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Pigmentation & Melasma

Pigmentation occurs when there are changes in melanin, the pigment responsible for your natural skin colour. When pigment-producing cells are damaged or overstimulated, darker patches may develop on the skin.

These patches, known as hyperpigmentation, can appear as freckles, lentigines, age spots, or uneven darkened areas, and often become more noticeable with sun exposure.

A common type of hyperpigmentation is melasma, which is often linked to hormonal changes and is notoriously challenging to treat. It frequently affects women, Asians and especially those living in regions with strong sun exposure.

Melasma usually begins as mild facial discolouration that gradually darkens and spreads over time. While it may fade after pregnancy in some cases, others may require treatment, and sun exposure remains a major contributing factor.

Individuals at higher risk of developing melasma include:

  • Pregnant women, particularly during the second and third trimesters
  • Women undergoing hormone therapy
  • Women taking oral contraceptive pills
  • Individuals using skincare products that irritate or sensitise the skin
  • Individuals with prolonged sun exposure

Understanding the difference between solar lentigines and melasma

Although both involve excess pigment, hyperpigmentation and melasma differ in cause, appearance, and management. Understanding these differences helps guide appropriate treatment, but a professional diagnosis is always recommended.
  • Appearance: Solar lentigines usually appear as distinct, isolated dark spots or freckles, while melasma forms larger, symmetrical patches that often blend together.
  • Cause: Solar lentigines typically triggered by external factors like sun exposure or inflammation, whereas melasma is collectively driven by internal factors such as hormones or genetics, although it can worsen with sun exposure.
  • Persistence: Solar lentigines, especially those that are more superficial, can improve with topical treatments and sun protection, while melasma tends to be chronic, recur, and often requires ongoing care.
  • Location: Solar lentigines can occur anywhere on the body, but melasma is usually concentrated on the face.

Types of pigmentation

Pigmentation often develops due to a combination of factors such as genetics, sun exposure, ageing, and hormonal changes such as pregnancy or contraceptive use. The most common types of pigmentation in Singapore include:

Freckles

Small, sun-induced spots are heavily influenced by genetics.

Sunspots / Age Spots / Solar Lentigines

Dark spots from prolonged sun exposure, typically seen in adults over 40, which should be monitored for potential skin cancer.

Hori’s Nevus

Bluish-grey patches seen mostly in Asian Chinese skin, usually on the cheeks or forehead.

Melasma

Large, irregular patches often triggered by hormonal changes, common during pregnancy, and prone to recurrence with sun exposure.

Post-Inflammatory Hyperpigmentation (PIH)

Dark spots following skin inflammation, injury, or acne.

Risk factors for melasma

Several factors can increase the likelihood of developing melasma or worsen existing pigmentation, including:
  • Hormonal changes: Fluctuations in hormones such as estrogen and progesterone, commonly during pregnancy, use of oral contraceptives, or hormone replacement therapy, can stimulate excess pigment production when skin is exposed to light.
  • Sun and light exposure: Ultraviolet (UV) rays remain the main trigger for melasma, often darkening existing patches and causing new ones to form. Visible light and heat exposure may also contribute to flare-ups.
  • Genetic predisposition: Individuals with a family history of melasma are more likely to develop the condition.
  • Darker skin tone: People with naturally darker skin tones are more prone to melasma due to higher melanin activity.
  • Other contributing factors: Certain medications, thyroid disorders, and the use of irritating or heavily fragranced skincare products may also trigger or worsen melasma in some individuals.

When to see a dermatologist for sagging skin

If you notice persistent, worsening, or recurring pigmentation on your face, it’s important to seek professional advice. Cosmetic concerns that affect your confidence or daily life are also valid reasons to consult a dermatologist.

At Auria Dermatology Clinic, Dr Laura Hui can assess your skin, identify the type and depth of your melasma, and recommend personalised treatment options. Early consultation helps prevent ineffective trial-and-error methods and ensures your treatment plan is safe and tailored to your skin.

