Pigmentation is one of the most common concerns among patients at our clinic — and one of the most misunderstood. Brown patches on Indian skin are often grouped under the label "pigmentation," but melasma, sun spots, and post-acne marks are three distinct conditions with different causes, different depths, and different treatment needs.
Treating them all the same way — with a skin-lightening cream or a single-modality laser — is why many patients cycle through products and procedures without lasting results.
Melasma
Melasma appears as symmetrical brown patches — typically on the cheeks, forehead, upper lip, and chin. It is strongly linked to hormonal changes (oral contraceptives, pregnancy, thyroid imbalance) and is dramatically worsened by sun exposure. On Indian skin, it tends to be deep-seated (dermal melasma) rather than surface-level, which is why simple bleaching creams rarely provide lasting clearance.
Dermal melasma requires a multi-layered approach: consistent sun protection as a non-negotiable daily step, targeted topicals to suppress melanin production, and carefully selected procedural treatments. Aggressive laser use without proper skin preparation can worsen melasma on darker skin tones — a phenomenon called post-inflammatory hyperpigmentation (PIH).
Sun spots (solar lentigines)
Sun spots are well-defined, flat brown marks caused by cumulative UV exposure. Unlike melasma, they are not hormonally driven and do not fluctuate with your cycle or medication. They tend to appear on the cheeks, temples, and forearms — areas with long sun exposure history.
Sun spots respond well to Q-Switched laser treatment, which targets melanin precisely without heating surrounding tissue. A course of 3–5 sessions typically produces significant clearance, provided consistent sun protection is maintained throughout.
Post-acne marks (PIH)
Post-inflammatory hyperpigmentation is the brown discolouration left behind after an acne lesion heals. It is not a scar — it is a pigmentation response triggered by inflammation. On Indian skin, PIH can be darker, deeper, and longer-lasting than on fairer skin types, often persisting for 6–18 months without treatment.
PIH responds best to a combination of topical depigmenting agents, chemical peels calibrated for Indian skin, and — in persistent cases — structured dermatological treatment. The key is also controlling active acne aggressively to prevent new PIH from forming.
Why Indian skin needs a calibrated approach
Fitzpatrick skin types IV–VI (the range covering most South Asian skin) produce more melanin in response to inflammation, trauma, and UV exposure than lighter skin types. This means the margin for error in pigmentation treatments is smaller.
- Aggressive peels at the wrong concentration can trigger more PIH than they clear.
- Certain lasers, used incorrectly, cause paradoxical darkening on darker skin.
- Whitening products that suppress melanin globally can cause patchy lightening rather than even-toned skin.
A dermatologist assesses your Fitzpatrick type, identifies which pigmentation pattern you have, and sequences treatments to minimise the risk of triggering new pigmentation while clearing the existing one.
What does treatment look like?
There is no single protocol that works for all pigmentation types on Indian skin. A realistic treatment plan typically involves prescription-grade topicals as a foundation, daily sun protection as a non-negotiable, and in-clinic procedures — peels, laser, or a combination — spaced to allow proper skin recovery between sessions.
If you've been using over-the-counter lightening products without progress, the most useful next step is an accurate diagnosis, not a more expensive product. Book a consultation with Dr. Pinanky Adhe to understand exactly what type of pigmentation you have and what a sequenced treatment plan looks like for your skin.