Melasma vs Hyperpigmentation

Melasma is a specific form of hyperpigmentation that commonly occurs on the face of women of childbearing age. However, not all forms of hyperpigmentation are melasma.

Hyperpigmentation means “excess pigment” – to be a little more precise, it means pigmentation above your normal skin tone.

Primary pigment disorders: Just as some people are predisposed to developing skin conditions such as eczema and acne, others are predisposed to developing skin pigmentation. In primary pigment disorders, hyperpigmentation occurs without any other symptoms. Melasma is the most common primary pigmentary disorder.
Post-inflammatory hyperpigmentation: In skin that tans easily, any type of skin inflammation usually resolves with hyperpigmentation. This hyperpigmentation is not permanent, but can last for several weeks to months depending on the area (areas further from the heart take the longest to resolve). Acne and eczema are the most common causes of post-inflammatory hyperpigmentation.
Sun-induced hyperpigmentation: The ability of the sun to cause wrinkles over time is generally known, but less known is the ability of the sun to cause redness and pigmentation of the skin over time. This usually presents as sunspots and a background, slight hyperpigmentation.

Melasma is a primary pigmentary disorder, which means that melasma presents with a progressive pigmentation of the skin without any other cause. Melasma usually presents with symmetrical flat patches ranging from tan to brown on the forehead, cheeks and/or upper lip. Melasma does not itch or burn and has no underlying scaling, pimples or pustules.

Increased oestrogen levels are a potential trigger for melasma, so it usually occurs in women under birth control and/or during pregnancy. However, it can occur in women without these triggers and even in men. It is more common in Asian, Hispanic and African-American skin tones, but occurs in all skin tones.
Sunlight is a trigger for melasma, so melasma tends to flare up in the summer months and/or during sunny holidays and improve naturally in winter. In addition, pollution and visible light can make melasma worse.

Hyperpigmentation vs Mélasma

Melasma can be differentiated from post-inflammatory hyperpigmentation by the absence of a previous rash and the symmetrical nature of melasma. Itchy skin suggests post-inflammatory hyperpigmentation due to an eczema-like rash. The presence of pimples and/or pustules suggests post-inflammatory hyperpigmentation due to acne.
Both melasma and sun-induced hyperpigmentation present without symptoms, but the symmetrical and cyclical nature of melasma helps to differentiate the two. Sun-induced hyperpigmentation progresses slowly each year with additional sun exposure. However, melasma is usually worse each summer and gets better each winter.
Of course, it is possible to have melasma and post-inflammatory hyperpigmentation or melasma and sun-induced hyperpigmentation. It is also quite possible to have all three. However, sun-induced hyperpigmentation tends to occur in lighter skin tones, and post-inflammatory hyperpigmentation tends to occur in darker skin tones.

Solutions

	*Treating sun-induced hyperpigmentation*	Treating post-inflammatory hyperpigmentation	*Prevention and treatment of melasma*
Prevention	A minimum SPF 30+ broad spectrum should be used daily, every day of the year.	Early and aggressive treatment of the underlying cause. This may include topical, oral or injectable medications to prevent the development of the previous rash.	A minimum SPF 30+ broad spectrum should be used daily, every day of the year.
Topicals	Daily use of topical antioxidants (vitamin C, vitamin E) and retinol can help reverse some sun-induced hyperpigmentation and help prevent further pigmentation.	For acne patients, a daily routine of retinol, azelaic acid and vitamin C is helpful in minimising post-inflammatory hyperpigmentation. For patients with eczema, topicals used to target pigmentation should be used with caution, as they are usually too irritating for sensitive skin.	Daily use of pigment-regulating topicals such as glycolic acid, vitamin C, retinol, azelaic acid, kojic acid, niacinamide and/or tranexamic acid can help minimise melasma.
Chemical peels at the institute or at home	This is the only form of hyperpigmentation where more aggressive chemical peels are beneficial.	These should be carried out under the guidance of experts. Overly aggressive chemical peels can aggravate post-inflammatory hyperpigmentation.	These should be carried out under the guidance of experts. Chemical peels that are too aggressive can aggravate melasma.
Laser	Intense Pulsed Light Therapy (IPL) is effective in treating the widespread redness and pigmentation that occurs with sun-induced hyperpigmentation. It is only suitable for fair skin.	Soft lasers such as microsecond and picosecond lasers can improve post-inflammatory hyperpigmentation. These should be performed with an expert as the wrong laser can create burns, scarring and/or additional post-inflammatory hyperpigmentation.	A range of low energy laser devices can be used to improve melasma, but lasers should be used with caution as melasma can be made worse by light and laser is a form of light.
Oestrogeen level controls			Switching to a non-estrogenic contraceptive may result in some improvement, although it may not lead to resolution of melasma. As different contraceptives have varying effectiveness, side effects and benefits, this decision should be made with the advice of your gynaecologist and dermatologist based on your specific skin problems and reproductive goals.
Oral therapy			For severe melasma, oral tranexamic acid can be very effective, but there are potential side effects. The risks and benefits should be discussed with your dermatologist.