun over decades: the upper cheeks, the temples, the bridge of the nose, the forehead, the backs of the hands, the décolletage and the shoulders.

Melasma is not a collection of spots. It presents as confluent patches with irregular, sometimes feathered borders, usually symmetrical across both sides of the face. The classic distributions are centrofacial (forehead, upper lip, nose, chin), malar (across the cheekbones) and mandibular (along the jawline). Symmetry is one of the most useful clues available to the naked eye. Photodamage is rarely so even-handed.

Colour and depth

Lentigines are usually a fairly uniform light to mid brown, sitting in the epidermis. Melasma can be light brown, grey-brown or slate-blue depending on whether the pigment is epidermal, dermal or mixed. That depth question is central to treatment planning. Epidermal melasma responds better to topical and procedural intervention. Dermal pigment is far more resistant and much easier to aggravate.

Behaviour over time

Ask a patient what the pigmentation does across a year. Solar lentigines are static. They may darken slightly in summer, but they do not disappear in winter and they do not fluctuate with the menstrual cycle, pregnancy, the combined oral contraceptive pill or hormone replacement therapy. Melasma does. It fades in the darker months, returns from March onwards, and often first appeared during pregnancy or after starting hormonal contraception. Heat matters too. Patients frequently report flares after hot yoga, saunas, cooking over a stove, or long-haul flights.

Age of onset

Melasma typically begins between the twenties and forties and is far more common in women, particularly those with Fitzpatrick skin types III to V. Solar lentigines usually emerge from the mid-thirties onwards and continue accumulating with age. A woman of 32 presenting with symmetrical cheek patches that worsened during her second pregnancy is a very different clinical picture from a man of 58 with scattered defined marks across sun-exposed sites.

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What the assessment involves

History first

The consultation begins with questions rather than devices. Hormonal history, medication history (including photosensitising drugs), family history of melasma, occupational and recreational sun exposure, previous treatments and, importantly, previous reactions to treatment. A patient who reports that a previous laser or aggressive peel initially lightened the pigment and then made it darker within weeks is describing something clinically significant.

Wood’s lamp examination

A Wood’s lamp emits long-wave ultraviolet light and is one of the simplest and most informative tools in pigmentation assessment. Under it, epidermal pigment becomes more sharply demarcated and appears to intensify, because the light interacts with melanin in the superficial layers. Dermal pigment does not enhance in the same way; it can appear unchanged or less distinct.

This helps in two directions. It clarifies the depth of melasma, which predicts how the condition is likely to respond. It also reveals the true extent of photodamage, often showing pigment that is not yet visible in ordinary light. Patients are frequently surprised at how much more the lamp shows than the mirror does.

Dermoscopy and lesion safety

Every pigmented lesion is examined dermoscopically before any cosmetic decision is made. This is non-negotiable. A solar lentigo, a seborrhoeic keratosis, a pigmented actinic keratosis and an early lentigo maligna can look similar to an untrained eye, and lentigo maligna characteristically arises on chronically sun-exposed facial skin in older patients. Treating a suspicious lesion with a pigmentation laser destroys the pigment without treating the underlying problem and removes the ability to assess it properly afterwards.

Laser is never a substitute for a mole check. Any lesion with atypical features is assessed appropriately, and biopsy or excision is arranged where clinically indicated before any cosmetic treatment is considered. If you are attending primarily because a mark has changed, that is a medical appointment, not a cosmetic one.

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Why the diagnosis changes the treatment plan entirely

Solar lentigines

Discrete photodamage-related pigment generally responds well to targeted light and laser treatment. Q-switched lasers deliver energy in extremely short pulses that fragment melanin, and intense pulsed light can address diffuse background photodamage and multiple lentigines across a wider area. Results are usually visible within a few sessions in appropriately selected patients, though the number required varies with skin type, lesion depth and the extent of underlying photodamage. Individual responses differ, and no outcome can be guaranteed.

Melasma

Melasma is a chronic condition, not a lesion to be removed. The melanocytes involved are hyperactive and hypersensitive to stimulation, including thermal stimulation. Aggressive laser can trigger post-inflammatory hyperpigmentation and rebound darkening, sometimes worse than the original presentation and considerably harder to manage.

