Hyperpigmentation is one of the most common skin concerns yet it is also one of the most misunderstood. Dark patches on the skin often get grouped together online and in everyday conversation, which is why many people assume they have the same condition when in reality the causes can be very different. The most common forms, melasma, sun damage and post-inflammatory hyperpigmentation (PIH), can look similar at first glance. However, they behave differently and may need different approaches. Failure to understand this can sometimes result in the wrong treatment which can be frustrating and in some cases even make things worse! In this article, we take a deep dive into differences between melasma vs other forms of hyperpigmentation and how this can affect treatment options.
What is Hyperpigmentation?
Hyperpigmentation refers to areas of skin that appear darker than the surrounding skin because of increased or uneven melanin production. Although it is often spoken about as a single issue, hyperpigmentation can behave very differently depending on what has triggered it and how deeply the pigment sits within the skin. Some forms fade gradually, others persist for years and some are prone to relapse even with good skincare routines. In practice, most people’s hyperpigmentation falls into three main categories. These are melasma, post-inflammatory hyperpigmentation (PIH) or sun-related pigmentation such as sunspots. Each of these has its own triggers, appearance and behaviour. Knowing these differences matters because it can provide a more effective approach to treatment and maintenance.
How Does Melasma Look?
Melasma is one of the most recognisable forms of hyperpigmentation but it is also one of the most easily misinterpreted. Although anyone can get it, it is more common in people with medium to darker skin and women are more at risk than men. Whilst its exact cause is unknown, it is strongly influenced by hormones, sunlight and heat. This is why it often appears during pregnancy and other periods of hormonal changes and usually worsens in the hotter seasons. However, whilst sun exposure does trigger and worsen melasma, it does not develop from UV damage alone. In general, melasma develops gradually, often fluctuates and can behave unpredictably vs other forms of hyperpigmentation. Typical features of melasma include:
- Pattern: Symmetrical patches of hyperpigmentation usually on the cheeks, forehead, temples or upper lip. It can also affect the neck and rarely other areas.
- Appearance: Brown or grey-brown patches with soft, blurred edges that blend gradually into surrounding skin.
- Behaviour: Deepens with heat, sunlight or irritation. Tends to fade slowly even with consistent treatment.
- Triggers: Hormones, sunlight, visible light and heat.
- Depth: May involve both superficial and deeper pigment which can lead to patchy response to treatment.
As a rough rule, melasma almost always has a soft, “smudged” quality rather than sharply defined borders. This can help distinguish it from post-inflammatory hyperpigmentation vs sunspots which tend to have clearer outlines. The condition also relapses easily, so successful management relies on long-term maintenance.
What is Post-Inflammatory Hyperpigmentation?
Post-inflammatory hyperpigmentation (PIH) refers to the dark areas of skin that appear after inflammation or injury. Acne, eczema flares, insect bites, burns, friction and even overuse of harsh skincare can leave behind these marks once the skin has settled. PIH can happen in any skin tone, although it tends to be more noticeable and persistent in medium to darker skin. Many people confuse PIH with scarring or melasma because it can linger long after the original issue has resolved. In reality, PIH is simply the skin’s response to inflammation and tends to follow the exact outline of where the irritation occurred. Typical features of PIH include:
- Pattern: Dark spots or patches that match the site of previous inflammation rather than appearing in new areas.
- Appearance: Tan, brown or grey-blue marks with more defined borders than melasma.
- Behaviour: Fades gradually over weeks to months (sometimes years) on its own. Improvement can be slower if the underlying inflammation is still active.
- Triggers: Acne, scratching or skin picking, eczema, rashes, burns or any injury to the skin.
- Depth: Superficial PIH fades more easily and is more common. Deeper PIH looks grey or blue and takes longer to improve.
Its worth noting that a related concern is post-inflammatory erythema (PIE), which shows up as pink or red marks instead of brown. PIE is more common in lighter skin tones and reflects temporary changes in blood vessels rather than excess melanin. The two can exist together and this can affect treatment options.
What are Sunspots?
Sun damage develops slowly over years of repeated exposure to sunlight. As the skin accumulates UV and visible light over time, pigment-producing cells can become overactive in specific areas. This leads to flat brown marks known as sunspots or solar lentigines. These are common with age and are often more noticeable in people who spend a lot of time outdoors or who have had inconsistent sun protection in the past. Sunspots are sometimes mistaken for melasma, but unlike melasma they are not influenced by hormones and do not fluctuate in the same way. Typical features of sunspots include:
- Pattern: Individual, well-defined brown spots rather than diffuse patches.They may be different shapes and sizes.
- Location: Areas with chronic sun exposure such as the cheeks, temples, chest, shoulders and hands.
- Appearance: Flat, round or oval light- to medium-brown spots with crisp borders.
- Behaviour: Deepen or increase with ongoing sun exposure and rarely fade on their own.
- Relevance: Long-term sun exposure contributes to these marks and may also signal underlying sun damage elsewhere on the skin.
