Answer first: hyperpigmentation is not one condition. The main types seen in Australian clinics are sun-induced pigmentation, post-inflammatory hyperpigmentation left behind by acne or injury, and melasma, which is hormonally influenced, sits deeper, and behaves very differently from the other two. They do not respond to the same approaches, and treating melasma as though it were sun damage can make it worse. Separately, some pigment changes are not cosmetic at all, and a new, changing or non-healing pigmented spot should be examined by a doctor before anyone discusses treating it.
What causes pigmentation in the first place?
Melanin is produced by cells called melanocytes, and it is the body’s response to insult, most commonly ultraviolet exposure. Hyperpigmentation is what happens when that production is increased, uneven, or when pigment ends up deposited where it is not usually visible.
Where the pigment sits matters as much as why it is there. Pigment in the upper layers behaves differently, and responds differently, to pigment that has dropped deeper into the skin. This is the reason a single approach does not work across all types, and it is the reason honest assessment precedes any treatment discussion.
What are the main types?
Sun-induced pigmentation. Solar lentigines, commonly called sun spots or age spots, and freckling. Usually well-defined, on areas with the most cumulative exposure: face, backs of hands, forearms, chest, upper back. In Australia these tend to appear earlier and in greater number than in most of the world, for the obvious reason.
Post-inflammatory hyperpigmentation. The flat brown or grey mark left behind after inflammation has resolved. Acne is the most common cause, but any inflammation can do it, including a burn, a scratch, an insect bite, eczema, or a cosmetic treatment that was too aggressive for the skin it was performed on. It is more common and more persistent in deeper skin tones. It is not a scar, and the distinction matters: a scar is a change in tissue structure, while post-inflammatory hyperpigmentation is a colour change that often fades over months, though sometimes slowly.
Melasma. Symmetrical, patchy, often on the cheeks, forehead, upper lip and jawline. Strongly associated with hormonal change, including pregnancy and the oral contraceptive pill, and driven by heat and light as well as UV. It disproportionately affects women, and it is more common in some ethnic backgrounds than others.
Melasma is the type that most needs to be identified correctly, because it is chronic and relapsing rather than curable, it can be aggravated by heat alone, and it can be significantly worsened by treatments that suit sun-induced pigmentation. Anyone who proposes an aggressive approach to melasma without discussing the risk of rebound is not managing it properly.
Other causes. Pigment change can also follow certain medications, be associated with endocrine conditions, or reflect a skin condition that needs diagnosis. Sudden, widespread or unexplained pigment change should be investigated rather than treated cosmetically.
Why does the type change what can be done?
Because the mechanisms are different.
Sun-induced pigmentation is a record of accumulated exposure. Without changing sun behaviour, anything done to it is temporary by definition, because the driver is still present.
Post-inflammatory hyperpigmentation is a consequence of something that has already resolved. Managing it usually starts with preventing further inflammation, which means addressing the acne or the underlying condition rather than the mark.
Melasma is an ongoing, hormonally and thermally influenced process. It is managed rather than cured, it commonly returns, and heat and visible light are relevant, not only UV. That last point is why sunscreen advice for melasma differs from general sunscreen advice.
If someone offers you the same protocol for all three, they have not distinguished between them.
When should you see a doctor rather than a cosmetic clinic?
This section matters more than the rest of the article.
See your GP, a skin cancer clinic or a dermatologist promptly if you notice:
- A new pigmented spot appearing in adulthood
- A spot that is changing in size, shape, colour or elevation
- A spot with an irregular or blurred border, or more than one colour within it
- A spot that itches, bleeds, crusts, or does not heal
- A spot that looks different from your others
- Sudden, widespread or rapidly developing pigment change
- Pigment change alongside other symptoms such as fatigue or weight change
A cosmetic clinic is not the right first stop for any of these. Treating a lesion cosmetically without knowing what it is can delay a diagnosis that matters, and in Australia, where melanoma incidence is among the highest in the world, that is not a theoretical concern.
Any registered practitioner assessing pigmentation should be prepared to tell you when something needs a doctor rather than a treatment plan, and should do so without hedging.
What is the foundation of managing pigmentation?
Sun protection, and it is not an exciting answer.
Daily broad-spectrum sunscreen, reapplied, plus shade, hats and clothing. Without it, pigmentation management is uphill, because the driver is never removed. For melasma specifically, protection from heat and visible light is also relevant, and this is one of the situations where a tinted product is often discussed for reasons beyond cosmetics.
Barrier health matters too, because compromised skin inflames more readily and inflammation drives pigment. We have covered that in understanding the skin barrier and what affects it.
The other foundation is patience. Pigmentation changes over months, not weeks, and approaches that promise speed generally do so by increasing inflammation, which in pigmented skin is precisely the wrong direction.
What is discussed in a clinic assessment?
An assessment looks at the pattern and distribution, takes a history including hormonal factors, medications, sun exposure and previous treatments, and considers your skin type, because skin type materially changes the risk profile of anything proposed.
BeautyFULL CMC offers a range of skin rejuvenation approaches, and the differences between two of the more commonly discussed ones are set out in microneedling and chemical peels: key differences.
What cannot honestly be said in advance of an assessment is whether any of them is appropriate for your pigmentation, or what would happen. Pigmentation is variable, some types respond partially, some recur, and some do not respond.
Skin treatments carry risks, and in the context of pigmentation one risk deserves particular emphasis: treatment itself can cause post-inflammatory hyperpigmentation, and that risk is higher in deeper skin tones and higher again in melasma. This is a genuine reason to be cautious rather than a disclaimer. Other risks include redness, swelling, flaking, sensitivity and infection. Our risks and safety information covers per-treatment side effects and when to contact the clinic.
Frequently asked questions
Can hyperpigmentation be permanently removed? Some sun-induced pigmentation responds well. Post-inflammatory pigmentation often fades over time. Melasma is generally managed rather than cured and commonly recurs. Claims of permanent removal should be treated with scepticism.
How long does post-inflammatory hyperpigmentation take to fade? Often months, and sometimes longer, particularly in deeper skin tones. Preventing further inflammation is the main lever.
Does melasma go away after pregnancy? It sometimes improves after pregnancy or after stopping hormonal contraception, and it sometimes persists. It varies.
Is pigmentation worse in Queensland? UV exposure is a primary driver, and the UV environment in south-east Queensland and northern New South Wales is high for most of the year, including winter. Incidental daily exposure accumulates.
Can makeup or skincare cause pigmentation? Products that irritate the skin can cause inflammation, and inflammation can leave pigment. Fragranced products and over-exfoliation are the common culprits.
Should I get a mole checked before a cosmetic treatment? If you are unsure about any pigmented lesion, have it examined by a doctor first. That is the correct order.
Speaking with a practitioner
General information about pigmentation is not a substitute for having your skin examined. If any lesion is new, changing or not healing, see a doctor before you consider a cosmetic treatment.
If you would like a registered practitioner to assess your skin and discuss what is contributing to your pigmentation, you can arrange a consultation at our Holland Park West clinic in Brisbane or our Kingscliff clinic in NSW through our contact page. A consultation includes a discussion of risks, alternatives and the option of no treatment, and does not commit you to proceeding.