Treatment options

Managing pigmentation and melasma usually requires a combination approach customised to your skin type and pigmentation pattern. Common options include:

Prescription topical creams

  • Hydroquinone - Inhibits enzymatic oxidation of tyrosinase leading to decreased melanin. A hydroquinone, retinoid and steroid combination cream is often considered the gold standard for lightening pigmentation.
  • Retinoids - Promote cell turnover, decrease melanosome transfer, inhibit tyrosinase transcription
  • Tyrosinase inhibitors - Other tyrosinase inhibitors include cysteamine, thiamidol, arbutin, kojic acid
  • Antioxidants - Azelaic acid, niacinamide, tranexamic acid, ascorbic acid (vit C)

Topicals are most effective under medical supervision to avoid irritation or rebound pigmentation.

Chemical peels

Chemical peels such as glycolic, salicylic or lactic acid peels exfoliate pigmented layers and encourage skin renewal. Multiple sessions are usually needed, and not all types of melasma respond equally.

Oral treatments and supplements

Oral treatments and supplements such as tranexamic acid and antioxidants may help manage melasma, often in combination with other treatments.

Laser treatment

Lasers can target deeper pigmentation and improve skin quality and texture, but the type of laser matters. Pigment lasers such as Q-switched Nd:YAG, Picosecond lasers are safe, while aggressive lasers should be avoided as they can worsen melasma and cause more hyperpigmentation. Professional guidance is essential, especially for darker skin tones.

Frequently Asked Questions​

Pregnancy melasma, also known as chloasma or the “mask of pregnancy,” is a common form of pigmentation that develops due to hormonal changes during pregnancy. It usually appears in the second or third trimester as symmetrical dark patches on areas such as the forehead, cheeks, and upper lip. The condition is often more noticeable in women with darker skin tones and can worsen with sun exposure. For many women, pregnancy may be their first experience with melasma.
While it is often not preventable, consistent maintenance, sun protection, and lifestyle measures can significantly reduce flare-ups and help maintain clearer, even-toned skin.

Melasma is a chronic condition that requires ongoing care to prevent relapse. Maintenance includes consistent sun protection, adopting skin-friendly lifestyle habits, and following a personalised treatment plan that may be adjusted for seasonal UV changes and/or exposure or hormonal fluctuations.

Regular check-ups with a dermatologist help monitor your skin and address early signs of recurrence, keeping pigmentation under control over the long term.

Yes, pigmentation can recur, especially without consistent sun protection and proper skincare. Your dermatologist will guide you on the right aftercare to help maintain results and prevent relapse.
Yes, a healthy diet rich in antioxidants, vitamins, and minerals can support skin health and help reduce pigmentation. Avoiding excessive sun exposure, quitting smoking, and managing stress also contribute to clearer skin. When combined with proper treatments, these lifestyle changes can improve the results of pigmentation management.
Many skin-lightening products are safe when used correctly, but some may contain harmful ingredients like mercury or excessive hydroquinone. It’s important to use products approved by regulatory authorities and follow usage instructions. Consulting a dermatologist can help you choose safe and effective options for your skin
Most pigmentation treatments can be adapted for different skin types, but the approach should be personalised. Sensitive skin may require gentler formulations or lower concentrations of active ingredients. A dermatologist can recommend the safest and most effective treatment for your specific skin type and pigmentation concerns.

Seeing a dermatologist at Auria Dermatology Clinic

Pigmentation concerns such as melasma, sun spots, and uneven skin tone can be frustrating and may affect how you feel about your skin. You’re not alone — these conditions are common and often influenced by factors such as sun exposure, hormones, and genetics.

During your consultation, our dermatologist, Dr Laura Hui, will take the time to understand your skin concerns, assess possible triggers, and guide you through suitable treatment options based on your individual needs.

Our goal is to help you manage pigmentation safely and effectively, while supporting healthier skin over the long term.

Begin Your Skin Journey with Confidence