Dr. Yvonne Nguyen · Dermatology Conditions

Melasma & Pigmentation

Accurate diagnosis is the essential first step in treating any pigmentation concern.

Pigmentation disorders are among the most common reasons Australians seek specialist dermatology care, and among the most frequently mismanaged. Melasma, post-inflammatory hyperpigmentation (PIH), solar lentigines (sunspots), and Hori's naevus each behave differently and respond to different treatments. Using the wrong approach, particularly the wrong laser, can make pigmentation significantly worse.

Melasma presents as symmetrical patches of brown or grey-brown discolouration across the cheeks, upper lip, forehead, and chin. It affects women far more than men and is especially common in those with medium to darker skin tones, including individuals of Asian, Middle Eastern, Latin, and Mediterranean backgrounds. The depth of pigmentation, whether epidermal, dermal, or mixed, is the critical factor determining which treatments are safe and appropriate.

Post-inflammatory hyperpigmentation (PIH) follows any inflammatory event such as acne, eczema, a procedure, or an insect bite, and is particularly persistent in medium to darker skin tones. In Australia's high-UV environment, all pigmentation types are more stubborn without rigorous sun protection running alongside active treatment.

Facial skin image representing melasma and pigmentation treatment

Melasma is driven by overstimulation of melanocytes (the pigment-producing cells) by UV and visible light, hormonal influences (oral contraceptive pill, hormone replacement therapy, pregnancy, sometimes called the "mask of pregnancy"), and genetic predisposition. It is now understood that visible light, not just UV, stimulates melanin production, which is why chemical sunscreens alone are often insufficient for melasma control.

How is it diagnosed?

Diagnosis is based on distribution, appearance, and a detailed history of sun exposure, hormonal use, skincare, and prior treatments. Dermoscopy helps assess pigmentation depth. Wood's lamp examination provides additional information in certain skin types. Biopsy is rarely required but may be performed to exclude conditions such as lichen planus pigmentosus or drug-induced pigmentation.

Topical treatments are the mainstay of melasma management. Options your dermatologist may discuss include hydroquinone (inhibits a key enzyme in melanin synthesis and is one of the most studied depigmenting agents), tranexamic acid (available topically and in oral form, with a strong safety profile across all skin tones), retinoids, kojic acid, azelaic acid, and niacinamide. Combination formulations often produce better results than single agents.

Chemical peels using superficial acids enhance topical treatment penetration and accelerate pigment turnover. In medium to darker skin tones, careful selection of peel depth is essential to avoid post-inflammatory darkening.

Laser and light-based treatments require careful patient selection. For melasma in particular, aggressive settings can paradoxically worsen pigmentation by stimulating deeper dermal melanocytes. For suitable candidates, specific laser and IPL technologies can produce excellent results for epidermal pigmentation such as sunspots and lentigines.

Oral treatments may be discussed for melasma that has not responded adequately to topical therapy.

Pigmentation treatment requires patience and a consistent approach. Combining active treatment with strict sun protection produces the best long-term results.

  • Apply SPF 50+ sunscreen every morning. For melasma specifically, a tinted mineral sunscreen containing iron oxides protects against visible light as well as UV
  • Reapply every two hours during outdoor activity
  • Avoid heat where practical, as infrared radiation is a recognised trigger for some patients
  • Review hormonal contraception with your dermatologist and GP if melasma is severe or recurrent
  • Facial discolouration worsened during pregnancy, while on the pill, or with sun exposure
  • Over-the-counter brightening products have not produced lasting results
  • You are considering laser or light treatments and want to ensure the right approach for your skin type
  • Pigmentation is affecting your confidence or quality of life
  • Any pigmented lesion is new, changing, or irregular; always assess for skin cancer first

Discuss Melasma & Pigmentation with Dr. Nguyen

Sources and further reading

These external resources provide general educational information and do not replace individual medical advice.