Melasma vs Hyperpigmentation vs PIH

Melasma, hyperpigmentation, and post-inflammatory hyperpigmentation are not the same condition, even though patients often use the terms interchangeably and the marks can look nearly identical to the eye. Melasma is a chronic, sun-driven pattern that tends to come back. Post-inflammatory hyperpigmentation, or PIH, follows a specific inflammatory event, like acne or an irritating treatment, and generally fades as the skin heals. "Hyperpigmentation" is the broader umbrella term that includes both, plus other causes like sun damage.

This article is for anyone who has been treating a pigment mark without much progress, or who wants to understand why one treatment plan worked for a friend's dark spots but not for their own. It covers what actually separates these three, how a physician tells them apart at a consultation, and why picking the wrong one to treat is one of the most common reasons pigment care stalls out.

What melasma actually is

Melasma appears as symmetric patches, most often on the cheeks, forehead, upper lip, and chin, and the skin around the pigment can show an increase in blood vessels (Dermatol Ther (Heidelb), 2017). It is common in melanin-rich skin: prevalence studies have found melasma in an estimated 8.2 to 8.8 percent of Latino populations studied in New York City and the American Southwest, and in 13.4 to 15.5 percent of an Arab-American population studied in Michigan, which is part of why ancestry and family history are part of the intake conversation, not an afterthought. The defining feature of melasma, more than its color or location, is that it is a chronic, relapsing condition: even a successful round of treatment does not mean it is gone for good. Melasma tends to darken again with new sun exposure, a hormonal shift, or even heat, which is why a melasma plan is built around long-term management rather than a single resolving treatment.

What post-inflammatory hyperpigmentation actually is

PIH is the dark mark left behind after the skin recovers from inflammation, whether that inflammation came from acne, a cut, an ingrown hair, or a treatment that pushed too hard. In melanin-rich skin, the pigment response to inflammation is more pronounced, which is why a minor breakout can leave a mark that outlasts the original blemish. Unlike melasma, PIH is tied to a specific triggering event, and once the underlying inflammation is controlled, the mark itself typically improves over time. How dark and how long-lasting a given PIH mark turns out to be depends partly on how deep the pigment settled, which is a separate question from how melanin-rich the skin is overall: two patients with similar skin tones can have very different PIH courses depending on whether the pigment stayed near the surface or dropped into the dermis, which is one more reason a single visual glance is not enough to build a treatment plan around.

Hyperpigmentation as the broader category

"Hyperpigmentation" describes any area of skin that has more pigment than the skin around it, and melasma and PIH are both specific types of it, alongside things like sun-driven solar lentigines, which are distinct flat brown spots that accumulate from cumulative sun exposure rather than from a single inflammatory event or a hormonal pattern. Solar lentigines tend to appear on the areas that get the most sun over years, like the cheeks, temples, and the backs of the hands, and unlike melasma they do not fade and return in the same recurring pattern; they simply accumulate more of them over time without consistent sun protection. Using the umbrella term "hyperpigmentation" is not wrong, but it is imprecise for treatment purposes, because the plan that helps a sun spot is not necessarily the plan that helps melasma or a post-acne mark. Getting specific about which condition you actually have is the step that determines everything after it.

Two dark spots can look the same and still need completely different treatment plans, which is exactly why the diagnosis has to come before the protocol.

How a physician tells them apart

Diagnosis leans on three things together, not any single one alone: your history, the pattern of the mark, and known triggers. History matters because melasma often has a hormonal trigger, like pregnancy or hormonal birth control, while PIH almost always traces back to a specific skin event you can usually name. Pattern matters because melasma tends toward symmetric patches on sun-exposed facial areas, while PIH follows the exact shape and location of whatever caused it, whether that is an acne lesion or a treatment area. Severity scoring tools like the Melasma Area and Severity Index exist specifically for melasma and are not used the same way for PIH, which is one more sign these are genuinely different conditions with different clinical frameworks. That scoring tool grades the darkness, area, and homogeneity of melasma patches across defined facial regions, which gives a provider a consistent way to track whether a treatment plan is actually working over months rather than relying on memory or a photo taken under different lighting each visit. A simpler, more practical office-based version of the same scoring approach has also been proposed specifically to make this kind of tracking easier to do consistently during a normal visit, without needing a research-grade setup.

Our melasma page covers how we manage melasma specifically, our post-inflammatory hyperpigmentation page covers what to expect once inflammation has been addressed, and our broader pigment explainer goes into why melanin-rich skin pigments the way it does. Our chemical peels and microneedling pages cover the treatments most often used once the diagnosis is settled.

What we check at Kintsu

A pigment consultation starts with Fitzpatrick typing, since it shapes every setting and product decision that follows. We take a full history of the mark, including when it appeared, what preceded it, whether it followed a hormonal change or an inflammatory event, and how it has behaved since. We assess the pattern and your history to get a clearer read on the likely cause. From there we build a plan around melasma, PIH, or general hyperpigmentation specifically, not a generic pigment protocol, and we set realistic expectations about timeline given what the diagnosis actually is. For melasma specifically, that means an honest conversation about maintenance and recurrence from the start, rather than presenting a treatment course as a one-time fix. For PIH, it means confirming the original inflammatory trigger is actually controlled before layering on pigment-focused treatment, since treating the mark while the underlying irritation continues tends to produce disappointing, short-lived results. Kintsu specializes in melanin-rich skin, and that same diagnostic rigor is what makes our care a careful choice for every skin tone, Fitzpatrick I through VI.

FAQ

Pigment that will not fade is frustrating precisely because "hyperpigmentation" gets used as a catch-all, when the actual condition underneath the mark determines whether a treatment plan will work at all. If your dark spots have not responded to what you have tried, the next step is a diagnosis, not another product, and not another round of the same routine that has not moved the needle so far. Book a consultation and we will start with what your skin is actually doing before recommending anything, so the plan you leave with is built around your actual diagnosis rather than a guess.