Hyperpigmentation vs Melasma: How to Tell the Difference — and Why It Changes Treatment
Hyperpigmentation and melasma are often used interchangeably — by patients, and sometimes even in skincare marketing. They're not the same condition. They share some treatment approaches, but they differ in cause, presentation, and importantly, in which actives are most appropriate and why.
Getting the distinction right matters because treating melasma like general hyperpigmentation — or using aggressive depigmenting agents on the wrong type — can produce suboptimal results or, in some cases, worsen the problem.
What hyperpigmentation is
Hyperpigmentation is a broad term for any area of skin that's darker than the surrounding skin due to excess melanin deposition. It's an umbrella term that includes several distinct types:
Post-inflammatory hyperpigmentation (PIH) — dark marks left after inflammation, most commonly acne, eczema flares, or skin injury. Triggered by the inflammatory process, which stimulates melanocytes to produce excess melanin. More pronounced in medium to darker skin tones.
Sun damage / solar lentigines — flat dark spots caused by cumulative UV exposure. Common on the face, hands, and décolletage. Increase with age and sun exposure.
Post-inflammatory erythema (PIE) — technically a vascular response (redness) rather than melanin-based, but often grouped with hyperpigmentation. Distinct treatment considerations. Read more about PIE vs PIH.
What melasma is
Melasma is a specific type of hyperpigmentation with distinct characteristics:
Pattern. Melasma appears in patches, typically symmetric, on the cheeks, forehead, upper lip, and chin. The symmetry and distribution are characteristic — melasma follows specific anatomical patterns that other hyperpigmentation types don't.
Trigger. Melasma is driven by hormonal factors — it's strongly associated with pregnancy, hormonal contraceptives, and perimenopause — combined with UV exposure. The hormonal component makes it distinctly different from post-acne marks or sun spots.
Mechanism. Melasma involves chronic overactivation of melanocytes in the affected areas. Even after existing pigment fades, the overactive melanocytes remain and can re-trigger with UV exposure or hormonal changes.
Depth. Melasma can be epidermal (shallower, more responsive to treatment), dermal (deeper, more resistant), or mixed. The depth affects how well it responds to topical treatment.
How to tell them apart
Hyperpigmentation (PIH/sun damage) Melasma Pattern Irregular, follows injury or sun exposure sites Symmetric patches on central face Trigger Inflammation or UV Hormones + UV Onset After specific trigger event Gradual, often during pregnancy or perimenopause Symmetry Usually asymmetric Usually symmetric Responds to Retinoids, brightening actives Requires combination protocol, ongoing management
In practice, many patients have both — post-acne PIH alongside hormonal melasma. The clinical assessment distinguishes between them and formulates accordingly.
Why treatment differs
For PIH and sun damage: the goal is fading existing melanin deposits and preventing new ones. Prescription tretinoin in the Core Formula accelerates cell turnover, shedding pigmented cells faster. The Pigment Modulation add-on adds tranexamic acid, azelaic acid, and kojic acid to inhibit melanin synthesis. Read more about how to treat melasma for a detailed breakdown of the prescription protocol.
For melasma specifically: the same actives apply, but the hormonal context requires additional consideration. Hydroquinone is used in cycles rather than continuously for melasma — because prolonged unsupervised use carries ochronosis risk. Sun protection is even more critical because UV is a primary ongoing trigger. Hormonal context — whether melasma is driven by active oral contraceptive use, pregnancy history, or perimenopause — informs the clinical approach.
The most important practical difference: melasma management is ongoing. Unlike PIH that fades after the trigger resolves, melasma requires continuous sun protection and often maintenance treatment to prevent recurrence.
Getting the right prescription
The Laevo assessment covers your pigmentation pattern, distribution, trigger history, and skin tone. Your clinician identifies what type of pigmentation you're dealing with and prescribes the appropriate combination — whether that's a retinoid plus brightening actives for PIH, a full melasma protocol with cycled hydroquinone, or a combination approach for mixed presentations.
Assessment fee applies. Prescription required — not all applicants will be approved. Individual results vary. This article is for informational purposes only and does not constitute medical advice.
