Melasma and post-inflammatory hyperpigmentation can both look like brown or grey facial patches, but they are not the same diagnosis. Melasma commonly forms symmetrical patches influenced by light, hormones and individual susceptibility. Post-inflammatory hyperpigmentation, or PIH, appears where acne, dermatitis, irritation, injury or a procedure has inflamed the skin.
The two can occur together. That is why choosing a peel, laser or “brightening” cream from a photograph can miss the real problem and sometimes make pigmentation worse.
What pattern suggests melasma or PIH?
| Clue | Melasma | Post-inflammatory hyperpigmentation |
|---|---|---|
| Typical pattern | Broad, often symmetrical patches on both cheeks, forehead, nose or upper lip. | Marks that follow the exact sites of spots, rash, friction, burns or procedures. |
| Trigger history | Light exposure, pregnancy or hormonal change can contribute; sometimes no single trigger is obvious. | A visible episode of inflammation or injury usually comes first. |
| What keeps it active | Ultraviolet and visible light, heat in some people, hormonal factors and relapse tendency. | Continuing acne, dermatitis, picking, friction or repeated irritation. |
| Course | Often chronic and recurrent even after improvement. | Can gradually fade after the trigger is controlled, although deeper pigment may persist. |
These are clues, not a home diagnostic test. The American Academy of Dermatology describes melasma as flat patches that commonly appear on both sides of the face. DermNet describes PIH as pigmentation that follows epidermal or dermal inflammation.
Why does the diagnosis change treatment?
With PIH, controlling the source of inflammation is central. Fading a post-acne mark while new inflammatory spots continue to form is an incomplete plan. Similarly, treating colour without stopping an irritating product or friction leaves the trigger in place.
Melasma needs a long-term maintenance mindset. Light protection is part of treatment, and improvement can relapse when protection or maintenance stops. Skinoq's live melasma care page describes this longer-view approach.
Some ingredients overlap across the two conditions, but that does not make the diagnoses interchangeable. Strength, combination, duration and procedure choice depend on pigment depth, skin tolerance, pregnancy or breastfeeding, medicines and previous reactions.
Can acne marks and melasma overlap?
Yes. A person may have symmetrical background melasma across the cheeks and separate darker spots at previous acne sites. Treating only one layer can create disappointing results even if that part improves.
A clinician may examine the distribution in ordinary light and use dermoscopy or another light-based examination when useful. No scan replaces the history: bring photographs showing when the patches began, note whether pregnancy or a medicine change preceded them, and list products or procedures that caused irritation.
What should the first phase include?
- A working diagnosis and an explanation of any uncertainty.
- Control of active acne, dermatitis or another inflammatory trigger.
- A gentle routine that does not create repeated stinging or peeling.
- Broad-spectrum sun protection and practical shade measures.
- A realistic timeline and a plan for maintenance or relapse.
For melasma, the AAD's self-care guidance recommends SPF 30 or higher and discusses tinted sunscreen containing iron oxide for added protection from visible light. A product is only useful if its shade, feel and cost allow you to apply enough and reapply as directed.
Where do peels and lasers fit?
Procedures are not automatic next steps. A superficial peel may help selected epidermal pigmentation, while a device may be considered for a specific indication. Both can also cause inflammation and new PIH if selection, technique or aftercare is unsuitable.
DermNet's melasma guidance notes that chemical peels and lasers require caution because they can worsen melasma or cause PIH. A 2024 systematic review of PIH treatment in skin of colour similarly found variable results and reported exacerbation after some laser treatments. “Advanced” therefore does not mean “risk-free,” and a stronger procedure is not necessarily a better first choice.
What improvement should you expect?
PIH may fade gradually once the inflammation stops, but the timeline varies with pigment depth, ongoing sun exposure and whether the trigger truly ended. Melasma often improves rather than permanently disappears. Recurrence does not automatically mean the original treatment was fraudulent; it may reflect the chronic biology of the condition, but the maintenance plan should have made that possibility clear.
Use photographs taken in similar lighting, angle and makeup. Judge irritation and new patches as well as colour. If a plan lightens one area but repeatedly inflames another, it needs review.
When is a new dark patch not routine pigmentation?
Arrange assessment for a single patch that is changing in shape or colour, bleeding, crusting, painful or associated with a persistent rash. Sudden widespread pigmentation or pigmentation accompanied by other symptoms also deserves medical review. Do not assume every brown facial mark is melasma.
Frequently asked questions
Can I tell melasma from PIH using a phone photo?
A photo may show distribution, but lighting, filters and makeup alter colour. History and examination are often needed, especially when both conditions may be present.
Is melasma always caused by pregnancy?
No. Pregnancy can trigger melasma, but it also occurs outside pregnancy and in men. Light exposure and individual susceptibility are important.
Will PIH fade without treatment?
It can fade after the trigger stops, but this may take months and deeper pigment can last longer. Ongoing acne, irritation or sun exposure can prolong it.
Can the same laser treat melasma and post-acne marks?
Do not assume so. The diagnosis, pigment depth, skin tone, device and parameters all matter, and heat or inflammation can worsen pigmentation in some people.
Name the pigment before treating it
Request a pigmentation consultation at Pal in Surat or Bodakdev in Ahmedabad. Bring your current products and photographs from before the pigmentation changed.
By Skinoq Editorial. General educational information; facial pigmentation needs individual diagnosis and treatment advice.
