Melasma is a specific, symmetrical facial pattern within the broader hyperpigmentation family, not a separate condition. Melasma accounts for the most common cause of facial hyperpigmentation, while about 90% of cases are female, according to British Association of Dermatologists guidance, and that distinction changes which treatments are safe.
The popular advice to treat every dark patch with the same brightening serum, peel or laser session is not safe enough. A mark left after acne, a sun spot and hormonally influenced melasma may all look brown, but they don't behave in the same way. When we treat melasma as generic sun damage, the heat or irritation can intensify the very pigmentation we're trying to reduce, especially in darker skin tones.
At Skin Revision, we start with the pattern, history and likely pigment depth before discussing treatment. The practical question isn't “How do we lighten this?” It's, “What caused it, where is the pigment sitting and what will calm the skin rather than provoke it?”
Why Not All Dark Patches Are the Same
Hyperpigmentation is the broad term for excess melanin or uneven pigment in the skin. Melasma is one named subtype within that wider category, recognised by a characteristic facial pattern and trigger profile. They're related, but they're not interchangeable diagnoses.
Post-inflammatory hyperpigmentation may follow acne, eczema, a scratch or irritation. A solar lentigo, commonly called a sun spot, reflects cumulative ultraviolet exposure. Melasma, by contrast, commonly appears as symmetrical, blotchy brown pigmentation across sun-exposed facial areas and becomes more pronounced after sun exposure, as described by UK dermatology patient guidance.
The risk of treating the label instead of the skin
A person with isolated post-acne marks may need a plan focused on calming inflammation and gradually reducing residual pigment. Someone with melasma needs a stronger emphasis on year-round photoprotection, trigger control and maintenance, because complete reversal usually isn't achievable and recurrence is common.
This matters particularly for Fitzpatrick skin types III to VI. UK-facing guidance warns that darker skin has a higher risk of post-inflammatory hyperpigmentation after aggressive procedures, so an intervention that appears suitable for a discrete sun spot may create a longer-lasting problem when applied to melasma-prone skin. A UK skin-of-colour consultation guide also emphasises diagnosis by distribution, history and sun sensitivity, rather than colour alone.
Our practical rule: If pigmentation is symmetrical, diffuse and centred on the face, we slow down before choosing an active ingredient or device.
The distinction between hyperpigmentation and melasma isn't cosmetic terminology. It determines whether we target a past inflammatory event, cumulative sun exposure or an ongoing tendency to flare. It also helps us avoid procedures that may produce a short-term change followed by rebound darkening.
Understanding Hyperpigmentation as the Broader Category
Hyperpigmentation is a broad description, not a diagnosis. It refers to darker skin caused by excess melanin, uneven melanin distribution or pigment left after inflammation. A patch may be limited to one mark or spread across the face, neck, hands, chest or another area of the body.
The most useful clue is often what happened before the colour appeared. Post-inflammatory hyperpigmentation, or PIH, follows inflammation or injury, including acne, eczema, friction, burns and other trauma. Solar lentigines are associated with cumulative ultraviolet exposure. Freckles, or ephelides, have a genetic basis and usually follow a different distribution.
What the appearance can tell us
General hyperpigmentation often appears asymmetrical or irregular. A mark may match the site of a healed blemish, trace the edge of eczema or sit on a sun-exposed area. Its colour can range from tan and brown to grey-brown, partly depending on the depth of the pigment.
Epidermal pigment tends to look more clearly defined and brown, while dermal pigment may appear grey-brown with softer borders. This visual difference can indicate how predictable treatment might be, but it cannot replace a proper assessment.
Skin of colour can develop a strong pigment response after relatively minor inflammation. Picking a blemish, over-exfoliating or continuing an irritating product may therefore prolong dark marks after the original acne or rash has settled. Our approach to post-inflammatory hyperpigmentation treatment starts by identifying and reducing the trigger, rather than escalating exfoliation.
Pregnancy and sensitive skin
Pregnancy-related pigmentation deserves a cautious plan. Hormonal changes may contribute to melasma, yet a new dark mark during pregnancy does not automatically follow a melasma pattern. safe skincare for pregnancy hyperpigmentation provides ingredient-conscious general guidance, while personalised advice should come from an appropriate healthcare professional.
Pigment may fade after its cause has settled, but improvement is gradual and not always complete. Sun protection, barrier support and carefully selected actives usually offer a safer route than aggressive correction, particularly for skin prone to post-inflammatory darkening.
