• Skin is made up of 2 layers- the upper ‘epidermis’ and the lower ‘dermis’.
  • In the lower most part of epidermis are present melanocytes, the cells that produce pigment called Melanin.
  • Color of skin depends on amount of Melanin in the skin layers. Other factors include blood supply and thickness of skin.
  • Darkening of an area of skin caused by increased melanin production is known as Hyperpigmentation.
  • Epidermal pigmentary disorders respond well to treatment. While the dermal pigmentation may take long time to lighten.


Causes of Pigmentation/Hyperpigmentation

  • Diseases- Addison’s disease, Cushing’s disease, Acanthosis nigricans
  • Linea nigra- dark line found on abdomen during pregnancy
  • Smoker’s melanosis- darkening of oral mucosa due to tobacco smoking

What is Melasma?

  • Brown patches appearing  on the sun-exposed areas of face.
  • Usually seen over the cheeks, forehead, nose, or upper lip. It is mostly symmetrical.
  • Melasma does not cause any other symptom beyond the cosmetic discoloration.
  • Commonly seen in females
    • Pregnant women
    • Women taking birth control pills (oral contraceptives)
    • Women taking hormone replacement therapy (HRT) during menopause
  • Men can also develop melasma.
  • Darkens on sun exposure
  • Types-
    • Epidermal- superficial, responds better to treatment
    • Dermal- deep
    • mixed

What is the cause of melasma?

Stimulation of pigment producing cells by female sex hormones to produce more melanin pigment, when the skin is exposed to sun.

Risk factors

  • Genetic predisposition
  • Thyroid disorders
  • Medications- anti-seizure medicines
  • Stress
  • Dark skin type

How to prevent melasma?

  • Sun avoidance
  • sun protection with broad spectrum 30+ SPF sunscreen
  • Healthy diet
  • Managing stress

Treatment of Melasma

  • May clear spontaneously without treatment.
  • It may clear with sunscreen usage and sun avoidance.
  • It may disappear following pregnancy or if birth control pills and hormone therapy are discontinued.
  • Topical skin lightening creams containing tretinoin, azelaic acid, hydroquinone, kojic acid, glycolic acid, steroids.
  • Chemical peeling

Do lasers work for melasma?

Laser treatment is not the primary choice to treat melasma as studies reveal little to no improvement  in the hyperpigmentation for most patients.

Under Eye Dark Circles (Peri-orbital Melanosis)

Dark blemishes around the eyes.

What is the cause of dark circles around eyes?

  • Hereditary tendency
  • Allergies, Asthma, and eczema
  • Anaemia, weakness/ disease
  • Fatigue
  • Ageing
  • Sun exposure
  • Shadows being thrown by your own facial features- careful use of cosmetics helps.

Home remedies for dark circles under eyes

  • Apply raw cucumber or potato  slices daily for 10-15 minutes.
  • Apply cool tea bags or ice cube wrapped in soft cloth.

Tanin in the tea bags reduces swelling and discoloration.

  • Cotton balls dipped in rose water
  • Apply some drops of almond oil and rub it around dark circles.

Tips to prevent Dark circles

  • Drink plenty of water
  • Healthy diet
  • Restrict salt intake
  • Avoid rubbing of the eyes, it irritates skin and breakes tiny blood vessels causing puffiness and discoloration.
  • Wear dark glasses
  • Adequate sleep- 7-8 hours.

What are Freckles?

  • Freckles  are small tan or light brown spots on the sunexposed skin due to  localized concentration of melanin in people with fair complexion.
  • Commonly found on face.
  • Darken on sunexposure.

Treatment of Freckles

Due to sunexposure

Commonly on the face, neck and the back.

Post inflammatory hyperpigmentation

  • Mainly seen in darker skin types
  • Seen after healing of Acne, Eczema/ dermatitis
  • Drug induced
  • Due to cosmetics