Hyperpigmentation vs. melasma: Their differences, symptoms, and treatments

Key takeaways:

• Melasma and hyperpigmentation are both skin conditions that cause dark patches on the skin, but they have distinct characteristics and causes.
• Hyperpigmentation is a term used to describe a skin condition in which some areas of the skin are darker than surrounding areas and is caused by increased production of melanin, the natural pigment that gives the skin its color. Melasma, on the other hand, is a type of hyperpigmentation that may be triggered by sun exposure and changes in hormones.
• Both hyperpigmentation and melasma have similar treatment options. Consulting a dermatologist and taking preventative measures can help to manage and prevent these conditions.

Who doesn't love clear and smooth skin? Of course, almost everyone does. It can be distressing to notice dark spots and patches on your face or any other part of your body. If this happens, understand that skin discolorations are common and usually not harmful. In most cases, it simply means you are experiencing either hyperpigmentation or melasma, which are not life-threatening conditions.

Hyperpigmentation and melasma are two related but different skin conditions that can result in an uneven skin tone or skin covered with spots or dark patches. 

Understanding the difference between hyperpigmentation and melasma can help you choose an effective treatment option and successfully prevent outbreaks or reoccurrences.

What is hyperpigmentation?

Hyperpigmentation is a general term for any skin condition that causes any area of the skin to be darker than the surrounding skin. It is caused by the excess production of melanin, which is the pigment that gives the skin, hair, and eyes their natural color. 

Hyperpigmentation can be triggered by many factors, such as:

• Sun exposure
• Acne
• Hormonal changes
• Aging
• Inflammation or injury
• Certain medications, which include antibiotics like tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimalarials such as chloroquine, amodiaquine, and quinacrine

What is melasma?

Melasma is a common type of hyperpigmentation that occurs on the face and other exposed parts of the body, such as the neck and shoulder. It appears as a brown-to-grayish patch on the face.

Although melasma can affect both males and females of any race, it is more common in women and people of the Black race. Although the exact cause of melasma is unknown, it is believed melasma occurs due to genetic predisposition, and it is triggered and worsened by certain factors such as:

• Changes in hormonal levels: this is one of the main factors that differentiates melasma from other types of hyperpigmentation. Pregnancy, oral contraceptives or birth control pills, hormonal therapies, thyroid disease, and certain medications that can result in fluctuations in hormone levels can trigger melasma.
• Sunlight: Prolonged exposure to sunlight can darken the skin and worsen the condition.

The difference between hyperpigmentation and melasma

The main difference between melasma and other types of hyperpigmentation lies in the cause.

Melasma is triggered by hormonal changes and worsens with exposure to sunlight. It is very common in women, especially during pregnancy, such that it has been nicknamed “the mask of pregnancy.”

On the other hand, the other types of hyperpigmentation are triggered by different factors. For instance, sunspots are caused by prolonged exposure to the sun, and post-inflammatory hyperpigmentation is caused by injuries or skin conditions like cuts, burns, acne, or eczema.

While hyperpigmentation can occur anywhere on the body, melasma usually appears on the face. Post-inflammatory hyperpigmentation occurs on any part of the body where there has been an injury, acne, or eczema flare-up, while sunspots appear on skin areas that are frequently exposed to the sun—usually the face and hands.

Melasma can occur as larger patches and blotches, while sunspots and post-inflammatory hyperpigmentation may appear as tiny spots that look like freckles. Also, post-inflammatory hyperpigmentation is more focused only on the affected spot or area.

Below is a summary of the differences between hyperpigmentation and melasma.

Symptoms of melasma vs. symptoms of hyperpigmentation

Melasma and hyperpigmentation share similar symptoms.

Symptoms of melasma

Melasma often doesn’t cause pain and isn’t itchy. But it can occur as:

• Light to dark brown patches on the face, usually on the forehead, jawline, cheeks, nose, and upper lips
• Blotchy patches with irregular borders
• Similar blotchy patches on both sides of the face
• Patches that can affect and cover a large skin area, as the unevenly shaped patches can merge, creating a large area of melasma
• Patches that worsen and become more noticeable when you spend more time in the sun

Symptoms of hyperpigmentation

Hyperpigmentation is any darkening of the skin. The discolorations can take any of the following forms:

• Dark-coloured sunspots on the skin
• Pigmentation patches
• Discoloration of the skin after an inflammation or injury 
• Skin darkening of any shape and size, smooth or bumpy, and can occur on any part of the body

Treatment for melasma vs. treatment for hyperpigmentation

There are many options for treating hyperpigmentation and melasma, and each of the options is geared towards achieving an even-toned skin. 