Recognising Melasma and Its Distinct Patterns
Melasma is a common, harmless facial pigmentation disorder with a symmetrical distribution. UK guidance describes centrofacial, malar and mandibular patterns, meaning patches may concentrate around the central face, cheeks or jawline. The forehead, upper cheeks and upper lip are frequent sites, and the pigmentation can look brown or grey-brown with a blotchy, sometimes diffuse quality.
The condition affects women disproportionately. British dermatology guidance reports that about 90% of cases are female and that onset most commonly occurs in the third and fourth decades of life. UK sources also describe melasma as more common in people with skin types III and IV, including many people of Latin American, Middle Eastern and Asian backgrounds. See our British guide to melasma treatment for further context.
Why depth changes expectations
Clinicians commonly discuss melasma as epidermal, dermal or mixed. Epidermal pigment is closer to the surface and may look more distinctly brown. Dermal pigment lies deeper and can look grey-brown or less sharply outlined, while mixed melasma contains features of both.
Depth matters because topical products and superficial treatments have less influence over pigment that lies deeper in the skin. It's one reason we avoid promising complete clearance. Primary Care Dermatology Society guidance states that no treatment produces complete reversal.
Hormones and light work together
Pregnancy, oral contraception and hormone replacement therapy can be associated with melasma. Ultraviolet exposure can deepen it, while visible light is also relevant, which is why tinted sunscreen may be useful for some people. The skin can remain susceptible even when the original hormonal trigger has changed.
Melasma is therefore best understood as a relapsing management issue, not a one-off stain. High-intensity procedures used for some sun damage can be unsuitable. UK clinic guidance specifically warns that IPL may worsen melasma, so we don't treat a symmetrical facial pattern as though it were an isolated sun spot.
Comparing Causes Triggers and Skin Depth
A consultation becomes clearer when we compare the likely cause, location and behaviour rather than relying on colour. Hyperpigmentation often tells us about a previous event. Melasma tells us about a continuing sensitivity to hormonal influence and light.
| Feature | Hyperpigmentation | Melasma |
|---|---|---|
| Typical cause | Acne, eczema, trauma, irritation or ultraviolet exposure | Hormonal influence combined with ultraviolet and visible light exposure |
| Distribution | May occur anywhere and is often localised or irregular | Usually symmetrical and facial, with centrofacial, malar or mandibular patterns |
| Border | Often more defined, particularly when pigment is epidermal | Frequently blotchy and diffuse, although appearance varies |
| Depth | Can be epidermal or dermal depending on the cause | May be epidermal, dermal or mixed |
| Behaviour | May gradually fade after the trigger settles | Often persists, flares or recurs with light and hormonal influence |
| Main treatment principle | Remove the trigger and reduce inflammation | Photoprotection, gentle pigment control and long-term maintenance |
How we reason through the pattern
First, we ask what happened before the pigmentation appeared. A cluster of marks in areas affected by acne points us towards PIH. A small number of sharply defined spots on chronically sun-exposed skin may suggest solar lentigines. Symmetrical patches across both cheeks or above the lip raise the possibility of melasma.
Next, we look at distribution. Hyperpigmentation can appear on the body wherever inflammation or exposure occurred. Melasma has a characteristic facial preference, which makes the map more informative than the shade.
Finally, we consider recurrence. If pigmentation repeatedly darkens after ordinary outdoor exposure or during hormonal changes, we're more cautious about procedures that create heat or inflammation. NHS-linked UK guidance recommends clothing, shade and sunscreen of at least SPF 30 with high UVA protection, with tinted sunscreen helping reduce visible-light exposure.
Skin of colour needs particular restraint because inflammation can leave additional pigment. A treatment that irritates the barrier can turn one concern into two, even when the original intention was correction.
How We Diagnose Pigmentation at Skin Revision
We don't diagnose pigmentation from a photograph alone. A photo can show colour and distribution, but it can't reliably explain the trigger, depth or whether inflammation is still active.
We begin with history. We ask about pregnancy, oral contraception, hormone replacement therapy, medication, acne, eczema, recent procedures, product irritation and daily sun exposure. We also ask whether the patches change seasonally or appear in a symmetrical pattern, because those details can point us towards melasma rather than isolated PIH.
What we assess in the clinic
Under good clinical lighting and magnification, we examine:
- Distribution: Whether the pigment is symmetrical, central, malar, mandibular or linked to individual blemishes.
- Colour and border: Whether it appears brown and defined or grey-brown and diffuse.
