Types of Pigmentation: Understanding the Most Common Forms of Hyperpigmentation

Written by Dr. Ginni Mansberg

Here's something that surprises a lot of people: "pigmentation" isn't actually one condition. It's a catch-all term for what happens when melanin- the pigment that gives skin its colour - is produced unevenly or in excess. But why that happens, where it happens, and how it behaves can be completely different depending on the type.  

A dark patch from hormones behaves nothing like a sunspot. A post-acne mark is different again. And freckles? Entirely their own thing. Lumping them all together as "pigmentation" and throwing the same products at all of them is one of the most common reasons treatment doesn't work. 

The four most common types of hyperpigmentation are: 

• Melasma - usually hormonal, patches rather than spots 
• Solar lentigines (sunspots) - caused by cumulative UV exposure
• Post-inflammatory hyperpigmentation (PIH) - triggered by inflammation or skin injury
• Freckles - largely genetic, different from the others in important ways 

Understanding which type you're dealing with is genuinely the most important first step. It determines what treatment approach is likely to work, how long it'll take, and how to stop it coming back. So, I thought it would be worth going through them. 

Why Identifying Your Pigmentation Matters 

Different Types Have Different Causes 

All four types involve excess melanin. But what triggers that melanin production is completely different. 

Hormones drive melasma – well, they do interact with your genes, UV or sun exposure. Years of UV exposure drive sunspots. Acne breakout or skin injury drives PIH. Your genetics largely drive freckles. The enzyme at the centre of all of it is tyrosinase (the key regulator of melanin production), but the signal telling tyrosinase to get overactive is different in every case. And that's what determines the right management approach. 

Different Types Respond Differently to Treatment 

Some forms of pigmentation respond well to topical skincare with consistent use over a few months. Others are more stubborn. A few behave more like chronic conditions that require ongoing management rather than a fixed course of treatment. 

Solar lentigines, for example, tend to respond well to both topical actives and professional treatments like laser. Melasma can respond beautifully to treatment. But it has a tendency to return quickly because its hormonal and UV triggers often remain active. PIH often resolves with skincare, time and sun protection alone. But it can be more intense and slower to fade in deeper skin tones. 

Can You Have More Than One Type? 

Absolutely, and it's more common than you'd think. Someone might have melasma from hormonal contraception and solar lentigines from years of UV exposure and PIH marks from a recent breakout, all at the same time. 

This is actually one of the reasons that seeing a GP or dermatologist is worthwhile if you're not sure what you're dealing with. Treating one type while inadvertently worsening another is a real pitfall without the right diagnosis. For example in one study of patients with melasma who got laser, 18% developed post inflammatory hyperpigmentation from the laser itself.  

Melasma 

What Is Melasma? 

Melasma is a form of hyperpigmentation that typically appears as symmetrical, brown or grey-brown patches on the face, most commonly the cheeks, forehead, upper lip, and chin. The symmetry is one of its most recognisable features: it tends to show up in matching patches on both sides of the face, sometimes described as a "mask." 

It predominantly affects women of reproductive age, and it can have a significant impact on confidence and quality of life. 

What Causes Melasma? 

Melasma is multifactorial, meaning it's usually caused by several things acting together rather than one single trigger. The major ones are: 

• Hormones. Particularly oestrogen, which directly stimulates melanocyte activity and enhances tyrosinase function. This is why melasma is so strongly associated with pregnancy and the oral contraceptive pill. 
• UV exposure. The most important activating factor, even in people with a hormonal predisposition. UV keeps melanocytes switched on. That’s why sunscreen is so essential.  
• Heat exposure. An underappreciated trigger. Clinical evidence shows melasma worsens after heat exposure independent of UV, through a completely separate pathway involving vasodilation and inflammation.
• Genetics. Between 48 and 64% of people with melasma have a first-degree relative with the condition. 

How Is Melasma Different From Other Types of Pigmentation? 

The patches are usually larger and more diffuse than individual sunspots or post-acne marks. The borders are irregular rather than sharply defined. And critically, melasma has a strong tendency to recur even after successful treatment, because the hormonal and UV triggers that drove it in the first place don't disappear. Up to 72% of people who stop treatment without a maintenance plan see their melasma return within two months. So, treatment including sunscreen, needs to be ongoing.  

Studies show melasma is more likely to be dermal- in other words it’s deep pigmentation.  

Because melasma is recurring, treatment needs to be considered as ongoing. Melasma also does not respond to a single product but needs a combination of products working together to reduce it. Effective treatment focuses on slowing melanin production, limiting melanosome transfer from melanocytes to keratinocytes, interrupting melanin synthesis, and helping the skin clear existing pigment. Daily broad spectrum SPF 50+ all day every day is essential.  