Although most of the treatment options are the same for melasma and other types of hyperpigmentation, melasma is more difficult to treat. This may be because melasma is triggered by internal factors such as changes in hormonal levels and is linked to genetics—both of which are factors that are hard to fix, especially with topical treatments.

Melasma triggered by pregnancy, hormonal contraceptives, or other medications may fade away on its own after giving birth or stopping the medications.

The treatment options for melasma and hyperpigmentation include:

1. Protection from direct sunlight

The sun's rays are one of the factors that cause hyperpigmentation and worsen melasma. Protecting your skin from direct sunlight can help fade sunspots and melasma. You can protect your skin from the sun by:

• Applying broad-spectrum sunscreen (SPF of 50 and above). Choose sunscreens that contain iron oxide, titanium dioxide, zinc oxide, and silicones for photoprotective and camouflage effects
• Putting on a wide-brimmed hat or using an umbrella when you are outside
• Staying under a shade

2. Topical treatments

This involves the use of:

• Skin-lightening creams: These include azelaic acid, kojic acid, cysteamine cream, methimazole, and tranexamic acid. These skincare ingredients work by preventing the formation of new melanin and reducing inflammation. They are available over-the-counter (OTC) and on prescription. They are usually applied once or twice a day, and they lighten skin over time.
• Exfoliating lotions: these lotions peel the outer layer of your skin, replacing the old skin with a new layer.
• Retinoids: lotions or creams made from vitamin A and mainly used to smooth and tone the skin.

3. Oral medication

Tranexamic acid is a medication that prevents the production of melanin by reducing excess blood vessels in the skin.

4. Cosmetic camouflage

This involves the application of makeup to cover up the flaws on the face or body.

5. Procedural treatment

When hyperpigmentation and melasma do not improve with the use of topical and oral medications, more advanced procedures can be used. These procedures include:

• Chemical peel: Chemical peel involves the application of specially formulated acids to the skin to treat hyperpigmentation. These acids can be alpha-hydroxy acids (AHA), such as glycolic acid, or beta-hydroxy acids (BHA), such as salicylic acid, which peel off the outer layer of the skin, revealing a new and smooth layer of skin.
• Laser treatments: Laser treatments use a low-power light beam to focus on and target specific areas of skin, breaking down excess melanin to reduce the appearance of dark spots.
• Microdermabrasion: Microdermabrasion is the removal of the outermost layer of skin using a specially designed handheld tool.
• Dermabrasion: Dermabrasion is similar to microdermabrasion, but the procedure goes a little deeper into the skin.

Each procedural treatment option needs to be performed with caution to prevent worsening melasma or hyperpigmentation. So, it is best performed by a skin expert, particularly a certified dermatologist, as they are trained to know the best procedure for each patient and how to carry out the procedure safely.

How to prevent hyperpigmentation

You can prevent hyperpigmentation by:

• Applying your sunscreen every 90 minutes to two hours
• Staying under a shade or wearing a wide-brimmed hat when outdoors
• Avoiding being outside when the sun is strongest, which is between 10 a.m. and 2 p.m.
• Choosing skin care products that are gentle on your skin
• Avoiding products that burn or sting when you apply them
• Addressing any skin condition that may cause a dark spot
• Avoiding touching and picking your skin when you have acne, rash, or after an injury

When to see a dermatologist

Once you notice dark spots or patches appearing on your skin, it is advisable that you see a dermatologist. A dermatologist can tell you whether you have post-inflammatory hyperpigmentation, sunspots, melasma, or another condition.

A dermatologist will also recommend the best treatment plan to improve your condition and achieve clearer skin.

Wrap up

Although both hyperpigmentation and melasma involve the appearance of dark patches on the skin, melasma is mostly associated with hormonal fluctuations, while hyperpigmentation can occur due to many factors, including sun exposure and inflammation.

It is important to understand the difference between hyperpigmentation and melasma to determine the right treatment option that can effectively treat dark spots and patches and achieve clear, smooth, and evenly toned skin.

Protecting your skin from direct sunlight and following a healthy skincare routine is important when it comes to preventing and managing any form of hyperpigmentation. It is also very important that you see a dermatologist for a personalized treatment plan if you are experiencing any skin conditions.