Hyperpigmentation: Melasma, Sun Spots and Post-Inflammatory Marks

• Identify the pattern before choosing products.
• Use broad-spectrum sunscreen every morning; for melasma, a suitable tint can add visible-light protection.
• Use one targeted pigment product rather than several “brightening” serums.
• Add a retinoid only if it is suitable and your skin barrier is settled.
• Avoid irritation: inflammation can create or prolong PIH.
• Expect gradual change over several months, with maintenance often needed for melasma.

Melasma

Melasma usually appears as flat brown or grey-brown patches on the cheeks, forehead, upper lip or jawline. It is often fairly symmetrical and may become more noticeable after sun exposure, during pregnancy or alongside other hormonal changes.

It behaves more like a long-term tendency than a mark that can simply be removed once. Treatment can improve it, but relapse is common, so maintenance and light protection matter.

UV-related pigmentation

Cumulative ultraviolet exposure can cause a mottled tone, freckles and defined brown marks often called sun spots or solar lentigines. They tend to appear on exposed areas such as the face and backs of the hands.

Skincare can improve general uneven tone and help prevent new marks. A single well-defined sun spot may respond better to clinician-led treatment, and any mark that is new, changing, irregular, bleeding or symptomatic should be medically assessed.

Post-inflammatory hyperpigmentation

PIH is the brown, grey-brown or red-brown colour that remains after inflammation. Acne is a common cause, but it can also follow eczema, picking, burns, irritation or a procedure.

It is often more persistent in deeper skin tones. The first step is to control whatever is creating new inflammation. An aggressive “brightening” routine that repeatedly irritates the skin can make PIH last longer.

Pigmentation treatment is difficult if light exposure continues to stimulate new pigment. Use a broad-spectrum sunscreen as the final step of your morning routine and apply enough to form an even layer.

For melasma, UVA and UVB protection may not be the whole story. Visible light can also worsen pigmentation, particularly in skin with more melanin. In a randomised trial, an SPF 50 sunscreen containing iron oxides for visible-light protection improved melasma outcomes more than a similar UV-only sunscreen when both were used alongside hydroquinone [1]. Another trial found better prevention of melasma relapse when protection extended into shorter wavelengths of visible light [2].

This does not mean everyone with pigmentation needs tint. The colour has to suit your skin well enough for you to apply it generously. For PIH or UV-related pigmentation, the most useful starting point may simply be a broad-spectrum sunscreen you will use consistently.

Melanin is made through a sequence of reactions. Tyrosinase is one of the key enzymes in that pathway, so many pigmentation treatments are designed to reduce its activity.

Examples include prescription hydroquinone and cosmetic ingredients such as kojic acid and azelaic acid. They do not all work equally, and the complete formula matters. A split-face study found that adding kojic acid to a hydroquinone and glycolic acid gel improved melasma outcomes compared with the same formula without kojic acid [3].

Other ingredients act through different pathways. Tranexamic acid may reduce signals that stimulate melanocytes, while niacinamide can reduce pigment transfer into surrounding skin cells. A randomised study found improvement with topical tranexamic acid formulations, although the evidence remains more product-specific than it is for prescription hydroquinone [4].

You usually need one well-chosen targeted product, not several pigment inhibitors at once. More layers can mean more irritation without a better result.

Retinoids can support pigmentation treatment by changing how epidermal cells mature and how pigment is distributed through the upper skin. Controlled trials have shown that topical tretinoin can improve hyperpigmented lesions associated with photoageing [5], PIH in Black patients [6] and melasma [7].

That does not mean everyone needs prescription tretinoin. A cosmetic retinoid may be more practical, especially if you also want to improve fine lines or texture. The benefit develops gradually, and irritation matters: redness and peeling can create more inflammation and may worsen PIH.

Chemical exfoliants such as glycolic acid can also help remove pigmented surface cells and improve texture. The aim is controlled, sustainable turnover rather than visible peeling.

For melasma

Think in terms of control and maintenance rather than a one-off cure. Start with consistent broad-spectrum sunscreen, and consider a tint with iron oxides if it suits you. Add one targeted pigment product and, where appropriate, a retinoid. Melasma often needs a personalised plan because hormonal factors, visible light, skin sensitivity and the depth of pigment can change the response.

For UV-related pigmentation

Daily sunscreen helps prevent new marks and stops existing pigmentation being continually stimulated. A retinoid and antioxidant or pigment-targeting product can improve general mottled tone over time. Individual sun spots may need assessment and a procedure if you want a more complete result.

For PIH

Treat the cause first. If acne is still active, preventing new breakouts is usually more important than adding another brightening serum. Keep cleansing and moisturising gentle, use sunscreen and add one targeted product. A retinoid may help, but introduce it cautiously.