- Skin condition: Whether dryness, redness, acne or sensitivity could be continuing the inflammatory cycle.
- Skin type: Fitzpatrick typing helps us judge how cautiously we should introduce actives or procedures.
- Pigment depth: Where appropriate, Wood's lamp assessment may help distinguish more superficial epidermal pigment from deeper dermal pigment, although it isn't infallible.
Epidermal pigment may appear more sharply defined and darker under Wood's light. Dermal pigment tends to look more diffuse and may show less visible change. PCDS guidance similarly highlights the practical difference between well-defined brown epidermal pigment and less distinct grey-brown dermal pigment.
Why guesswork can backfire
We're cautious with aggressive IPL, high-fluence laser procedures and strong peels when the pattern suggests melasma or the skin is prone to PIH. Heat, barrier disruption and inflammation can all encourage darker pigment. A useful independent starting point for comparing local treatment providers is this Glowmi clinic listing for Skin Revision, but any treatment decision still needs an individual assessment.
Diagnosis doesn't guarantee a quick result. It does give us a safer basis for deciding what not to do, which is often just as important.
Treatment Approaches That Respect Your Skin Tone
The safest melasma plan is usually layered. We combine light protection, barrier support and carefully selected pigment-control products before considering an in-clinic procedure. This approach may feel slower than a dramatic correction, but reducing irritation protects against the rebound cycle we're trying to avoid.
Build the daily foundation
Photoprotection is the cornerstone. UK patient guidance states that protection from sunlight is the most important part of melasma treatment and should continue throughout the year, while PCDS advice on melasma also highlights protection against sunlight as a way to reduce worsening and support improvement.
A practical routine may include:
- High UVA protection: Use sunscreen with at least SPF 30 and strong UVA protection, then add shade, clothing and a hat where possible.
- Visible-light awareness: Tinted sunscreen can help reduce visible-light exposure, which may aggravate melasma.
- Calm product selection: Choose products that don't sting, burn or leave the skin persistently tight.
- Consistent pigment support: Azelaic acid may help some people, although PCDS notes that 20% azelaic acid twice daily can irritate, and irritation itself may worsen pigmentation.
Choose procedures conservatively
At Skin Revision, our available options include microneedling, chemical peels, HydraFacial, LED therapy, AlumierMD skincare, DMK facials and SQT bio-microneedling. We also offer Plaxel Plasma, which is separate from Jet Plasma, along with CryoPen, Thermavein, Botox, dermal fillers, Profhilo and polynucleotides. Not every option is appropriate for melasma, and we don't offer laser therapy, laser resurfacing, ablative lasers, subcision, punch excision or TCA CROSS.
Microneedling or a gentle peel may have a place for selected pigmentation concerns, but treatment intensity must match the skin type and diagnosis. Our pigmentation treatment guidance explains why dark-spot treatment shouldn't be approached as a universal procedure.
The honest expectation: We can often improve uneven tone and reduce visible contrast, but melasma usually needs ongoing maintenance rather than a permanent cure.
We also discuss whether the client's routine, heat exposure, hormonal history or ongoing acne is keeping the pigment active. The goal is sustainable control without sacrificing the barrier.
Book a Pigmentation Consultation in Beaconsfield
A client may arrive describing “dark spots” after trying several brightening products. During consultation, the pattern may show separate post-acne marks alongside symmetrical cheek pigmentation. That combination needs a different plan from either condition alone, and treating every area with the same intensity could create more irritation.
At Skin Revision, we assess pigmentation under clinical lighting, review relevant medical and hormonal history and consider distribution, skin type and likely depth. Our lead practitioner, Jacqui Bannister, is a multi award-winning paramedical skin therapist with more than 20 years of experience, supported by Sarra Kourdi, advanced skin therapist.
We're based at Skin Revision, 9a Burkes Parade, Station Road, Beaconsfield HP9 1NN. A consultation is designed to clarify whether we're seeing PIH, melasma, sun-related pigmentation or a combination, then set out realistic expectations, home care and suitable treatment options.
We offer personalised pigmentation consultations and tone-conscious treatments at Skin Revision, including AlumierMD skincare, LED therapy, microneedling and carefully selected peels. Visit Skin Revision to book a consultation and let us assess your pigmentation before you invest in a treatment that may aggravate it. We welcome clients from Beaconsfield, Gerrards Cross, Amersham, High Wycombe, Marlow, Slough, wider Buckinghamshire, Berkshire and Hertfordshire.
