The Difference Between Melasma and Hyperpigmentation

We all love that sun-kissed glow.

But often, these can transform into troublesome brown patches.

Otherwise known as hyperpigmentation, which can be challenging to treat

Especially when it’s a condition referred to as melasma.

In this article, we examine these two conditions in-depth and examine what sets them apart.

Understanding Hyperpigmentation

Hyperpigmentation refers to patches of skin marked by heightened pigmentation relative to surrounding unaffected areas.

These areas manifest as an irregularity in skin colour and tone, prompting the need for tailored treatments.

Dark spots on the skin can encompass a wide range of manifestations, as this study found (1), and each requires its specific therapeutic considerations, as we discuss below:

Types of Hyperpigmentation

Photodamage

Prolonged exposure to ultraviolet (UV) radiation leads to photodamage, resulting in the emergence of lentigos, or sunspots, on your skin.

Actinic bronzing, characterised by darkening and unevenness in sun-exposed regions, typifies this hyperpigmentation.

Post-inflammatory Hyperpigmentation (PIH)

This type of pigmentation is particularly prevalent in people with darker skin.

This is due to inflammatory skin conditions such as acne or picking, in which dark spots persist after acne lesions resolve or following other traumatic skin injuries, including scarring.

If this sounds like you and you’d like to learn more about this condition, follow the link.

Lentigos and Actinic Bronzing

If you have a lighter skin tone, you may be predisposed to spots referred to in the skincare industry as lentigos, actinic bronzing, or sunspots.

There is another distinct category of hyperpigmentation: melasma, which we discuss below.

Understanding Melasma

Melasma is one of the most prevalent forms of hyperpigmentation.

Chloasma, often called the “mask of pregnancy,” is a common challenge characterised by the emergence of dark patches on the skin.

It can be mistaken for melasma, but the difference is that it predominantly occurs during pregnancy.

It primarily affects women with darker skin tones and manifests as hyperpigmented patches predominantly on facial regions such as the cheekbones, forehead, and upper lip.

Additionally, these patches can extend to the nose, chin, lower cheeks, and neck, exhibiting a characteristic irregularity in skin tone and colouration.

The development of melasma is multifaceted, influenced by genetic predispositions and environmental factors.

Hormonal fluctuations, particularly during pregnancy or due to the use of birth control pills, often serve as precipitating factors, exacerbating the condition in response to sun exposure and elevated temperatures.

At the cellular level, melanocytes—pigment-producing cells residing in the epidermis—remain perpetually stimulated to produce melanin, the pigment responsible for skin colouration.

This stimulation suggests a deficiency in regulatory mechanisms governing melanin production, highlighting the need for deeper exploration into the underlying pathophysiology of melasma.

If you are concerned that you have melasma, it is essential to note that it clinically manifests as uneven skin tone, marked by facial discolouration and irregular brown patches. These patches exhibit a characteristic distribution pattern:

• Melasma will predominantly affect your central facial region, such as your forehead, nose, cheekbones, upper lip, jaw, and chin.
• Occasionally, this can extend to peripheral areas such as the sides of your neck, upper arms, and forearms.

Mistaken Melasma

Despite the prevalence of melasma, not all hyperpigmentation instances indicate this condition.

Several systemic diseases and drug-induced factors can mimic the clinical presentation of melasma, necessitating a comprehensive diagnostic approach:

• Adrenal gland failure, or Addison’s Disease, can lead to dark pigmentation on the skin.
• Polycystic Ovarian Syndrome (PCOS) is another common disorder among women that is often associated with hyperpigmentation.
• Hemochromatosis, lupus, Cushing’s Disease, and systemic sclerosis are systemic conditions linked to hyperpigmentation.
• Drug-induced pigmentation, accounting for approximately 15% of cases, can result from the use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs), cytotoxic drugs for cancer, and phenytoin, an antiepileptic medication.

In light of these considerations, a detailed understanding of melasma and its distinguishing features is essential for accurate diagnosis and appropriate management.

As estheticians, we feel that continued research like this study (2) is required to gain a thorough understanding of the underlying causes of this troubling skin concern, so that we can advance our therapeutic capabilities and, consequently, improve our client outcomes.

Melasma Triggers

Gender Disparity and Hormonal Influence

It can disproportionately affect more women than men, with a ratio of approximately 1-in-4 women to 1-in-20 men.

This skewed prevalence underscores the important role of hormonal influences, especially estrogen, in the pathogenesis of melasma.

The onset of melasma and chloasma mask typically occurs during the early twenties to forties, coinciding with periods of hormonal fluctuations such as pregnancy or the use of birth control pills.

Racial and Genetic Predisposition

Race and genetics also play a role in predisposing those to this condition, with certain ethnic groups demonstrating heightened susceptibility.

Darker skin tones, particularly those classified under Fitzpatrick skin types 3-4, do exhibit a heightened risk, with Asian women facing a 40% chance of developing melasma.

Sun Exposure and UV-induced pigmentation

Overexposure to ultraviolet (UV) radiation can also trigger this condition, precipitating melanocyte activation and subsequent melanin production.

If genetically predisposed to this condition, you may have exacerbated pigmentation after sun exposure, especially during the summer when UV intensity peaks.

UV-induced damage deepens pigmentation and exacerbates existing melasma patches, highlighting the importance of sun protection in managing this tricky condition.

Hormonal Factors and Medications

The relationship between hormonal fluctuations and melasma is multifaceted, with various factors contributing to its pathogenesis.

Hormone replacement therapy, intrauterine implants, and oral contraceptives can disrupt hormonal balance, triggering melasma onset and making existing patches become even darker.

Additionally, certain medications, such as antiseizure medications, can stimulate melanin production and make your skin prone to pigmentation, especially when exposed to UV light.

Fragrances can be another potential trigger, causing a photo-toxic reaction in some people, so please steer clear of products and spray fragrances, especially in affected areas.

Inflammatory Pathways and Liver Health

This condition is often associated with skin sensitivity and inflammation.

This is because, beneath the visible brown pigmentation of melasma, lie underlying inflammatory processes related to hormonal imbalances.

Hormones associated with birth control pills or pregnancy after the age of 30 can also contribute to liver inflammation, which can exacerbate melasma symptoms.

Therefore, healing liver damage is essential for mitigating the severity of melasma in your skin.

To conclude. The naked truth

Hyperpigmentation is a broad term in skincare that encompasses many manifestations of irregular skin colour and tone.

Post-inflammatory hyperpigmentation (PIH) and lentigos present distinct challenges and require tailored treatment strategies.

This skin condition is the most prevalent form of hyperpigmentation, primarily affecting women with darker skin tones and is influenced by a complex interplay of genetic predispositions and environmental factors.

Understanding the underlying mechanisms and triggers of hyperpigmentation and melasma can help achieve a more uniform and radiant complexion over time.

Because of these multifactorial triggers, a comprehensive management approach that involves sun protection, hormonal regulation, and calming inflammation in the skin is essential to treat these conditions effectively.

References

1. Skin Pigmentation Types, Causes and Treatment—A Review
2. Update on Melasma—Part II: Treatment