Dermal melasma responds better to RF microneedling. Lasers (including Q switched lasers) and IPL are often used, but it’s important to understand their limits: they can help clear existing melanin faster, but they don’t stop new melanin from forming. Plus ALL of them can cause rebound hyperpigmentation. So, they can help but will not cure melasma.  

→ For a full deep dive: [Melasma: What It Is, Why It Happens and Why It Keeps Coming Back]

Solar Lentigines (Sunspots) 

What Are Sunspots? 

Solar lentigines, also called sunspots, age spots, or liver spots are flat, well-defined, brown spots that appear on areas of cumulative sun exposure: face, hands, forearms, décolletage, and shoulders. They're one of the most common signs of photoaged skin and affect more than 90% of fair-skinned people over the age of 50. 

What Causes Sunspots? 

Sun-damaged melanocytes, along with nearby skin cells like keratinocytes and collagen-producing fibroblasts, start sending the wrong messages to each other. The damaged keratinocytes keep telling melanocytes to make more pigment. The result is that in areas of particular damage, you develop discrete brown spots. Key drivers: 

• Chronic sun exposure. The cumulative dose over a lifetime, not just individual sunburn events 
• Ageing. As skin ages, melanocyte distribution becomes less even, and repair mechanisms slow down
• Photodamage. UV-induced DNA damage and oxidative stress that accumulates over time 

How Are Sunspots Different From Other Types of Pigmentation? 

Sunspots appear as individual, discrete spots rather than larger patches.  They’re typically a few millimetres to a centimetre across, with more defined edges than melasma. They usually sit in the epidermis (the outermost skin layer), which is why they tend to respond better to topical treatment and professional procedures than melasma. They're not hormonally driven, which means managing UV exposure removes the primary ongoing trigger.   

→ For a full deep dive: [Solar Lentigines: What Actually Works for Sunspots?]

Post-Inflammatory Hyperpigmentation (PIH) 

What Is Post-Inflammatory Hyperpigmentation? 

PIH is the dark mark left behind after inflammation or injury to the skin. It's not technically a condition in itself. Rather, it's a response. When skin experiences inflammation, melanocytes nearby produce excess melanin as part of the healing process. The result is a flat, darkened area where the inflammation was. 

It's one of the most common forms of pigmentation overall and a major concern for people who experience regular breakouts, eczema flares, or certain skin procedures. 

What Causes PIH? 

Any form of skin inflammation can trigger it: 

• Acne. The most common cause, particularly when spots are squeezed or picked (which amplifies the inflammation and worsens the resulting mark) 
• Eczema and other inflammatory skin conditions. Flares can leave areas of darkened skin even after the active condition has settled
• Skin injuries. Cuts, burns, insect bites
• Cosmetic procedures. Chemical peels, laser treatments, or microneedling at settings that are too aggressive for the skin type can trigger PIH, especially in deeper skin tones 

How Is PIH Different From Other Types of Pigmentation? 

The defining feature of PIH is that it follows a visible trigger.  You can usually trace back exactly where it came from (that spot, that eczema patch, that procedure). It appears precisely where the inflammation occurred rather than in a hormonally or UV-driven pattern. 

PIH is particularly common and more severe in Fitzpatrick skin types IV–VI (medium to deep skin tones). Deeper skin tones have more reactive melanocytes and greater baseline melanin production, so the pigmentation response to inflammation is more pronounced, takes longer to fade, and is more likely to require active treatment rather than just time. 

→ For a full deep dive: [Post-Inflammatory Hyperpigmentation (PIH): What It Is and Why It Happens] 

Freckles 

What Are Freckles? 

Freckles (ephelides) are small, flat, light-brown spots that appear scattered across the skin. They’re most often on the face, arms, and shoulders. They're different from the other types covered here in an important way: they're largely a genetic trait rather than a sign of skin damage or a medical concern. 

What Causes Freckles? 

Two main factors: 

• Genetics. Freckles are strongly associated with variants in the MC1R gene, which influences how melanocytes respond to UV and the ratio of darker eumelanin to reddish pheomelanin produced. They're particularly common in people with fair skin, red or blonde hair, and lighter eye colour. 
• Sun exposure. Freckles typically darken in summer and fade in winter. The melanocytes in freckling-prone skin produce localised bursts of melanin in response to UV rather than distributing it evenly. This seasonal behaviour is one of the hallmarks that helps distinguish freckles from solar lentigines. 

How Are Freckles Different From Other Types of Pigmentation? 

Freckles tend to appear earlier in life (often in childhood) rather than developing with age or after a specific trigger. They're considered a normal variation of skin pigmentation rather than a pathological response. They're not caused by skin damage, don't carry the same recurrence dynamics as melasma, and for most people, are more of a personal preference question than a treatment priority. 

→ For a full deep dive: [Freckles: What Causes Them and Can They Be Treated?] 

