Pigmentation & Melasma

Understanding Pigmentation and Melasma

Pigmentation concerns can develop for a number of reasons and may present as localised spots, patches or more diffuse changes in skin colour. Melasma is a chronic pigmentary disorder that commonly presents as symmetrical areas of brown or grey-brown pigmentation, most often on the face. Accurate assessment is important, as different types of pigmentation can respond differently to treatment.

Pathogenesis

Pigmentation disorders can involve:

Melanocyte hyperactivity, increased activity of the cells responsible for producing melanin.
Increased melanin production
Dermal pigment deposition
Vascular changes, particularly in some cases of melasma.

The depth and location of pigmentation within the skin can influence how it responds to treatment.

Types of Pigmentation

Common types of pigmentation include:

Melasma Subtypes

Melasma may be classified according to the depth and characteristics of the pigmentation:V

Vascular changes may also contribute to melasma in some patients.

Contributing Factors

A number of factors can contribute to pigmentation and melasma, including:

Ultraviolet exposure
Visible light
Heat
Hormonal influences
Genetics
Inflammation
Certain medications
Lifestyle and environmental factors

Grading

Pigmentation is assessed according to:

Depth
Distribution
Severity
Pattern
Potential triggers
Previous treatments
Impact on quality of life

Treatment by Severity

Mild

Azelaic acid, vitamin C, niacinamide, retinoids, strict SPF.

Moderate

Combination topicals, hydroquinone (short courses), peels, laser toning, microneedling.

Moderate–Severe

Triple therapy, advanced peels, Q-switched/picosecond lasers, vascular lasers, oral tranexamic acid.

Severe

Multimodal therapy, long-term maintenance, dermatology referral.