Melasma:

It is a hormonal pigmentation disorder which presents with symmetrical brown or grayish-brown patches and usually affects the cheeks, forehead, upper lip, nose, and chin. The most common triggers for melasma include hormonal changes during pregnancy, oral contraceptives, and hormone replacement therapy, although sun exposure may considerably worsen the condition.

Sun Spots (Solar Lentigines/Age Spots):

Flat, tan to dark brown spots caused by cumulative sun exposure and UV damage. These are commonly seen on sun-exposed parts of the body, including the face, hands, shoulders, and arms. Unlike freckles, sun spots do not naturally disappear and usually increase with age.

PIH:

PIH is dark patches that form after skin inflammation or injury usually caused by conditions like acne, eczema, burns, and improper laser treatment. Skin tone and the depth of pigmentation determines whether these PIH lesions will appear brown, red, black, pink, or purple.

Ephelides (Freckles):

These are tiny brown spots that appear when the skin, due to sun exposure, creates extra melanin to be a protective pigment against UV rays. Freckles are most frequently found in people with fair skin and those that have light-colored hair.

Hormonal Pigmentation:

It is a pigmentation issue that is brought about by the hormonal changes and typically occurs in women during pregnancy, menopause, or when they are on hormone-related medication. This often coincides with melasma.

Sun exposure:

This is the most common cause of pigmentation. UV radiation stimulates melanin production; this causes sun damage, age spots, and aggravation of pigmentation. Melanocytes proliferate locally with chronic sun exposure.

Hormonal Changes:

Estrogen and progesterone, among other hormones, directly stimulate melanin production. Pregnancy, oral contraceptives, hormone replacement therapy, and menopause tend to produce the common triggers, especially for melasma. Hormones also heighten skin sensitivity to sun exposure.

Post-Inflammatory Hyper-Pigmentation:

Skin injury due to acne, lacerations, burns, eczema, or allergic reactions leads to inflammation, which destroys the skin cells. This destruction releases pigment into the surrounding skin and causes discoloration. This phenomenon is more common in darker skin types.

Genetic Factors:

A familial predisposition and also ethnicity are important in the development of disorders of pigmentation. People with skin types III-V are more likely to develop pigmentation because of higher melanin content.

Aging:

Melanocyte distribution becomes uneven as skin ages. Cumulative UV damage results in age spots and general discoloration of the skin. Medications: A number of drugs such as oral contraceptives, antimalarial agents, antidepressants, and phototoxic drugs can cause or exacerbate pigmentation by increasing the sensitivity of skin to sunlight.

Heat Exposure:

Increased blood flow to the skin due to heat can provoke or worsen melasma.

Q-Switched Nd:YAG LASER (1064nm & 532nm):

This laser treatment approach represents the gold standard in treating pigmentation. The laser functions with nanosecond pulsations that break down excessive deposits of melanin. The wavelength 1064 nm penetrates deeper and is used for dermal pigmentation and melasma, whereas 532 nm is used for superficial epidermal pigmentation, sun spots, and age spots. It is also safe for all skin types, including dark-toned skin.

Laser Toning (Low-Fluence Q-Switched Nd:YAG):

This is the technique that uses lower energy, multiple passes to gently lighten the pigmentation, stimulating collagen production and resulting in skin rejuvenation and tightening.

Fractional CO2 Laser:

This creates microtreatment zones that remove damaged, hyperpigmented skin cells while stimulating collagen production. Effective at improving the overall skin texture and tone with very minimal downtime.

Intense Pulsed Light (IPL) Therapy:

Emits multiple wavelengths of light converted into heat energy in melanin-rich cells, thus destroying the pigmentation and therefore improving brown spots, texture, and the overall skin tone.

Glycolic Acid Peels:

20-70% range, sugar cane-derived alpha-hydroxy acid peels that remove the surface layer of the skin, encourage the production of new cells, and promote the synthesis of collagen. It is a very potent treatment for melasma, post-inflammatory hyperpigmentation, and photoaging. Besides that, it is also quite a tolerant procedure with only minimal recovery time.

Trichloroacetic Acid (TCA) Peels (10-35%):

These are the peels of medium depth, which penetrate the skin layers much further than glycolic acid peels, hence they are able to deliver more significant results for pigmented areas that are resistant to treatment. Useful in the treatment of melasma, sun damage, and deeper skin discoloration.

Combination Peels:

Combination of Glycolic Acid and TCA. The sequential application yields deeper, more uniform results compared to either peel alone. It is effective in resistant pigmentation and photoaging. Jessner's Solution: Salicylic acid combined with lactic and resorcinol acids for hyperkeratotic lesions and pigmentation.

Triple Combination Cream:

The three substances: Hydroquinone which reduces melanin; tretinoin that enhances cell turnover; and corticosteroid, an anti-inflammatory, are combined in one cream to comprehensively treat melasma.

Hydroquinone (2-4%):

A skin-lightening agent that inhibits the activity of melanocytes and therefore reduces melanin production.

Azelaic Acid:

This acid can be used twice a day to effectively and safely reduce pigmentation even if the patient is going through pregnancy.