Melasma laser safety in London practice therefore means restraint. Management is led by topical and, where appropriate, systemic therapy, alongside rigorous photoprotection. Tyrosinase-inhibiting topicals, retinoids, antioxidants and prescription combination regimens form the foundation. Where a device is used, it is used at conservative settings, often in low-fluence protocols and always after the pigment has been stabilised medically first. Chemical peels may play a supporting role in selected cases. The plan is judged over six to twelve months, and maintenance is expected rather than optional.

Photoprotection is not a footnote

Laser resurfacing and pigmentation lasers both require strict sun avoidance and daily broad-spectrum SPF 50 before and after treatment. Suitability also depends on Fitzpatrick skin type; higher phototypes carry greater risk of post-inflammatory hyperpigmentation and require more cautious parameters, or a non-laser pathway altogether.

For melasma specifically, sunscreen alone is insufficient. Visible light, particularly the blue end of the spectrum, drives melasma in darker phototypes, which is why tinted formulations containing iron oxides are recommended over untinted ones. A wide-brimmed hat and shade-seeking behaviour do more than most serums. This is also why the autumn window matters: starting treatment as UV levels fall gives the plan its best chance before the following spring.

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Why choose Dermasurge Clinic

Dermasurge Clinic is a consultant-led dermatology practice in central London. Assessment is carried out by Dr Hiba Injibar, a consultant dermatologist on the GMC specialist register, which means pigmentation is evaluated as a medical question first and a cosmetic one second.

Medical and cosmetic dermatology sit under one roof. That structure matters for pigmentation because the correct answer is sometimes a prescription regimen and photoprotection rather than a device, and sometimes it is a biopsy. A practice that only offers laser has only one thing to recommend.

The clinic has on-site M22, Q-switched and IPL platforms, so where energy-based treatment is appropriate, the device can be matched to the diagnosis and to your skin type rather than the diagnosis being matched to the available machine. Every plan is evidence-based and personalised, with realistic timelines discussed openly at the outset.

You can read more about melasma assessment and treatment, our approach to laser dermatology and pigmentation, or explore the wider range of services at Dermasurge Clinic. Our related post on managing sun damage and photoageing covers the prevention side in more detail.

An assessment with a consultant dermatologist is required to determine the appropriate treatment.

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Frequently asked questions

Can melasma and sun spots occur at the same time?

Yes, and this combination is common in patients over 35 with a history of regular sun exposure. When both are present, the treatment sequence matters. Melasma is usually stabilised with topical therapy and photoprotection first, and any laser treatment for solar lentigines is planned carefully afterwards, using conservative settings to avoid triggering a melasma flare in the surrounding skin.

Will laser make my melasma worse?

It can, if the wrong device or the wrong settings are used, or if it is used before the condition is medically stabilised. Melasma-affected melanocytes react to heat and inflammation, which is why aggressive treatment can cause rebound hyperpigmentation. Laser is not excluded from melasma management, but it is a supporting tool used cautiously within a broader plan rather than a primary solution.

How soon after a holiday should I book a pigmentation consultation?

Waiting around four weeks after sun exposure is generally sensible, as recently tanned skin alters both the appearance of pigment and the safety margin for any energy-based treatment. Autumn is a practical time to start post-holiday pigmentation treatment because UV levels are falling and there is a longer window before the following spring.

What is a Wood’s lamp and does it hurt?

A Wood’s lamp is a handheld ultraviolet light used to examine pigment depth. The examination is painless, takes a few minutes and involves no contact with the skin. It helps distinguish epidermal pigment, which tends to respond better to treatment, from dermal pigment, which is more resistant.

Does melasma ever go away permanently?

Melasma is a chronic, relapsing condition rather than a curable one. Most patients find that a sustained plan combining topical therapy, photoprotection and periodic review achieves meaningful and lasting improvement, but ongoing maintenance is usually needed to hold it. Individual responses vary and outcomes cannot be guaranteed.

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Next steps

If pigmentation has appeared or worsened since the summer, the useful first step is a diagnosis rather than a treatment booking. Knowing whether you are dealing with melasma, solar lentigines or both determines everything that follows, including whether laser has any part to play.

Book a consultation at Dermasurge Clinic for a consultant-led pigmentation assessment in central London.

Meta title: Melasma Flare After Holiday or Sun Spots? | London

Meta description: Post-holiday pigmentation may be melasma or sun spots, and laser suits only one. How a consultant dermatologist in London tells them apart. Book a consultation.

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