The Complete Guide to Pigmentation and Melasma
Understanding Pigmentation in Indian Skin
Pigmentation is one of the concerns I discuss most frequently with my patients. Indian skin types (Fitzpatrick III to V) have higher baseline melanin levels, which means our skin is more reactive to any trigger that disrupts melanocyte activity. This is why pigmentation disorders are disproportionately common in South Asian populations.
The first step in effective treatment is accurate diagnosis. Not all dark patches are the same, and treating the wrong type can actually make things worse.
Types of Pigmentation
Melasma is the most challenging type I treat. It presents as symmetrical brown or grey-brown patches, typically on the cheeks, forehead, bridge of the nose, and upper lip. It is driven by a combination of UV exposure, hormonal factors, and genetic predisposition. Melasma tends to be chronic and requires ongoing management rather than a one-time fix.
Post-inflammatory hyperpigmentation (PIH) occurs after skin injury or inflammation. Acne, burns, cuts, or even aggressive beauty treatments can leave dark marks that persist for months. The inflammation triggers melanocytes to overproduce melanin in the damaged area.
Solar lentigines (sun spots or age spots) are flat brown spots that appear on sun-exposed areas after years of cumulative UV damage. Unlike melasma, they do not fluctuate with hormones and respond well to laser treatment.
Why Pigmentation Is Harder to Treat in Darker Skin
The very melanin that gives Indian skin its beautiful tone also makes pigmentation treatment more nuanced. Aggressive treatments like high-energy lasers or deep peels can trigger a paradoxical response: the trauma itself causes more pigmentation. This is why I always start conservatively and build intensity based on your skin's response.
Effective Treatment Approaches
At Leor, we use a layered strategy that addresses pigmentation at multiple levels:
- Q-Switch laser at carefully calibrated energy levels breaks down existing melanin deposits without damaging surrounding tissue. For Indian skin, we use lower fluences with more frequent sessions rather than aggressive single treatments.
- Chemical peels with tyrosinase inhibitors suppress new melanin production while exfoliating the pigmented surface layer. We customize the acid blend based on whether you have epidermal, dermal, or mixed pigmentation.
- Topical regimens with ingredients like arbutin, kojic acid, vitamin C, and carefully dosed retinoids form the daily maintenance that prevents recurrence between clinic visits.
Sun Protection Is Non-Negotiable
I tell every pigmentation patient the same thing: the best treatment in the world will fail without rigorous sun protection. SPF 50+ every morning, reapplied every 2 to 3 hours when outdoors, is the foundation of any pigmentation protocol. Even indoor light from windows can reactivate melasma.
At Leor
Our pigmentation protocols begin with a Wood's lamp examination to determine the depth of your pigmentation. We then design a combination plan using Q-Switch laser, medical peels, and a prescribed homecare routine. Most patients see significant improvement within 6 to 8 sessions. Book your assessment to get started.