The Differences between Melasma and Typical Hyperpigmentation — and How to Treat Them
Acne scarring. Sun damage. Inflammation lingering from an eczema flare-up. Hyperpigmentation, a broad term that refers to a skin condition in which the skin is discoloured or darkened, can be brought on by many different factors.
Credit: Getty Images
But, as it turns out, there's a type of hyperpigmentation that you may have never heard of until now. It's known as melasma, and it's a pigmentary condition that affects more than five million Americans, most of them being women. Much like general hyperpigmentation, melasma appears in the form of discolouration on the skin and is exacerbated by exposure to the sun. However, there are actually quite a few differences that set it apart from your run-of-the-mill hyperpigmentation (which we'll get into, don't worry).While no one should ever feel like they have to hide a skin ailment, it's important to know the differences between the two conditions if you choose to treat them. Ahead, a definitive breakdown of melasma and hyperpigmentation, the differences between the two, and how to treat them — as detailed by four trusted dermatologists.
Hyperpigmentation can refer to any darkening of the skin.
Whether you have post-blemish scarring from a stubborn breakout, freckles that expanded into full-blown sunspots from excess exposure, or discolouration caused by a condition like eczema or psoriasis, the discolouration usually all falls under the umbrella of hyperpigmentation. This is because acne, sunlight, skin rashes, and the like have the potential to stimulate melanocytes, the pigment-making cells in the skin, to make a surplus of pigment, "causing them to dump their pigment into lower levels of the skin, like tattoo pigment, where it doesn't belong," explains Adam Friedman, an associate professor of dermatology at George Washington University Medical Faculty Associates in Washington, D.C. The deeper the pigment, the tougher it is to treat. Put it this way: A section of skin that's been consistently exposed to harmful UV rays without the proper protection will be harder to diminish than say, a dark spot leftover from a pimple that you've been careful to shield from the sun. In other words, the level of severity varies, but if you spot discolouration on your skin that wasn't there before, it's safe to assume it's hyperpigmentation. But always consult your doctor to be sure, of course.
Melasma is in a league of its own.
Melasma is a form of hyperpigmentation that's more commonly seen in women (especially in those with darker skin tones) and is thought to be triggered by UV exposure, as well as hormonal influences. The latter is what distinguishes it from traditional hyperpigmentation and makes it tougher to treat. "Hormonal influences play a significant role here, as seen by the increased prevalence of pregnancy, oral contraceptive use, and other hormonal therapies," says Friedman. "The problem is preventing its worsening, especially from the hormonal angle, as it can be hard to remove the instigating factors."
You can usually tell if you have melasma based on its appearance alone. "[It] typically appears as symmetric blotchy hyperpigmented patches on the face, usually the cheeks, bridge of the nose, forehead, chin, and upper lip," says Sejal Shah, a dermatologist and founder of Smarter Skin Dermatology in New York City. While less common, melasma can appear on other parts of the body — especially those more prone to sun exposure (like the neck and forearms) — and many people say their melasma worsens in the summer and improves in the winter. "It may [also] appear during pregnancy or after starting birth control or other hormonal treatments," Shah says. (Something to consider if you've seen discoloration appear shortly after switching up your birth control or undergoing a hormonal change.)
Finally, there are a couple of factors that can contribute to the spreading of melasma: visible light and heat. For the former, New York City-based dermatologist Shari Marchbein recommends using makeup that contains iron oxide to help block visible light. Unfortunately, steering clear of infrared heat proves more difficult, as it can be generated just by being in hot environments such as a sauna, a steamy kitchen, or even the gym.
Most treatments are the same, but melasma is harder to get rid of.
As mentioned above, melasma is difficult to treat. This is because, unlike traditional hyperpigmentation, which responds to a variety of over-the-counter products that contain brightening agents like vitamin C, kojic acid, niacinamide, hydroquinone, and azelaic acid, melasma hasn't seen the same rate of success or consistency.
"Often what works for one person doesn't work for another, therefore, it is hard to pinpoint one treatment that is most effective for melasma," explains Shah. That said, she recommends a combination of sunscreen, brightening ingredients, and laser treatments, whereas, for basic hyperpigmentation, she typically uses chemical peels in place of lasers.
Marchbein echoes a similar plan of action when it comes to treating melasma. "The treatments are virtually the same for hyperpigmentation, except lasers in lower energy can be helpful in treating melasma," she says. Marchbein's favorite is the Clear + Brilliant laser, which she explains uses low energy fractionated technology to improve melasma, sun damage, and skin texture. The only caveat? Multiple treatments (at least three, according to Marchbein) will be needed on a monthly basis, and then every six months after that, to help maintain results.
All of this to say: Treatment depends on the severity of your melasma. Everyone's experience will be unique, and no treatment plan will be 100 percent perfect (something Friedman points out) or work the same way for someone else. So whether you have stubborn hyperpigmentation or melasma, be sure to talk with your dermatologist first to figure out the best form of treatment.
You can't correct or prevent either without sun protection.
We've stressed the importance of diligent sunscreen use too many times to count, but that's because it's basically the end-all-be-all when it comes to staving off any sun-induced ailment. Melasma is also triggered by hormonal factors, but that does applying an SPF 30 or higher every two hours, even if you're just going to be inside sitting near a window. It also can't hurt to double up on the protection with a moisturizer that contains SPF.
Bottom line: Hyperpigmentation and melasma happen, but with the proper precaution (hi, SPF) the skin conditions can likely be avoided.