Hyperpigmentation: Understanding Melasma, Sun Damage, and What Topical Treatments Actually Do

When your skin starts showing dark patches-especially on your face-it’s easy to assume it’s just sun damage. But what if it’s not? What if those brown spots aren’t from the sun at all, but from hormones, heat, or something deeper? That’s the real problem with hyperpigmentation: it looks simple, but it’s not. Two of the most common types-melasma and sun damage-look almost identical. Yet they need completely different treatments. Get one wrong, and you could make it worse.

What’s Really Going On With Your Skin?

Sun damage, or solar lentigines, is straightforward. It’s caused by years of UV exposure. Think of it like a sunburn that never faded. These spots show up on your face, hands, shoulders-anywhere the sun hits. They’re small, round, and well-defined. Around 90% of people over 60 with fair skin have them. The skin cells in those spots are just overloaded with melanin. No new melanocytes (pigment cells) are born-just more pigment packed into the old ones.

Melasma is different. It’s not just about the sun. It’s about hormones, heat, and visible light. You’ll see it as large, blotchy patches on the cheeks, forehead, upper lip, or chin. It’s symmetrical-same on both sides. It mostly affects women, especially those with medium to dark skin tones (Fitzpatrick types III-VI). Pregnancy, birth control pills, or hormone therapy can trigger it. Even indoor light through windows can make it worse. And here’s the kicker: heat from your phone, laptop, or even a warm room can stimulate melanin production. That’s why melasma doesn’t just fade when you avoid the beach.

There’s a third type-post-inflammatory hyperpigmentation (PIH)-that shows up after acne, eczema, or a scratch. But unlike melasma or sun damage, it doesn’t show up in sun-exposed areas. It shows up where the skin got irritated. And it’s more common in darker skin tones.

Why Sunscreen Isn’t Enough (Even If You’re Using It)

Visible light-blue light from screens, fluorescent bulbs, even sunlight-penetrates deeper. It makes melanocytes go crazy. And infrared heat? It activates the same pathways. That’s why someone can sit indoors near a window and still see their melasma darken.

Harvard Medical School’s Dr. Kourosh says it bluntly: “The sun is stronger than any medicine I can give you.” And he’s right. Studies show that without strict photoprotection, melasma comes back within six months of stopping treatment-95% of the time.

So what sunscreen actually works? You need mineral-based formulas with zinc oxide or titanium dioxide-and crucially, iron oxides. Iron oxides block visible light. Look for tinted sunscreens. They’re not just for coverage. They’re medical-grade protection. The American Academy of Dermatology says you need SPF 30+ daily, even inside. And you need to reapply every two hours if you’re near a window or outside.

Topical Treatments: What Actually Works

Hydroquinone is the gold standard. It blocks tyrosinase-the enzyme that makes melanin. At 4% concentration, it’s the most effective topical for melasma. But it’s not a magic bullet. Used alone, it helps about 30% of people. Used in a triple combination with tretinoin and a corticosteroid, it works for 50-70%. That’s why dermatologists now prescribe triple creams as first-line treatment for moderate melasma-up from 45% in 2018 to 75% today.

But there’s a catch. Hydroquinone can’t be used longer than 3 months. After that, there’s a 2-5% risk of exogenous ochronosis-a rare but permanent blue-black discoloration. That’s why it’s prescription-only in the U.S. and banned in the EU and Japan.

Tretinoin (0.025-0.1%) doesn’t lighten pigment directly. It speeds up skin turnover. Think of it like a gentle exfoliator that pulls melanin out of the skin faster. It’s usually used at night, alternating with hydroquinone to avoid irritation. About 30-40% of users get redness or peeling, especially at first. That’s why dermatologists recommend starting with a low dose and building up over 4-6 weeks.

Vitamin C (L-ascorbic acid) is an antioxidant. It doesn’t stop melanin production-it neutralizes the oxidized melanin that makes skin look darker. At 10-20% concentration, it’s effective. Used in the morning, it also boosts sunscreen protection. It’s gentle, stable, and safe for long-term use. Many people use it as a maintenance step after stopping hydroquinone.

Other options like niacinamide, kojic acid, and tranexamic acid are gaining traction. Tranexamic acid, applied topically at 5%, showed 45% improvement in melasma in a 12-week study. It’s not as strong as hydroquinone, but it’s safer for long-term use. Cysteamine cream (10%) is new-showing 60% improvement in trials with almost no irritation. These are becoming popular for people who can’t tolerate hydroquinone or want to avoid it entirely.

Laser and Light Therapies: When They Help-and When They Hurt

IPL (Intense Pulsed Light) works great for sun damage. It targets melanin with light energy, heating and destroying the dark spots. The spots darken, then flake off in 3-5 days. Success rate? 75-90% improvement in 2-3 months.

But for melasma? IPL has a 30-40% chance of making it worse. Why? Because heat triggers melanocytes. If your melanocytes aren’t already suppressed by topical treatment, IPL can turn a mild case into a chronic one.

Dermatologists now use a “melanocyte rest” protocol for melasma: 8-12 weeks of topical treatment first. Then-if the pigmentation has faded enough-they consider laser. This cuts recurrence from 60% down to 25%.

Chemical peels (glycolic, salicylic, or trichloroacetic acid) can help too. Used every 4-6 weeks, they boost topical treatments by 35-50%. But again-only if your skin is calm. In darker skin tones, peels carry a 25% risk of causing PIH. That’s why they’re done cautiously.

The Real Cost-Money, Time, and Patience

When that doesn’t work, they go to a dermatologist. Prescription topicals cost $50-$150 a month. Laser sessions? $300-$600 each. And you might need 3-5.

But the biggest cost isn’t money. It’s time. Melasma takes 3-6 months to improve. Sun damage? 8-12 weeks. And even then, if you skip sunscreen for a week, it comes back.

Studies show only 35% of patients stick with their treatment for the full recommended time. Why? Because it’s tedious. Applying three products every day. Reapplying sunscreen. Avoiding heat. It’s exhausting. That’s why simplifying regimens matters. Some dermatologists now combine hydroquinone and tretinoin into one cream. Others offer once-daily formulas.

What You Can Do Right Now

• Take a photo of the spots. Compare it in 4 weeks.
• Check if they’re symmetrical (melasma) or scattered (sun damage).
• Stop using any product that stings or burns. That’s not working-it’s irritating.
• Switch to a tinted mineral sunscreen with iron oxides. Use it every day, even indoors.
• Don’t touch your face with your phone or laptop. Heat matters.
• If it’s been 3 months and nothing changed? See a dermatologist. Don’t wait.

There’s no cure for melasma. But there’s control. And it starts with understanding what you’re really dealing with. Sun damage? You can remove it. Melasma? You manage it. And the most powerful tool isn’t a cream or a laser-it’s consistency. Daily sunscreen. No exceptions. Because even one missed day can undo weeks of progress.

What’s Next for Hyperpigmentation Treatment?

Meanwhile, new agents are coming. Tranexamic acid pills (oral) are being studied for melasma. Cysteamine cream is getting FDA approval. And non-hydroquinone options are growing fast-up 15% a year in prescriptions.

But the biggest breakthrough won’t be a new ingredient. It’ll be better education. Most people don’t know that visible light causes melasma. Or that sunscreen needs iron oxides. Or that hydroquinone has a 3-month limit. Once you know, you can fight smarter.