Your guide to hyperpigmentation/ melasma treatment: the process, the patience and the results

Lorraine Avanessian
Dec 3, 2021
6 min read

Updated: Nov 25

Managing hyperpigmentation/melasma: key to a clear lasting complexion

As we transition into different seasons, I often hear the same concerns from clients:

"I have irregular skin pigmentation."
"My skin tone is so uneven."
"these dark spots or patches on my skin has become darker"

The primary concern isn't discomfort—hyperpigmentation doesn’t hurt—but rather its effect on appearance. These dark spots and uneven patches can feel like a barrier to the smooth, even complexion many of us desire.

The truth is, Hyperpigmentation/melasma affects around 90% of adults globally, and while it’s typically harmless, its impact on aesthetics can affect one’s confidence, leading many people—especially women—to seek treatment (myself included).

When it comes to treating, or as I would like to say, “managing” this condition, there are several factors to consider for effective treatment.

cellular health is key

It’s crucial to first focus on the overall health of the skin with a 360 deg approach. An in depth consultation is crucial. A strong, well-functioning skin is essential for managing hyperpigmentation or melasma. This means ensuring that our client’s skin is properly hydrated, their barrier is intact, and they’re following a consistent at-home skincare routein. Once we understand the processes of how pigmentation works we can then start to repair that process rather than just the symptom.

A healthy, resilient skin allows skin cells to respond better to treatments, reducing the risk of unexpected reactions and enabling results to be more consistent and long lasting.

Melanin in a nutshell

We all have melanin in our skin—it's what gives us our unique skin tone and protects us from UV damage. Melanin is produced by specialized cells called melanocytes. However, sometimes these cells get a little too excited, often triggered by factors like sun exposure, hormonal changes, or inflammation. This "overzealous" response results in an excess production of melanin, creating those unwanted dark patches and an irregular complexion. leading to dark spots or uneven pigmentation on the skin.

So, what’s triggering your pigmentation?

Before we move forward, it's essential to identify the root cause and triggers of hyperpigmentation. Without this understanding, we can't effectively manage the condition. We must first evaluate the various factors at play.

Here are some key questions you need to ask yourself if you're considering treating your pigmentation:

Internal Factors

Hormonal Changes Hormonal fluctuations can significantly affect pigmentation in both men and women. A common example is melasma, often referred to as the "mask of pregnancy," which occurs during pregnancy but can also be triggered by birth control, menopause, hormone replacement therapy (HRT), IVF
Post-Inflammatory Hyperpigmentation (PIH)This occurs after skin trauma, such as acne, surgery, or wounds that haven't healed properly. PIH is particularly common in people with darker skin tones, such as those of Asian or African descent, and it can happen if the skin is repeatedly picked or scratched.
Photosensitizing Medications Certain medications, like antibiotics, HRT, contraceptive pills, or natural remedies like St. John’s Wort, can make your skin more sensitive to the sun, potentially triggering pigmentation.
Medical Conditions Conditions such as diabetes or autoimmune diseases that cause inflammation within the body can also contribute to pigmentation changes.
Genetics Some people are genetically predisposed to ephelides (freckles), which isn’t a problem for everyone, but can be more noticeable depending on skin tone and sun exposure.
Natural Aging Age spots, also called senile lentigo, are a common form of pigmentation that appears as we age. These are often seen in sun-exposed areas like the hands, face, and shoulders.
Stress stimulates the melanocyte hormone

External Factors

Sun Exposure and sun bed user Unprotected exposure to the sun is one of the most significant contributors to hyperpigmentation. Excessive sun exposure not only triggers the development of new pigmentation but also darkens existing spots, especially during certain times of the year. How would you rate your sun protection habits? Do you wear sunscreen daily? Do you spend time sunbathing or using tanning beds? Your relationship with the sun plays a massive role in pigmentation.
Topical Cosmetics and Fragrances Many cosmetics, especially those containing essential oils or fragrances, can make the skin more sensitive to light, contributing to pigmentation. Are you frequently applying perfume to areas like your neck or wrists? These areas are often exposed to the sun, which can worsen pigmentation.
Heat Exposure Heat, especially in the form of saunas, steam rooms, or prolonged time spent in hot environments (like kitchens), has been shown to exacerbate conditions like melasma. If you're frequently in hot conditions, this could be aggravating your pigmentation.

