Different Kinds of Pigmentation: Causes & Treatments | Dr Maryam Zamani Guide

Pigmentation is one of the most common skin concerns we see at The Clinic. Many patients also look for clarity on why it develops and which treatments genuinely work long-term. According to Dr Maryam Zamani, leading eyelid surgeon and facial aesthetics doctor, pigmentation can emerge from things like UV exposure, hormonal changes or inflammation, and each type requires a tailored approach. 

Understanding these distinctions is key to choosing the best treatment for melasma on the face, and for understanding the most suitable laser treatment for pigmentation. In this guide, Dr Zamani explains the different types of pigmentation, how they form and what causes them, and which evidence-based skincare and in-clinic treatments can improve pigment while minimising the risk of recurrence.

Types of Pigmentation

1. Sun-Induced Pigmentation (Solar Lentigines)

Often called sunspots or age spots, these dark patches are caused by cumulative UV exposure. 

UV rays stimulate melanocytes, prompting them to overproduce melanin, which collects in visible patches. This form of pigmentation responds well to options such as peels, light-based devices and targeted laser treatment for dark spots, particularly in lighter skin tones.

Dr Zamani’s recommendation: Brighten & Perfect 10% Vitamin C Corrective Serum

2. Melasma

Melasma, which Dr Zamani has personally experienced, appears as symmetrical brown patches on the cheeks, forehead, jawline or upper lip. It is strongly linked to hormonal fluctuations - pregnancy, oral contraceptives or other hormonal shifts, and is often worsened by UV exposure and heat. Dr Zamani has her own personal experience with Melasma during her pregnancy, and has designed a pioneering treatment plan for those having the same experience as her.

Melasma involves:

• Overactive melanocytes
• Vascular and dermal changes
• A tendency to recur

Determining the best treatment for melasma on the face requires specialist assessment, as melasma is notoriously reactive and needs a gentle, long-term management approach.

Dr Zamani’s recommendation: Melasma Protocol

3. Post-Inflammatory Hyperpigmentation (PIH)

PIH appears after inflammation or injury, from acne, eczema, bites, trauma or harsh cosmetic procedures. The deeper the inflammation, the darker and longer-lasting the pigment.

PIH is especially common in darker skin tones, and cautious, non-irritating treatment strategies are essential.

How Does Pigmentation Develop?

Regardless of the trigger, whether it’s sun, hormones or inflammation, pigmentation follows a similar process:

1. A trigger activates melanocytes.
2. Melanocytes produce excess melanin.
3. Melanin is transferred into surrounding skin cells.
4. Pigment accumulates in the skin’s upper (epidermal) or lower (dermal) layers.

The depth of melasma determines whether topical skincare, peels or laser treatment for dark spots will be most effective.

Can Skincare Improve Pigmentation?

Yes, most definitely! MZ SKIN uses science-led, evidence-based topical ingredients that significantly reduce pigmentation by inhibiting melanin production, increasing cell turnover or reducing inflammation.

Key Active Ingredients

Hydroquinone (HQ)
A gold-standard prescription agent that reduces melanin production. Best used in short cycles under medical supervision.

Azelaic Acid
A well-tolerated option for melasma and PIH, often as effective as hydroquinone.

Retinoids (Retinol, Tretinoin)
Boost cell turnover and help disperse pigment, making them valuable in combination regimens.

Tranexamic Acid (TXA)
Highly effective for melasma, available topically and orally. Addresses pigment and vascular pathways.

Other helpful ingredients
Niacinamide, Vitamin C, Kojic Acid, Cysteamine and Arbutin support brightening and even skin tone.

How Long Does It Take to See Results?

Pigmentation rarely fades quickly. Patients should expect:

• 4–8 weeks: early changes in mild superficial pigmentation
• 8–12+ weeks: improvement in melasma or deeper pigment
• Several months: sustained clearance and maintenance

Consistency and daily sun protection are essential.

Is Hydroquinone Still the Best Prescription Treatment?

Hydroquinone remains the gold standard as an effective, particularly for stubborn superficial pigmentation. However:

• It must be used under medical supervision.
• Long-term use can cause irritation or, rarely, ochronosis.
  
  

Modern alternatives, such as azelaic acid, topical tranexamic acid and cysteamine, offer strong results with fewer side effects and are suitable for long-term maintenance.

The best treatment for melasma on the face may combine prescription skincare with in-clinic therapies, depending on skin type and severity.

Effective In-Clinic Treatments for Pigmentation

Many professional treatments can enhance pigment clearance, but careful selection is essential, particularly for darker skin tones with continued skincare..

1. Chemical Peels

(Glycolic, Lactic, Low-Strength TCA)
Useful for superficial pigmentation, but must be used conservatively in darker skin types.

2. Fractional & Non-Ablative Lasers

(Picosecond, Q-Switched, MOXI, HALO)
These can effectively target pigment or stimulate remodelling.
They are often chosen when seeking the most effective laser treatment for dark spots, but expert selection is crucial to avoid rebound pigmentation.

3. IPL / BBL

Ideal for sun-induced pigmentation in lighter skin tones.
Higher PIH risk in darker phototypes.

4. Microneedling & RF Microneedling

Valuable adjuncts for PIH and melasma, with broad safety in varied skin tones in combination with other treatments or topical skincare..

The Importance of Skin Tone

Darker skin tones (Fitzpatrick III–VI) have a higher risk of post-inflammatory hyperpigmentation and require more conservative, tailored treatment plans.

Low-strength peels, tranexamic acid, microneedling and select radiofrequency devices may be safer alternatives to energy-based lasers.

Does Pigmentation Return?

Unfortunately, pigmentation, particularly melasma, can recur. Long-term maintenance is key.

Prevention and Maintenance

1. Daily UV Protection
Broad-spectrum SPF 30–50, ideally mineral-based (zinc/titanium), is non-negotiable.

2. Maintenance Skincare
Retinoids, azelaic acid, niacinamide or intermittent hydroquinone support long-term stability.

3. Hormone Review
For melasma, reviewing hormone triggers may reduce recurrence.

4. Medical Management
Oral TXA can be considered for difficult melasma cases under specialist guidance.

In Summary

Pigmentation is multifactorial and often persistent, but with expert-led treatment, from prescription skincare to targeted laser treatment for dark spots, significant improvement is achievable. Melasma, in particular, benefits from a carefully structured approach to identify the best treatment for melasma on the face, maintain results and prevent relapse.

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