Melasma vs Hyperpigmentation: Most People Treat the Wrong One
You’ve been using a vitamin C serum diligently for three months. The dark patches on your cheeks are no lighter. You try a retinol. Still there. You consider a brightening treatment at a skincare counter. The aesthetician looks at your skin and recommends something else entirely.
Sound familiar? It’s one of the most common frustrations in skin care — and one of the most medically significant. Because melasma and post-inflammatory hyperpigmentation look similar on the surface, but they are fundamentally different conditions with different causes, different behaviours, and critically different treatment approaches.
Getting the diagnosis right is not a minor detail. It’s the entire foundation of an effective treatment plan. Without a clinical assessment, choosing a laser for pigmentation becomes a game of chance; while the right device can precisely shatter stubborn melanin, the wrong wavelength can trigger a defensive inflammatory response, potentially making conditions like melasma darker and more resilient than before.
Melasma is a chronic skin condition characterised by brown or grey-brown patches that appear primarily on sun-exposed areas of the face — the cheeks, upper lip, forehead, and bridge of the nose. It has a characteristic bilateral symmetry: if you have it on the right cheek, you almost certainly have it on the left.
The underlying cause involves the overactivation of melanocytes — the pigment-producing cells in the skin. In melasma, these cells behave erratically, producing excess melanin in response to multiple triggers. The primary triggers are:
Even brief sun exposure can darken melasma significantly. This is the most consistent trigger across all patients.
Oestrogen and progesterone stimulate melanocyte activity. This is why melasma is strongly associated with pregnancy (earning the historical name “the mask of pregnancy”), hormonal contraception, and hormonal fluctuations around perimenopause.
Infrared radiation — heat rather than UV — is increasingly understood as an independent trigger for melasma. Hot environments, hot showers, and even heated indoor spaces can worsen it.
Skin injury or inflammation can activate melanocytes locally, deepening existing patches.
Melasma is classified by depth — epidermal (in the outer layers), dermal (in the deeper dermis), or mixed — which affects which treatments will be effective.
“Melasma is the most challenging pigmentation condition we treat,” says Dr. Low Chai Ling, Medical Director, SW1 Clinic. “It’s chronic. It recurs. It responds erratically to treatment. Patients who’ve tried everything and made things worse have often been treated too aggressively — which ironically triggers more pigmentation. The first principle of treating melasma is: do no harm.”
Hyperpigmentation is a broader term for any darkening of the skin above the normal baseline. It can be caused by:
- — darkening after acne, eczema, or skin injury
- — discrete dark spots from cumulative UV exposure
- — genetically determined, UV-activated
- — from certain medications
Unlike melasma, many forms of hyperpigmentation are not chronic conditions. A post-acne dark mark, for instance, is the skin’s normal inflammatory response to injury and will fade on its own over weeks to months — with appropriate treatment accelerating that process.
Sun spots tend to be more discrete, more uniform in colour, and less hormonally influenced than melasma. They respond exceptionally well to laser and light-based treatments that target melanin. Treatments like Quattro Toning are particularly effective for these concerns; by utilizing four distinct laser wavelengths, it can precisely break down pigment at various depths while maintaining a “cold” thermal profile that respects the skin’s integrity.
The clinical features that distinguish melasma from other pigmentation:
| Feature | Melasma | Sun Spots / PIH |
|—|—|—|
| Location | Cheeks, forehead, upper lip | Variable; often cheeks, nose, temples |
| Pattern | Bilateral, diffuse patches | Discrete spots or marks |
| Edges | Irregular, feathery | Usually sharper |
| Hormonal link | Strong | Weak or absent |
| UV sensitivity | Very high | Moderate |
| Heat sensitivity | Yes | Usually no |
A Wood’s lamp examination (a specific UV light tool) can help assess pigmentation depth. Dermal melasma, which sits deeper in the skin, appears lighter or absent under Wood’s lamp, while epidermal pigmentation enhances under it.
“One of the most common mistakes I see in patients who come to me after failed treatments is that they were treated for sun spots when they had melasma, or vice versa,” says Dr. Lee, SW1 Clinic. “Aggressive laser on melasma — particularly Q-switched or high-intensity treatments without the right protocol — can make it dramatically worse. The diagnosis directs everything.”
Melasma is managed, not cured. The treatment approach combines:
— non-negotiable and ongoing. Broad-spectrum SPF 50+, reapplied every two hours outdoors. Heat protection (wearing hats, avoiding hot environments) is increasingly recognised as equally important.
— hydroquinone (available by prescription), tranexamic acid, azelaic acid, kojic acid, and retinoids are used in various combinations to reduce melanocyte activity.
— gentle, low-density treatments with picosecond laser or low-fluence Q-switched nd:YAG are used at SW1 Clinic in carefully managed protocols to reduce melasma without triggering rebound. uses this principle effectively.
— increasingly used in Singapore and across Asia, tranexamic acid taken orally has well-documented efficacy in reducing melasma with minimal side effects [1].
These conditions generally respond more directly to:
— vitamin C, niacinamide, kojic acid, alpha-arbutin
— picosecond laser and BBL (broadband light) target discrete melanin deposits effectively. and at SW1 Clinic are designed for discrete pigmentation.
— superficial glycolic or salicylic acid peels accelerate pigment clearance in post-inflammatory hyperpigmentation.
Hui Lin, 38, had spent years treating what she assumed were sun spots with over-the-counter brightening products. The patches on her cheeks — symmetrical, diffuse, and resistant to everything — were in fact melasma.
After a proper diagnosis at SW1 Clinic, she was started on oral tranexamic acid, a topical combination protocol, and a series of gentle low-intensity laser treatments. “The approach was completely different from what I’d been doing,” she said. “Within three months, the patches had significantly lightened. The doctor told me to keep using SPF diligently and we’d maintain the result.”
If you’ve been treating skin pigmentation without seeing satisfying results, the problem may not be the treatment — it may be the diagnosis. A proper skin assessment will clarify exactly what you’re dealing with and what approach is most appropriate.
Book a consultation at to get an accurate picture.
[1] Karn, D., Kc, S., Amatya, A., Razouria, E. A., & Timalsina, M. (2012). Oral tranexamic acid for the treatment of melasma. , 10(40), 40–43. [2] Sheth, V. M., & Pandya, A. G. (2011). Melasma: a comprehensive update. Part II. , 65(4), 699–714. [3] Grimes, P. E. (1995). Melasma. Etiologic and therapeutic considerations. , 131(12), 1453–1457.
