Overview
Types of pigmentation.
- Melasma: symmetric brown patches on the cheeks, forehead and upper lip, driven by hormones, sun and visible light. Common in pregnancy and with hormonal contraception.
- Sun spots (solar lentigines): flat brown spots on sun-exposed skin.
- Post-inflammatory hyperpigmentation (PIH): dark marks after acne, eczema or skin injury, especially common in deeper skin tones.
How we treat
How Dr. Burris treats pigmentation.
- Daily tinted mineral sunscreen with iron oxides, which protects against visible light and is essential for melasma
- Prescription topicals: hydroquinone, tretinoin, azelaic acid and combination creams
- Non-hydroquinone brighteners: tranexamic acid, cysteamine, kojic acid and niacinamide
- Oral tranexamic acid for stubborn melasma, in appropriate candidates
- Chemical peels, carefully selected to avoid rebound darkening
Questions
Frequently asked questions.
Can melasma be cured?
Melasma is chronic and tends to recur with sun and hormonal triggers. It can be lightened significantly and kept controlled with consistent maintenance.
Why does my melasma come back every summer?
UV and visible light reactivate pigment cells. Year-round tinted sunscreen, hats and maintenance treatment are the best defense.
Is it safe to treat pigmentation during pregnancy?
Some treatments, such as hydroquinone and retinoids, are avoided in pregnancy, while others, such as azelaic acid and sun protection, are considered safe. See our pregnancy and postpartum page.
Are lasers good for melasma?
Some lasers can worsen melasma. Dr. Burris favors topical therapy, sun protection and carefully chosen peels as the foundation of treatment.