Melasma vs hyperpigmentation: How to tell them apart

Living in a sunny place means enjoying bright skies almost all year round. Good weather is a blessing, but it also comes with high UV radiation. It’s no surprise that people of all skin tones often notice the appearance of dark spots on their skin, sometimes even shortly after relocating.

But not all spots are the same. Two of the most common causes are melasma and hyperpigmentation, and although they may look similar at first glance, they behave differently and require different approaches.

Melasma is a chronic condition, more common in women, strongly influenced by hormones, genetics, and sun exposure. It is commonly associated with other conditions such as PCOS, hypothyroidism (when our thyroid gland doesn’t work properly), and pregnancy.
It usually shows up on the face, and tends to worsen during the summer when exposed. The patches are typically symmetrical, sometimes described as “mask-like,” affecting the cheeks, forehead, nose, upper lip, or jawline, areas hit stronger by the sun. The colour ranges from light brown to gray-brown, and the condition often relapses. It’s a medical condition that requires constant care.
In my daily practice, I often see women who come in convinced it’s just “sun spots,” but once we look closer under proper medical examination, it turns out to be melasma, which explains why simple creams alone weren’t working.
Hyperpigmentation, on the other hand, is an umbrella term. It generally means “darkening of the skin”. It can follow any external trigger: acne breakouts, eczema, scratches, burns, waxing, or even certain medications and cosmetic procedures such as laser therapy. In this case, the spots appear in scattered, irregular patterns, not symmetrical and usually have a clear “cause-and-effect” history: “I had a pimple here, and now I have a dark mark there.”
Many patients come after summer with these small, irregular marks, often following acne or waxing: the good news is that, unlike melasma, they usually respond faster once the trigger is controlled.

The summer makes both conditions more challenging. The high UV index, the heat, and even visible light (especially blue light) all stimulate pigmentation pathways. Here’s why sometimes, even with sunscreen, patches don’t fully fade or come back quickly once summer arrives.

How to take care of Melasma and Hyperpigmentation:

The first step for both conditions is always the same: strict photoprotection. Daily use of SPF 50+ with strong UVA coverage is essential. For melasma, tinted sunscreens containing iron oxides are especially valuable, as they also protect against visible light. Reapplication every 2-3 hours when being under the sun, along with hats and sunglasses, makes a real difference. Skincare routines should stay gentle: non-foaming cleansers and barrier-supporting moisturisers instead of harsh scrubs or irritants.

For melasma specifically, there’s a wide spectrum of medical treatments. They often include topical agents (such as azelaic acid, cysteamine, kojic acid, and niacinamide). Prescription combinations may involve hydroquinone or retinoids, carefully dosed and monitored. In some selected cases, tranexamic acid can be added, either topically or orally, under medical supervision. Procedures should be chosen cautiously: chemical peels and lasers may help, but need to be expertly managed. The key mindset is to aim for control, not cure.

Hyperpigmentation follows a different path. Here, the priority is to address the underlying trigger: acne, eczema, or irritation must be calmed first to prevent new marks from forming. Brightening creams (azelaic acid, vitamin C, alpha-arbutin, niacinamide, or retinoids used mostly at night) can gradually lighten existing spots and the skin itself. The various procedures and therapies here are often more effective than in melasma, but they must be tailored to the individual’s skin type, especially for darker skin types, where the risk of rebound pigmentation is higher.

The “Don’ts”

There are also clear “don’ts” that apply to both conditions.
Please: skip home hacks like lemon or vinegar, which irritate more than they help! Don’t over-exfoliate, especially in the summer.

It is always worth seeing a doctor if pigmentation changes quickly, has irregular borders, bleeds, or continues to spread. Medical guidance is also important for pregnancy-related pigmentation, for persistent spots that don’t improve with sunscreen, or for darker skin tones considering peels or laser treatments, which require tailored protocols.

At the end of the day, the guiding principle is this: melasma is about maintenance, hyperpigmentation is about consistency. With patience and the right plan, both can be managed effectively, even under Malta’s strong sun!