Dark patches of pigmentation that appear on the skin can be incredibly frustrating - they prevent the reflection of light, contributing to a dull and uneven complexion – and it can often feel that no matter what you do they never totally disappear. But did you know that not all dark spots are created equal and identifying what’s triggering an increase in patchy pigmentation could help immensely when it comes to how you go about evening out your skin tone.

"Any increased pigmentation in the skin beyond its baseline colour is described as hyperpigmentation. It can be caused by a variety of factors, but is usually secondary to inflammation or hormonal shifts. One common example of hyperpigmentation is melasma,” explains EV Expert and Cosmetic Physician Dr Emmaline Ashley.

It can be tricky to differentiate regular hyperpigmentation and melasma (sometimes called the mask of pregnancy). However, while melasma falls under the umbrella of hyperpigmentation, it has a distinct underlying cause.

What is melasma?

You can usually tell if you have melasma, as it has a broad, often symmetrical patch pattern, found on the cheeks, forehead, upper lip and chin. “It primarily occurs in women with darker skin tones, and typically emerges between the ages of 20 and 40 years,” says Dr Ashley.

While some people are genetically predisposed to developing melasma, there are known triggers, including sun exposure, hormonal shifts and certain medications. “The primary catalyst is fluctuating hormones, which is common during pregnancy or while using oestrogen-containing oral contraceptives or hormone replacement therapy (HRT). These hormonal changes activate an excessive production of melanin in certain areas of the skin,” shares Dr Ashley. And it’s this hormonal component of melasma that sets it apart from other forms of hyperpigmentation.

What is hyperpigmentation?

Hyperpigmentation can appear on the skin as freckles, clusters of dark spots or larger patches of discolouration. It shows up when the melanocytes the pigment producing cells in the skin – are triggered to produce more melanin.

“The number one culprit of hyperpigmentation is excess UV exposure – it stimulates the melanocytes to churn out more melanin to protect the skin from the sun,” says Dr Ashley.

Similarly, blue light from screens can trigger hyperpigmentation, particularly in darker skin tones. Then there’s post-inflammatory hyperpigmentation. If you’ve ever injured your skin — be it a graze, a spot or a burn - and then gone out in the sun, you may have noticed a darkening of the new skin area. This trauma triggers melanin production and those with Black and brown skin are more susceptible to this type, as their melanocytes are more active.

How to treat hyperpigmentation and melasma

Skincare

Sun exposure can exacerbate melasma and make existing hyperpigmentation worse, so diligent use of a factor 50 sunscreen is your first port-of-call.

Since melasma has a hormonal influence and affects the deeper layers of the skin, it can be more challenging to treat. Try to determine its instigating factor. “If you’ve recently started taking birth control or HRT and developed skin discolouration, you may want to consider stopping. If pregnancy is the root cause, it should improve significantly after birth,” says Dr Ashley.

Tyrosinase is an enzyme that makes pigment in your cells, so blocking this can help halt excess pigmentation production. “Look out for ingredients such as azelaic acid, liquorice extract, arbutin, and ascorbic acid, which can block tyrosinase production, while brightening the skin,” advises Dr Ashley.
For stubborn discolouration and melasma, dermatologists may prescribe retinoids or hydroquinone, which work on a deeper level to lower the activity of the melanocytes and increase cell turnover.

In-clinic 

There is no one-size-fits-all option for tackling melasma, as treatment will depend on the cause, the depth of the darkness and your skin tone. Seek advice from a professional who may recommend a combination of treatments including chemical peels, lasers and prescription skincare.

“Regular chemical peels can be helpful as they increase cell turnover to even out and brighten the skin,” says Dr Ashley. Currently dermatologists are raving about the depigmenting effects of the Cosmelan Peel, which includes a potent exfoliation mask to be applied in clinic and washed off, at home, ten hours later.

Lasers can also work wonders, however those with darker skin tones must tread lightly, as some can exacerbate pigmentation. Dr Ashley recommends pigment-zapping lasers like the Q-switched Nd:YAG, which is suitable for all skin tones. Similarly, the recently launched UltraClear is a cold ablative laser that can blitz all types of hyperpigmentation in just one 20-minute session.