Hyperpigmentation comes in three forms — PIH, melasma, and sunspots — and telling them apart decides the treatment. Sun protection plus tyrosinase inhibitors and gentle exfoliation fade pigment; aggressive lasers and deep peels can make melasma and darker skin worse. Melasma is managed, not cured.
Few concerns are more common — or more easily worsened — than dark spots. Hyperpigmentation responds beautifully to the right plan and rebounds aggressively against the wrong one, and the difference usually comes down to how well the practitioner understands what kind of pigment they are treating.
The three main kinds of hyperpigmentation
| Kind | Trigger | Depth | Difficulty |
|---|---|---|---|
| Post-inflammatory (PIH) | Acne, injury, aggressive treatment | Epidermal to dermal | Moderate |
| Melasma | Hormones + UV + heat | Mixed, often dermal | Hard, chronic |
| Sun/age spots (solar lentigines) | Cumulative UV | Epidermal | Easier |
Reading which one you're facing decides everything, because the same laser or peel that clears a sunspot can inflame melasma into a worse pattern.
Why melasma is different (and stubborn)
Melasma is driven by a combination of hormones (pregnancy, birth control), UV exposure, and — importantly — heat. That heat sensitivity is why melasma flares in the Florida sun and why heat-based devices can aggravate it. It is a chronic condition to be managed, not a spot to be erased, and setting that expectation with clients is part of the job.
What triggers pigment
At the center of all three is the melanocyte responding to a signal — UV, inflammation, or hormones — by overproducing melanin. Higher Fitzpatrick skin types have more reactive melanocytes, which is why post-inflammatory hyperpigmentation is both more common and more lasting in deeper skin.
Treatments that help — and one that backfires
- Sun protection first. No pigment plan works without daily broad-spectrum SPF; without it, everything else is wasted effort.
- Tyrosinase inhibitors (vitamin C, azelaic acid, kojic acid, and prescription options) slow melanin production.
- Gentle, superficial exfoliation and mandelic or lactic peels fade epidermal pigment gradually.
- What backfires: aggressive resurfacing, hot lasers, or deep peels on melasma or darker skin can trigger a rebound — more pigment than you started with. Restraint is the skill.
Skin-of-color considerations
Because darker skin carries the highest PIH risk, pigment work in Fitzpatrick IV–VI demands conservative depth, pre-conditioning, and patience. Our guide to treating skin of color goes deeper, but the headline is simple: slower is safer, and safer is what actually clears pigment. This is core to the Advanced Clinical Aesthetician training.
FAQ
Can estheticians treat hyperpigmentation?
Yes. Facial specialists treat epidermal pigment with sun protection, tyrosinase-inhibiting ingredients, and superficial peels. Deeper or hormonal pigment like melasma is best co-managed with a physician.
Why is my melasma getting worse after treatment?
Melasma is heat- and inflammation-sensitive. Aggressive peels, lasers, or even hot treatments can trigger a rebound. It requires gentle, conservative management and strict sun protection, not aggressive resurfacing.
What is the best treatment for dark spots?
Daily broad-spectrum SPF plus tyrosinase inhibitors (vitamin C, azelaic acid) and gentle superficial exfoliation. Sunspots clear fastest; melasma is managed long-term.
Does hyperpigmentation go away permanently?
Sunspots and PIH often clear with consistent treatment and sun protection. Melasma is chronic and tends to recur, so it is controlled rather than cured.
Written by Dr. Tali Arviv, MD, Co-Founder and Medical Director of MedSpa Institute. Credentials verifiable through the Florida Department of Health.
- Three kinds of pigment — PIH, melasma, sunspots — need different approaches.
- Melasma is heat- and hormone-driven, chronic, and easily worsened by aggressive treatment.
- Daily SPF plus tyrosinase inhibitors and gentle exfoliation is the safe core plan.
- Darker (Fitzpatrick IV-VI) skin needs conservative depth to avoid rebound pigment.