Sunspots often appear alongside other signs of solar ageing such as fine lines, rougher texture, large pores or visible blood vessels. Their defined edges and predictable location usually help distinguish them vs melasma or post-inflammatory hyperpigmentation. Because sunspots do not fluctuate or fade much without treatment, they tend to be more consistent in appearance once they develop. This is one of the simplest visual clues that you are dealing with sun-related pigmentation rather than hormonally driven or inflammation-related causes.
How to Tell the Difference Between Melasma vs Other Types of Hyperpigmentation
Although hyperpigmentation often looks similar on the surface, there are a few practical clues that can help distinguish melasma, PIH and sun damage. None are perfect on their own and many people have more than one type at the same time. However looking at the overall pattern can give a clearer sense of what you’re dealing with. The key differences between melasma vs the other main forms of hyperpigmentation include:
- Location: Melasma sits symmetrically across central areas of the face such as the cheeks, temples, forehead or upper lip. PIH appears exactly where inflammation or injury occurred. Sunspots favour areas with long-term sun exposure including the cheeks, hands and chest.
- Edges: Melasma usually has soft, blurred borders that fade gradually into neighbouring skin. PIH shows sharper, more defined edges that mirror the outline of the original inflammation. Sunspots tend to have crisp, round or oval borders that stay consistent.
- Colour: Melasma is usually brown or grey-brown. PIH can range from tan or brown to a deeper grey-blue depending on how far down the pigment sits. Sunspots are usually light to medium brown depending on skin tone and often look more uniform in colour.
- Behaviour: Melasma deepens with heat, sunlight or irritation and often fluctuates over time. PIH fades slowly if the underlying inflammation settles and is less likely to recur once triggers are controlled. Sunspots remain relatively stable once they appear and tend to accumulate with ongoing sun exposure rather than fading.
Why Any of This Matters
Correctly identifying the type of pigmentation you have is important because each behaves differently and responds to different treatments. This matters because each one responds differently to treatment. Melasma, for example, can worsen with certain light-based procedures, PIH often deepens with over-exfoliation and sunspots rarely improve without targeted treatment. A clearer understanding of the underlying cause of hyperpigmentation makes it easier to choose the best treatments and management approach. Here are some of the key reasons why the difference between melasma vs other types of hyperpigmentation matters:
- Melasma: This form of pigmentation often worsens with heat, irritation, visible light and certain in-clinic treatments. As such gentler pigment-suppressing skincare such as hydroquinone, regular use of retinoids (if tolerated), azelaic acid, tranexamic acid or cysteamine can be helpful, but progress is slow. Strict protection from sunlight using iron oxide-containing sunscreens and heat are essential. Avoid heat-based procedures, excessive exfoliation and certain laser or light treatments as these can worsen melasma. Long-term maintenance is almost always required.
- PIH: This responds best when inflammation is controlled early and the skin barrier is kept calm. Retinoids, azelaic acid, pigment suppressors and niacinamide can all help fade marks gradually. However, over-exfoliation or using too many actives tends to backfire by prolonging irritation or causing purging. Chemical peels, resurfacing lasers and LED treatments can help in some cases. Picking, friction and harsh products or treatments can make PIH darker and more persistent. As such a slower, steadier approach with consistent sun protection usually delivers the most reliable improvement.
- Sunspots: These marks are the least likely to fade without targeted treatment and tend to accumulate with ongoing sun exposure. Daily sunscreen and antioxidants help prevent new spots. Retinoids can improve skin texture and support cell turnover. Sunspots often also need prescription skincare or in-clinic treatments such as chemical peels, IPL or certain types of laser. Treating sunspots also requires strict sun protection as this is what causes them.
Most hyperpigmentation is harmless and can be safely managed with consistent, gentle skincare. However, a professional opinion can be helpful if something doesn’t behave as expected or if you feel unsure about the best way to treat it. It’s sensible to seek a review if you’re unsure what you’re dealing with or if your hyperpigmentation spreads quickly, deepens without a clear trigger or shows irregular borders, asymmetry or unusual colours. Itching, bleeding, pain or persistent scaling are not typical of routine hyperpigmentation and should also be assessed. Likewise, new or changing lesions in areas of long-standing sun exposure are worth checking, particularly if you have a personal or family history of skin cancer.
Melasma, PIH and sunspots may look similar at first glance, but they behave very differently and this is why treating them in the same way doesn’t always work. A clearer understanding of the pattern, colour and behaviour of your hyperpigmentation helps you choose skincare that is more likely to make a meaningful difference and avoids approaches that can worsen the problem. It also helps identify optimal ways to maintain your results and prevent recurrence. As with most things in skincare, progress takes time so you need to add consistency and patience to your skincare routine. If you’re unsure about the best approach for you or are not managing to see progress, its worth seeking professional advice.
At City Skin clinic, we are beyond passionate about personalised skincare. Our virtual skin clinic offers safe and effective custom skin treatments. Where appropriate our doctors use ingredients such as Tretinoin, Hydroquinone and Tranexamic acid to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
