Melasma vs hyperpigmentation: how to tell the difference
They can look alike, but they have different triggers, behave differently over time and need different approaches. Here’s how they compare.
The short version
- Hyperpigmentation is the broad term for darker skin. Melasma is one specific type.
- Post-inflammatory hyperpigmentation follows injury or inflammation, such as acne, in the same spot.
- Melasma is driven by light, hormones and genetics, and often returns, so it needs longer-term care.
Dark patches on the face are a common concern, and melasma is easy to confuse with other types of pigmentation. The two can look similar, but they have different triggers and call for different approaches. This guide explains how they compare. It’s general information and doesn’t replace an assessment by a doctor.
The quick answer: hyperpigmentation is the umbrella term for any skin that’s darker than the skin around it. Melasma is one specific type: symmetrical patches driven by light, hormones and genetics, which tend to fade and return over years. Post-inflammatory hyperpigmentation is another type, marking the exact spot where a pimple, rash or injury has been.
What is hyperpigmentation?
Hyperpigmentation simply means areas of skin that are darker than the skin around them. All skin colour comes from melanin, made by cells called melanocytes, and hyperpigmentation happens when some areas make more of it. Melasma is one type. Two other common types are pigmentation from years of UV exposure, and post-inflammatory hyperpigmentation. Our complete guide to pigmentation explains more.
What is post-inflammatory hyperpigmentation?
Post-inflammatory hyperpigmentation (PIH) is the skin’s response to injury or inflammation. It shows up as dark spots or patches exactly where the problem was. Common causes include:
- acne, the most common cause
- psoriasis
- burns and other injuries
- contact dermatitis, including reactions to cosmetic products
PIH is more common in darker skin tones. It can take months to years to fade, even with treatment, and UV can make it darker. That’s why it’s best not to pick at spots, and why daily sunscreen matters if you’re prone to breakouts.
What is melasma?
Melasma causes symmetrical, blotchy brown patches, most often on the face. It’s more common in women, usually starting between 20 and 40, though men can have it too. It typically appears across the forehead, cheeks, nose and upper lip, across the cheeks and nose, or along the jawline. It can also affect sun-exposed areas such as the forearms and shoulders.
There’s no single cause. Contributors include:
- genetics: in a survey of 324 women with melasma, 48% had a family history of it1
- sun exposure, including both UV and visible light, which can cause darker, longer-lasting pigment in olive and darker skin2
- hormones, such as pregnancy and some hormonal contraceptives
- some medicines and scented products
RelatedThe best sunscreen if you have melasma
What’s the difference between melasma and hyperpigmentation?
Melasma
- Symmetrical patches on both sides of the face
- Triggered by light, hormones and genetics
- Often fades and returns over years
Post-inflammatory hyperpigmentation
- Marks exactly where a spot or injury was
- Triggered by inflammation or injury
- Fades slowly once the cause settles
In both, irritation adds to pigmentation, which is why harsh products can backfire.
RelatedWhy does melasma come back every summer?
Why diagnosis matters
The wrong approach can make pigmentation worse. Melasma is usually diagnosed from its appearance and your history, and a biopsy is rarely needed. Doctors also consider other causes of facial pigmentation, such as sun spots and pigmentation caused by some medicines.
What suits one type can backfire on another. Chemical peels, lasers and microneedling are sometimes used for pigmentation, but they can worsen melasma or trigger PIH, so they need expert hands. Getting professional advice before trying a DIY approach is the safer start.
Not sure which one you have? A Qr8 doctor can assess your pigmentation with you by private video. Book a doctor consultation →
How each is managed
Melasma
Melasma is usually long-term and tends to come back, particularly in summer. Researchers now describe it as a photoageing condition, with changes beneath the surface that keep pigment cells primed.3,4 So care combines daily protection, gentle skincare and medical assessment, adjusted over time.
- Protection from light. Year-round sun protection, including a broad-brimmed hat and a broad-spectrum SPF50+ sunscreen. Tinted sunscreens with iron oxides also help block visible light.
- Gentle skincare. Irritation makes pigmentation harder to fade, so tolerability matters as much as strength.
- Medical assessment. A doctor looks at your history, medicines and skin, and decides whether treatment is appropriate.
- Maintenance. Improvement isn’t the same as cure, so the focus shifts to keeping triggers under control.
Our melasma page explains how this works at Qr8.
Post-inflammatory hyperpigmentation
Care for PIH centres on calming whatever caused the inflammation, and protecting skin from UV so the marks don’t darken. Because acne is the most common cause, getting breakouts under control is part of the picture, along with gentle skincare, daily sunscreen and not picking. Patience matters, as fading takes time.
Common questions
How do I tell which one I have?
Symmetrical brown patches across the cheeks, forehead, nose or upper lip suggest melasma. Dark marks where a pimple or injury has healed suggest post-inflammatory hyperpigmentation. Only a clinical assessment can confirm it.
Why did I suddenly get melasma?
Light, hormonal changes such as pregnancy or hormonal contraception, family history, and some medicines or scented products can all play a part.1,2 A doctor can help work out which apply to you.
Does melasma go away for good?
It’s generally considered long-term and relapsing. It can improve a lot, but it may return, especially in summer or when triggers remain.3,4 That’s why ongoing care and consistent sun protection matter.
How long does post-inflammatory hyperpigmentation take to fade?
Several months to years, and UV can darken it in the meantime. Daily sun protection and not picking both help.
Doctor consultations
Not sure what your pigmentation is?
Melasma and other types of pigmentation can look alike, and what helps one can make the other worse. A Qr8 doctor can assess your skin, your history and what you’ve already tried with you by private video, from home, and talk you through your options.
Between appointments, your own dermatology nurse is a message away.
No referral needed. Australia-wide.
Book a doctor consultationReferences
- Ortonne JP, Arellano I, Berneburg M, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23(11):1254-1262. https://doi.org/10.1111/j.1468-3083.2009.03295.x
- Mahmoud BH, Ruvolo E, Hexsel CL, et al. Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol. 2010;130(8):2092-2097. https://doi.org/10.1038/jid.2010.95
- Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell Melanoma Res. 2018;31(4):461-465. https://doi.org/10.1111/pcmr.12684
- Kwon SH, Na JI, Choi JY, et al. Melasma: updates and perspectives. Exp Dermatol. 2019;28(6):704-708. https://doi.org/10.1111/exd.13844
This article is general information only. It isn’t a substitute for personal medical advice, so speak with a health professional about your own skin.