Quick Comparison: Common Types of Pigmentation 

How to Tell Which Type of Pigmentation You Have 

Look at the Pattern 

Shape and distribution are useful clues: 

• Symmetrical patches across both cheeks or the forehead? Think melasma. 
• Scattered individual spots on sun-exposed areas? Likely solar lentigines or freckles. The location and size will help differentiate (freckles are usually smaller and appear earlier in life; lentigines are more discrete and appear with age).
• A dark flat mark exactly where a pimple was? That's PIH. 

Think About What Triggered It 

The history matters enormously. Did it appear during pregnancy or while you started the pill? That points to melasma. Did it develop slowly over years of sun exposure? Sunspots. Did a specific spot or rash leave a mark behind? PIH. Have you always had these marks and they darken in summer? Freckles. 

Consider Where It Appears 

• Face only, in a patchy pattern: Melasma 
• Face, hands, forearms or anywhere with cumulative sun exposure: Solar lentigines
• Exactly at the site of a previous breakout or injury: PIH
• Scattered widely, appearing in childhood: Freckles 

When to Seek Professional Advice 

It's worth seeing a GP or dermatologist if: 

• You're not sure which type you're dealing with and treatment isn't working 
• A mark is growing, changing shape, has irregular borders, or is changing colour
• Pigmentation appeared after a medication change (some medications trigger hyperpigmentation)
• You have a deeper skin tone (Fitzpatrick IV–VI) and are considering professional treatment. The risk of triggering new PIH with procedures is higher and a specialist can guide appropriate settings
• Any dark spot that looks asymmetrical, has ragged edges, or bleeds should be assessed by a doctor. Not all flat brown marks are benign pigmentation 

The Bottom Line 

Not all pigmentation is the same, and treating it like it is tends to lead to frustration, wasted money, and occasionally, making things worse. 

The four most common types - melasma, solar lentigines, PIH, and freckles - each have different causes, different behaviour, and different optimal treatment strategies. Getting clear on which type you're dealing with (or which combination) is genuinely the most valuable first step you can take. 

Once you know what you're working with, treatment becomes much more straightforward: the right ingredients, the right timeline, and the right expectations. Daily broad-spectrum sun protection sits at the foundation of managing every single type. That part is non-negotiable regardless of which category you fall into. 

ESK's Pigmentation Kit brings together the key evidence-based actives for targeting multiple stages of the pigmentation pathway. We include tyrosinase inhibition, melanin transfer reduction, and skin renewal all in one place. 

Shop ESK Pigmentation Collection

Pigmentation Kit

The Pigmentation Kit combines evidence-based ingredients designed to support a refreshed skin and a more even skin tone while restoring hydration. 

Key features:

• Supports the appearance of a more even skin tone.
• Hydrating formulations to support skin barrier function. 
• Ultimate A Gold replaces Ultimate A; you can build your own kit if you prefer Ultimate A. 

Retinal is not suitable for use during pregnancy or while trying to conceive. 

C Forte can exacerbate acne and may be too strong for irritable skin.

We've swapped Ultimate A with the new Ultimate A Gold. If you prefer Ultimate A, you can build your own kit here.

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References 

1. Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539–549. PMC2671032
2. Mardani M et al. Treatment of solar lentigines: a systematic review of clinical trials. J Cosmet Dermatol. 2025. PMC11948172
3. Hormonal Crosstalk in Melasma: Unraveling the Dual Roles of Estrogen and Progesterone in Melanogenesis. PMC. 2025. PMC12652859 
4. StatPearls: Melasma. NBK459271
5. StatPearls: Postinflammatory Hyperpigmentation. NBK559150
6. Balkrishnan R et al. The effect of melasma on self-esteem: a pilot study. J Drugs Dermatol. 2006. PMC5986109
7. Cosmoderma. Photonic frontiers in melasma: heat and vascular contribution to melanogenesis. 2025. Cosmoderma
8. Passeron T et al. New mechanistic insights of melasma: genetic predisposition and family history. CCID / PMC. 2023. PMC9936885
9. Han, H.J., Kim, J.C., Park, Y.J. et al. Targeting the dermis for melasma maintenance treatment. Sci Rep 14, 949 (2024). https://doi.org/10.1038/s41598-023-51133-w  
10. Bastiaens MT et al. Melanocortin-1 receptor gene variants determine the risk of nonmelanoma skin cancer independently of fair skin and red hair. Am J Hum Genet. 2001;68(4):884–894 PubMed. 
11. Box NF, Duffy DL, Irving RE, et al. Melanocortin-1 receptor genotype is a risk factor for basal and squamous cell carcinoma. J Invest Dermatol. 2001;116(2):224–229. PubMed
12. Rodrigues M et al. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2015;90(5):771–773. PMC4155956 

This article is for informational purposes and does not constitute medical advice. Any pigmented lesion that is changing, bleeding, irregular, or new should be assessed by a doctor before treatment.