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Understanding Hyperpigmentation & Melasma

August 2024


How to Identify and Treat Common Skin Pigmentation Issues

Hyperpigmentation and melasma are often confused because they present the same way, but they are not the same skin condition. Melasma is a type of hyperpigmentation, but not all hyperpigmentation is melasma. This distinction is important because causes and treatments may vary depending on whether you have melasma or another hyperpigmentation issue.  

In this blog post, we’re going to discuss what hyperpigmentation is – and how to identify it – with insights from Jill Bickford, MSN, APRN, AGNP-BC, who serves patients at our Stratham, NH location, and we’ll focus on melasma, a common and highly treatable type of hyperpigmentation with different causes.

What is Hyperpigmentation? 

Hyperpigmentation is any darkening of the skin’s pigment that is caused by an increase in melanin (melanin is the naturally occurring pigment that gives color to the skin). Hyperpigmentation occurs when the skin’s pigment-making cells, called melanocytes, are stimulated and make a surplus of pigment.  

This surplus can be triggered by sun exposure, inflammatory skin conditions like eczema or acne, medications, or hormones. In fact, hyperpigmentation is common during pregnancy because of the body’s hormonal changes. This is often called the “mask of pregnancy”. 

When hyperpigmentation occurs, it can appear as large blotches of brown spots, or as smaller spots like freckles. Types of hyperpigmentation include: 

  • Sun Spots: Also known as solar lentigines, liver spots or age spots, these darkened patches often appear in sun-exposed areas of the skin like the face and on the hands and arms. While they are harmless, they can be an unwelcome sight on the body and there are treatments to reduce their appearance.  
  • Freckles: These highly common small brown spots typically occur on areas of the skin with high sun exposure when the skin produces excess melanin to protect the skin from UV radiation. Sun spots are a type of freckle that develops later in life.  
  • Post-Inflammatory Hyperpigmentation (PIH): Hyperpigmentation can occur as a result of a skin injury or inflammatory condition, such as eczema or acne, leaving behind brown, red, black, pink, or purple patches of skin. Skin cells involved in the healing process following injury or inflammation can produce excess melanin, resulting in darkened areas of the skin. While PIH may fade over time, it can be treated by a dermatologist.  
  • Melasma: As we’ll explain in more depth below, melasma manifests as darkened patches on and around the face. It is unique in that it often appears symmetrically – if it occurs on one cheek, it usually occurs on the other cheek as well.  

How to Treat Hyperpigmentation 

Treatments for hyperpigmentation include medical-grade topical skin care products called tyrosinase inhibitors such as Vitamin C, Azelaic acid, Kojic acid, and Tranexamic acid, which can all aid in decreasing or suppressing melanin production.  

Chemical peels, lasers, and light treatments are offered at Optima Dermatology. These include Forever Young BBL™ (BroadBand Light), HALO® Hybrid Fractional Laser, Fraxel®, and more. Your provider can help you determine the best treatment for your hyperpigmentation issue and work with you to improve its appearance.  

All About Melasma 

Melasma is a highly common skin condition, although the exact cause is not known. Some triggers include: 

  • Hormonal changes, such as during pregnancy or as a result of thyroid disorders 
  • Sun exposure 
  • Medications 
  • Genetics 

Melasma is most often brought on by hormonal changes, and is therefore most common in pregnant women, women taking contraceptives, using hormone replacement therapy drugs (HRT), going through menopause, or experiencing other hormonal changes or imbalance.  

Progesterone and estrogen hormones cause the production of melanocytes on the skin, resulting in darkened or red spots or patches.   

While it is often noticeable, as it typically appears on sun-exposed areas like the nose, cheeks, forehead, or upper lip, it does not cause itching, pain, or burning symptoms.  

This condition most often manifests in women but can occur in anyone at any age. Many describe the appearance of melasma as ‘dirty’, or ‘muddy’. While it is treatable and not serious, the dark patchiness that appears on the face can have emotional impacts such as depression and heightened self-consciousness when out in public. For this reason, it’s important to speak with a dermatologist to understand your treatment options. Additionally, melasma should be checked to rule out cancer if discoloration appears suddenly or in an area of the skin not often exposed to sunlight.  

Identifying and Treating Melasma 

If you notice irregularly shaped, darkened areas on your skin, you may have melasma. It is commonly tan, brown, or gray-brown. It does typically manifest on sun-exposed areas and especially forehead, temples, cheeks, and upper lip, but has been known to appear on other parts of the body as well.  

Melasma is exacerbated by sun exposure or exposure to UV light, so it’s always recommended to wear a sunscreen of at least 30 SPF, wear sun-protective clothing, and avoid tanning beds and long-term direct sunlight. In addition, melasma may flare from exposure to excessive heat from hot weather, hot cars, saunas, steam rooms, hot tubs, and hot yoga) 

Melasma may go away on its own once hormones become more balanced, but is often a lifelong condition that can be managed, but not cured.  At times, changing birth control, or hormone replacement therapy may help reduce melasma.  

Depending on your melasma, your dermatologist may recommend other treatment options that can include: 

  • Chemical peels 
  • Topical skin lighteners or corticosteroids 
  • Laser therapy 
  • IPL/BBL therapy  
  • Microdermabrasion 

It’s important to meet with a dermatology provider to understand your melasma and identify the best treatment option.  

If you think you have hyperpigmentation or melasma, and want to discuss treatment options, schedule an appointment with one of our board-certified dermatologists and providers. We can help you get back to feeling confident in your skin! Book a consultation today.