Pigmentation is one of the most searched skin concerns in Australia — and one of the most frequently misunderstood. Many clients arrive at The Skin Nurse having spent months or years trying to treat their pigmentation with over-the-counter brightening products, only to find their dark spots have remained stubbornly in place, or in some cases, worsened.
The reason is simple: not all pigmentation is the same. Melasma, sunspots, and post-inflammatory hyperpigmentation are three distinct conditions with different underlying causes, different depths of pigment in the skin, and different treatment requirements. Using the wrong treatment approach — or even a good treatment applied at the wrong time — can make pigmentation significantly worse.
This guide explains what each type of pigmentation is, how to identify what you might be dealing with, and what clinical options are available to treat them effectively.
Melasma: Hormonal and Stubborn
Melasma is a chronic pigmentation condition characterised by symmetrical patches of grey-brown or brown discolouration — most commonly appearing on the forehead, cheeks, upper lip, and chin. It is far more common in women than men, and is strongly linked to hormonal influences including:
• Pregnancy (it was historically known as ‘the mask of pregnancy’)
• Oral contraceptive use
• Hormone replacement therapy
• Changes in oestrogen and progesterone levels
Melasma is considered one of the most challenging forms of pigmentation to treat because it sits in both the epidermis (surface layer) and the dermis (deeper layer), and because it has a strong tendency to recur — particularly when triggered by sun exposure or hormonal shifts.
Crucially, aggressive laser treatments or high-strength peels can worsen melasma by causing post-inflammatory pigmentation on top of the existing condition. This is why correct diagnosis before treatment is so important.
Post-Inflammatory Hyperpigmentation: The After-Effect
Post-inflammatory hyperpigmentation (PIH) is the darkening that occurs in the skin following inflammation or injury. Common causes include:
• Acne breakouts — the most frequent cause of PIH in our clinic
• Eczema or psoriasis flares
• Cuts, burns, or skin trauma
• Aggressive skincare treatments used incorrectly
PIH typically appears as flat brown, red-brown, or even grey marks at the site of former inflammation. It can occur in any skin type but tends to be more pronounced and longer-lasting in people with medium to dark skin tones, where melanocytes are more active.
The good news is that PIH is generally more responsive to treatment than melasma, with the right combination of topical actives and clinical treatments, significant improvement is achievable within three to six months.
Sunspots (Solar Lentigines): UV Damage
Sunspots — also called solar lentigines or liver spots — are flat, well-defined patches of darker pigmentation caused by cumulative UV exposure. They appear most commonly on areas that receive the most sun: the face, hands, chest, and shoulders.
Unlike melasma, sunspots are not hormonally driven. They are epidermal (surface-level) pigmentation, which makes them generally more responsive to targeted treatments such as BBL laser and chemical peels. They also tend to have sharper, more defined borders than melasma, making them easier to identify and target.
In Perth, where UV intensity is exceptionally high year-round, sunspots are extremely common — even in clients who believe they have been careful about sun protection.
How We Identify Your Pigmentation Type at The Skin Nurse
Correctly identifying the type and depth of your pigmentation is the essential first step before any treatment is recommended. At your Skin Health Assessment, our nurses use a combination of visual analysis, skin history, and in some cases specialised light technology to assess:
• The pattern and distribution of your pigmentation
• Whether it is epidermal (surface), dermal (deep), or mixed
• Your skin tone and sensitivity level
• Your medical and hormonal history
• Any prior treatments and how your skin responded
This information determines which treatments are appropriate for you — and equally importantly, which treatments to avoid.
Clinical Treatment Options for Pigmentation
BBL (BroadBand Light) Laser
BBL laser uses intense pulsed light to target melanin in the skin, breaking down concentrated areas of pigment. It is highly effective for sunspots and superficial pigmentation and is one of the most popular treatments at The Skin Nurse for this purpose. BBL is not the first choice for melasma, as the heat can sometimes stimulate further melanin production.
Clinical Corrective Peels
Carefully selected acid peels can accelerate cell turnover, helping to lift surface pigmentation and even skin tone. We use peels containing lactic acid, kojic acid, and other brightening agents for pigmentation-focused treatments. Peel depth and frequency are calibrated to your specific pigmentation type.
SkinPen Microneedling
Microneedling stimulates collagen production and improves overall skin texture. When combined with vitamin C or other brightening serums, it can also help to address PIH and improve skin tone more broadly.
Sylfirm X RF Microneedling
Sylfirm X is uniquely suited to treating melasma due to its ability to selectively target melanin-producing cells without causing the thermal injury that can worsen the condition. It is one of the very few technologies we can use confidently on melasma-prone skin.
Topical prescription actives
Clinical-grade vitamin C, hydroquinone (where appropriate), niacinamide, retinol, and azelaic acid all have strong evidence for treating hyperpigmentation. These are prescribed as part of your at-home routine to complement and extend the results of in-clinic treatment.
What Not to Do
Some common approaches that can worsen pigmentation:
• Picking at acne — the number one cause of PIH
• Sun exposure without SPF during or after treatment
• Aggressive DIY peels or scrubs on active melasma
• Starting a laser treatment without a proper diagnosis first
Start with the Right Diagnosis
If you are dealing with pigmentation and feel like nothing is working, the most important step is getting a proper professional assessment before investing in further treatments. Book a Skin Health Assessment at The Skin Nurse. We’ll identify exactly what type of pigmentation you have, build a treatment plan tailored to your skin, and give you clear, honest guidance on what to expect.
