Pigmentation Types Explained: Melasma, Tanning and Post-Acne Marks

Walk into a dermatology clinic in Pune or Mumbai describing "dark patches on my face" and the first clinical question you will be asked is: what kind? Melasma, post-inflammatory hyperpigmentation, solar tanning, and freckles look similar to the untreated eye but respond to almost entirely different interventions. The reason treatments fail — and they fail often — is that the wrong intervention is applied to the wrong pigmentation type. Understanding which you have is the most useful piece of information you can bring to any skin consultation.

Melanin: The Common Thread

All skin pigmentation originates with melanin — the pigment produced by melanocytes in the base layer of the skin. Melanocytes produce melanin in response to UV radiation, hormonal signals, inflammation, and oxidative stress. The trigger determines the type of pigmentation, the pattern, the depth, and crucially — what will actually improve it.

Melasma: The Hormonal Pigmentation

Melasma presents as symmetrical, brownish-grey patches on the face — typically the cheeks, forehead, upper lip, and chin — driven primarily by oestrogen and progesterone signalling to melanocytes. It is significantly more common in women and strongly associated with pregnancy, oral contraceptive use, and hormone replacement therapy. Sun exposure dramatically worsens melasma by activating already hyperstimulated melanocytes.

Melasma is among the most treatment-resistant pigmentation conditions in dermatology. The hormonal driver is often ongoing — the skin keeps producing excess melanin as fast as treatment reduces it. Consistent SPF is one of the most clinically significant interventions — not an afterthought but a mandatory companion to any treatment. IV glutathione and vitamin C works systemically, inhibiting tyrosinase across the entire skin, which can be more effective for diffuse melasma than targeted topicals alone. Our skin health and IV therapy guide covers the mechanism.

Post-Inflammatory Hyperpigmentation

PIH is the dark mark left after skin inflammation — most commonly acne, but also eczema, burns, or procedures. The inflammatory process triggers melanocyte activity as part of healing; the melanin deposited during healing is the mark that persists. In South Asian skin (Fitzpatrick IV-V), PIH tends to be deeper, longer-lasting, and more visible. Managing the source of inflammation — treating active acne — is as important as treating the marks themselves. See: acne after 25 in Indian skin.

Solar Tanning: The UV Response

A tan is a protective melanin response to UV radiation. Acute tanning from a holiday is typically diffuse and fades as skin turns over — usually four to eight weeks. Chronic cumulative UV damage produces irregular, patchy pigmentation mixed with texture changes and requires longer-term antioxidant management. The ALIV de-tan protocol covers both acute and chronic sun damage approaches.

How do I know which pigmentation type I have?

Wood's lamp examination reveals depth — epidermal pigmentation appears more prominent, dermal less so. This distinction matters because superficial pigmentation responds better to topical and IV antioxidant therapy than deep dermal pigmentation. Pattern, distribution, hormonal history, and trigger history all contribute to the clinical picture. At ALIV, skin assessment is part of every pre-IV skin consultation.

Can IV glutathione treat all pigmentation types?

IV glutathione works systemically, benefiting diffuse and hormonally-driven pigmentation (melasma) most reliably. For focal, deep PIH — specific post-acne marks — targeted topical or procedural interventions are often more directly effective. The combination of IV glutathione plus topical therapy plus SPF is consistently more effective than any single modality.

Is melasma permanent?

Melasma is a chronic condition with an ongoing hormonal trigger — UV exposure reliably reactivates it. With consistent management — SPF, topical inhibitors, IV antioxidant support, hormonal assessment — melasma can be significantly controlled. Permanent cure is not a realistic goal; well-managed and minimally visible with maintained treatment is the honest description.

Why does pigmentation worsen in Mumbai summers?

UV intensity in Mumbai and Pune during summer reaches Very High to Extreme indices. UV directly stimulates melanocytes, worsening every pigmentation type present. Broad-spectrum SPF 50+ applied 20 minutes before exposure and reapplied every two hours is the foundational intervention — without it, no pigmentation treatment works optimally.

Does pigmentation look worse before it improves with treatment?

Some topical treatments — chemical exfoliants, vitamin C serums — temporarily darken the surface as mobilised melanin is shed during skin turnover. This is normal and is not a sign of worsening. Being warned beforehand prevents patients from discontinuing effective treatment prematurely.