Pigmentation… the tip of the iceberg

When it comes to pigmentation, what you see on the surface is often just the beginning. In fact, pigmentation issues start much deeper—at the base of the epidermis (the top layer of the skin). This means that even though it may look like a surface problem, the root cause lies deeper within the skin.

As a skin professional, it’s important for me to look beyond what’s visible to the naked eye. That’s where advanced skin analysis technology comes in. Using a skin analysis machine that shines various types of light onto the skin, I can identify:

The type of pigmentation present
Whether it’s superficial or deep
Its severity—mild, moderate, or severe

This in-depth analysis allows me to create the most effective and tailored treatment plan for each client. My clients can also see the changes and improvements for themselves during their journey.

We are essentially addressing what lies beneath and not just what lies on the surface.

The only way for pigmentation....is up

We already know that pigmentation forms at the base of the epidermis. Once melanin is produced, it gradually rises to the skin's surface—and that’s where the visible dark spots appear.

To effectively treat pigmentation, we need a dual approach: targeted in-clinic treatments to help repair the processes, combined with high-performance skincare products. This combination not only help control the production of melanin, but also helps fade existing dark spots and prevent new ones from forming.

Popular treatments include:

Organic skin peels
Micro-needling
IPL or laser therapies

We need to identify the triggers. What is it that has caused the undesired dark spots or melasma in the first place? There are many possibilities: past or current medication, inflammation internal or external, hormonal changes over the years, an existing medical condition, your relationship with the sun and many more. treatment cannot be successful if the above is not addressed, changes made or managed.

We need to treat the source. That means repairing and re-educating your skin cells to stop overproducing melanin.

One word to remember: inhibitors. These are key to managing and reducing hyperpigmentation. They work by interrupting the process that leads to excess melanin production caused by the triggers.

Here are some of the most effective pigment inhibitors to look for:

Vitamin C
Niacinamide (Vitamin B3)
Kojic Acid
Arbutin
Licorice Extract
Azelaic Acid
Tranexamic Acid
Retinoids

So, the next time you're looking at skincare products Do they contain any of these ingredients? Because that’s where real, long-term pigment correction begins.

What to expect when treating hyper/pigmentation.

Your pigmentation during treatment may look worse before it looks better, in some cases pigmentation will become darker before it becomes lighter and there may be a time when there seem be more of it.

Don’t panic! because the pigmentation that has been lying dormant below the surface of the skin has now made its way to the top of the skin and this process may continue to do so for a while depending on the severity of your condition and the treatment used.

So, hang on in there, this is not the time to give up!

Once we have achieved our goal, we now need to maintain a clear complexion, my advice is to continue to do the following, consistently:

Know your triggers - Always be aware of factors that could cause a flare-up of pigmentation, such as sun exposure, heat or inflammation.
Daily use of antioxidants and SPF - such as Vitamin C and a mineral based SPF to help minimise damage.
Use inhibitor rich products - Using a product containing any of the above inhibitors on a daily basis. This will keep things under control, especially when your skin encounters unexpected triggers.
Retinol for exfoliation. Retinol/retinal's can help increase the skin’s natural exfoliation process, bringing pigmentation to the surface more quickly. Just be sure to start slowly and build up your tolerance whilst making sure your skin barrier is not compromised.
Regular skin professional check-in. Finally, visit a skin professional regularly. Ongoing treatments and expert advice can help ensure your skin stays healthy and resilient, maintaining the results you’ve worked so hard for.