Melasma appear as brownish to blackish stains on the cheeks, upper lip, chin and forehead. These usually appear during times of hormonal change, such as menopause, endocrine illness, through the use of contraceptives, in ageing, or during pregnancy. The typical dark stain in the form of a butterfly that appears on the front of the face during pregnancy, receives the special name of chloasma or gravidic melasma. This is the most difficult condition to treat as the pigmentation can be deep. The most effective treatment has been found to be combination of special lightening creams with chemical peels such as Obagi or Cosmelan. Beware of treatments with IPL, as it can worsen the melasma. There are refractory forms of melasma that require oral antioxidants to be taken in addition to existing treatments.
Moles are larger spots of hyperpigmentations. Removal is mostly through a carbon dioxide laser.
Freckles or Ephelides are innocuous pale hyperpigmentations of variable colour. They are common in exposed areas, in people with fairer complexions, and are stimulated by sun exposure. Excellent clearance with an IPL.
Hori’s Naevus, also known as “Acquired bilateral nevus of Ota-like macule”, is a cutaneous condition characterised by multiple brown–gray to brown–blue macules, primarily in the malar region of the face. The pigmentation is in the deeper dermal layer of the skin, making it very difficult to clear. The only effective treatment is by a Q- switch laser. This requires several sessions.