Pigmentation & Hyperpigmentation: Why It Happens and How to Treat It Safely

Pigmentation is one of the most common skin concerns I see in clinic, and one of the most frustrating to treat. It can be stubborn, it often returns, and the wrong approach can genuinely make it worse.

The darker marks left after a blemish. Brown patches across the cheeks. Sun spots that become more noticeable over time. They may look similar, but they are not always caused by the same thing, and they should not all be treated in the same way.

When treating pigmentation and hyperpigmentation, getting the diagnosis right is the first part of the puzzle. From there, the aim is not to attack pigment aggressively, but to understand what is driving it and treat the skin consistently.

Gentle and patient beats fast and harsh every time.

What Causes Hyperpigmentation?

Your natural skin colour comes from melanin, a pigment produced by cells called melanocytes. Inside these cells, an enzyme called tyrosinase helps control melanin production.

Hyperpigmentation develops when melanocytes become overstimulated and produce excess pigment in certain areas.

The main triggers are:

• Ultraviolet light
• Inflammation
• Hormonal changes

Heat and visible light can also contribute, particularly in melasma.

Most effective pigmentation treatments work by helping to regulate pigment production. But treatment will always be limited if you do not also address the trigger behind it, and very often, that trigger is sunlight.

What Are the Different Types of Pigmentation?

Understanding the type of pigmentation you have is essential because melasma, post-inflammatory hyperpigmentation and sun spots need slightly different approaches.

Melasma

Melasma usually appears as symmetrical brown or grey-brown patches across the cheeks, forehead, upper lip or chin.

It is strongly influenced by hormones and may appear during pregnancy or alongside hormonal contraception or HRT. UV exposure, heat and visible light can all worsen it.

Melasma is chronic and relapsing, so patience is essential.

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation, or PIH, is the flat brown pigmentation left behind after inflammation or injury.

Acne, eczema, burns and some skin procedures can all trigger it. It is particularly common and persistent in deeper skin tones and may take months to fade.

Sun Spots

Sun spots, or solar lentigines, tend to develop on areas with high cumulative sun exposure, including the face, chest and hands.

Sun Protection Is Part of the Treatment

If you take one thing from this article, make it this: sunscreen is not an optional extra when treating pigmentation.

UV exposure stimulates melanin production and can undo the progress you are making elsewhere in your routine.

I recommend a broad-spectrum SPF 50 every day, all year round, with appropriate reapplication when outdoors.

For melasma, a tinted SPF containing iron oxides can offer additional protection from visible light.

Hats, sunglasses and shade also matter. Protect properly and every other treatment has a better chance of working and lasting.

The Best Skincare Routine for Pigmentation

It helps to think of pigmentation treatment as a ladder.

Sun protection sits permanently at the bottom. From there, we build with barrier support and targeted skincare before considering prescription or in-clinic treatments where necessary.

The first rule is to keep the skin calm.

Over-cleansing, harsh exfoliation and an overloaded routine can increase inflammation, potentially making pigmentation more difficult to manage.

In the morning, Light Cleanse provides a gentle cleanse before AM actives.

In the evening, Deep Cleanse supports thorough cleansing as part of the PM protocol.

Follow with Preparatory Mist and a moisturiser suited to your skin, such as Peptide Emollient Veil or Peptide Emollient Veil+.

A calm, resilient barrier creates a better environment for targeted ingredients to work.

Repair before you treat.

The Best Ingredients for Pigmentation

Once the skin is stable, we can start targeting excess pigment more directly.

Vitamin C + Niacinamide

Vitamin C provides antioxidant support while helping improve brightness and uneven tone.

Niacinamide helps reduce the transfer of pigment into skin cells while supporting the skin barrier.

For the morning, Protect Elixir combines stabilised Vitamin C and Niacinamide to support brightness, antioxidant defence and barrier function.

Azelaic Acid

Azelaic Acid helps regulate excess pigment production while also calming inflammation, making it particularly useful for post-inflammatory hyperpigmentation and melasma.

Alpha Arbutin + Retinoids

Alpha Arbutin helps inhibit tyrosinase activity, while Retinoids support skin-cell turnover and the gradual clearing of existing pigment.

At night, Treat Tincture supports skin renewal and uneven tone as part of the PM protocol.

Retinoids should be introduced gradually and consistently and are not suitable for use during pregnancy.

The best treatment is not simply the strongest one. It is the one your skin can tolerate well enough to use consistently.

Can Exfoliation Help Hyperpigmentation?

Yes, but more is not better.

Too much exfoliation can compromise the skin barrier, increase inflammation and potentially worsen pigmentation, particularly in melasma and deeper skin tones.

For suitable skin, Weekly Decree provides a structured once-weekly resurfacing treatment designed to support tone, texture and skin renewal without encouraging constant over-exfoliation.

Consistency beats intensity.

What Professional Treatments Can Help Pigmentation?

When skincare alone is not enough, prescription and in-clinic treatments may be useful.

Options can include prescription-strength Azelaic Acid, Hydroquinone and, in selected cases of melasma, oral Tranexamic Acid under medical supervision.

Carefully selected chemical peels can also help with superficial pigmentation.

Lasers and light-based treatments require more caution. They can work well for some sun spots, but aggressive lasers and IPL may worsen melasma or trigger post-inflammatory hyperpigmentation in deeper skin tones.

The treatment needs to suit the type of pigmentation, skin tone and underlying trigger.

How Long Does Hyperpigmentation Take to Fade?

There is no single timeframe.

Post-inflammatory pigmentation may take several months to fade, while melasma is chronic and relapsing, meaning the aim is often long-term control rather than a quick permanent fix.

Constantly changing products or escalating to stronger treatments can be counterproductive.

Pigmentation is a project measured in months, not days.

When Should Pigmentation Be Checked?

There is one safety point I never skip.

If a pigmented spot is new, changing, growing, has an irregular border, contains more than one colour or simply looks different from the others, please have it professionally assessed.

Most pigmentation is harmless. However, melanoma and other skin cancers can sometimes present as a dark or changing lesion, and that should never be treated as a cosmetic pigmentation concern.

When in doubt, get it checked.

Dr Anita's Approach to Treating Pigmentation

Pigmentation is not something I believe should be attacked.

Identify the type first. Reduce the triggers driving excess melanin production. Protect the skin from UV exposure. Keep the barrier healthy and introduce targeted actives gradually.

Then give the skin time.

Pigment is a project measured in months, not days.

Gentle and patient beats fast and harsh every time.