If discolouration across your cheeks have become more noticeable, or marks remain long after a breakout has settled, it can be difficult to know whether you are seeing one concern or several occurring together.
Melasma, sunspots and post-acne marks can overlap in appearance, yet they behave differently. An approach that improves an isolated sunspot may be inappropriate for reactive melasma. Acne can leave brown marks or lingering redness after a breakout has settled. These require different treatment considerations, and where breakouts continue, controlling the active acne is an important part of the plan.
During your consultation, I bring those details together: where the colour appears, how it developed and how your skin has responded to previous care. Establishing the type of pigmentation and whether several forms coexist guides the treatment I prescribe.
Recognising the Pattern of Melasma
Melasma commonly presents as brown or grey-brown patches across the cheeks, forehead or upper lip. It often affects both sides of the face, although the distribution and intensity vary between individuals.
You may notice that the patches become more prominent after sun exposure or that they first appeared during pregnancy or after a change in hormonal contraception. For other clients, the pigmentation develops gradually without an obvious starting point.
Ultraviolet exposure, visible light, hormonal influences and genetic predisposition can all contribute.
Melasma also has a tendency to recur. The complexion may improve with treatment, then darken again when the skin encounters a trigger.
When I assess melasma, I pay particular attention to how readily your skin becomes irritated and whether previous treatments caused an initial improvement followed by renewed pigmentation. That history can influence both the treatment I prescribe and the preparation required.
An overly intensive procedure can stimulate further melasma pigmentation in reactive skin. The objective is therefore controlled improvement, supported by a plan that accounts for recurrence and maintenance.
My approach to melasma treatment may include topical care, sun protection and a carefully prescribed laser protocol where appropriate. The sequence depends on your skin’s condition and response to previous treatment. Depending on the diagnosis and your medical history, additional medical management can be discussed during your consultation
Understanding Sunspots
Sunspots, clinically known as solar lentigines, develop in association with accumulated ultraviolet exposure. They commonly appear on the face, décolletage, shoulders and backs of the hands.
They usually present as individual, flat brown areas with relatively defined borders. Unlike freckles, they tend to remain visible throughout the year.
For a confirmed solar lentigo, targeted treatment may help reduce its appearance. Before discussing that treatment, however, I first examine the lesion to establish that it is benign.
Other pigmented lesions can resemble a sunspot. If a mark is new, changing, bleeding or noticeably different from those around it, it should be medically assessed before cosmetic treatment is considered.
Where there is diagnostic uncertainty, I may recommend further investigation. A medical skin check provides the opportunity to assess a concerning lesion and determine the appropriate next step.
Once the diagnosis is established, we can discuss whether treatment is appropriate for your goals, the potential for improvement and the risk of temporary or persistent pigment changes.
Why Pigmentation Can Remain After Acne
A brown mark that remains where a breakout has healed may be post-inflammatory hyperpigmentation.
Inflammation stimulates pigment production, leaving discolouration after the original lesion has settled. Similar marks can follow eczema, irritation, picking or injury to the skin.
Post-inflammatory pigmentation can develop in any skin tone, but it is often more pronounced and persistent in darker skin.
If you are still experiencing breakouts, I assess the active acne alongside the residual marks. Treating existing pigmentation while new inflammation continues may leave you with an ongoing cycle of discolouration.
In that presentation, controlling acne becomes an essential part of improving the complexion. I may address both concerns within the same plan, adjusting the treatment sequence to your skin’s tolerance.
It is also important to distinguish brown pigmentation from other changes left by acne. Red or pink marks may reflect residual vascular changes, while an indentation involves the structure of the skin.
Each requires its own clinical approach. During an acne consultation, I establish whether the concern is active inflammation, residual colour, scarring or a combination.
When Several Forms of Pigmentation Coexist
You may have melasma across the cheeks, isolated sunspots near the temples and post-acne pigmentation along the jawline.
This is where an individual treatment plan becomes particularly important.
A procedure appropriate for an isolated sunspot may need to be adjusted or deferred where reactive melasma surrounds it. If irritation is also present, restoring skin tolerance may take priority before procedural treatment.
I assess these areas together so the prescription accounts for both their distinct features and the way they interact. The treatment depth, intensity and timing should reflect the pigmentation present in each area.
What Your Pigmentation History Reveals
During your consultation, I ask when the pigmentation appeared, how it has developed and whether you have noticed a relationship with sun exposure, hormonal changes or inflammation.
I also review previous treatments and your response to them. Pigmentation that returned after a procedure, irritation from topical products or a tendency to develop dark marks after minor inflammation can all influence my recommendations.
Your current skincare, medicines and relevant medical history form part of that assessment.
On examination, I consider the distribution, borders, colour and surrounding skin. Magnification or additional examination techniques may help clarify the diagnosis, while any lesion with unusual features is assessed separately.
You do not need to identify the type or depth of pigment before your consultation. Your observations and desired outcome provide the starting point; my role is to interpret the clinical findings and explain the appropriate treatment pathway.
Determining the Treatment Approach
For melasma, I consider how to improve visible pigmentation while limiting irritation and supporting longer-term stability. Topical care and maintenance often remain relevant even when a laser protocol forms part of the plan.
For confirmed sunspots, targeted laser or light-based treatment may help reduce the appearance of individual lesions. Post-inflammatory pigmentation requires a different consideration: the inflammation that created it should be controlled, and treatment should avoid introducing further irritation.
At DOCTOR SHAMMI in Melbourne, options considered during a pigmentation consultation include pico laser and Moxi laser. They serve different purposes. Pico laser delivers very short pulses of energy to target pigment, while Moxi provides fractional treatment that may be considered when uneven pigmentation accompanies broader concerns about skin tone and texture.
Melasma requires particular caution with either approach. The diagnosis, skin preparation, treatment settings and intervals determine whether a laser protocol has an appropriate role.
If you have brown or darker skin, inflammation can leave pigmentation that persists after the skin has otherwise healed. I pay particular attention to how your skin has responded to acne, irritation and previous treatments before prescribing a laser protocol.
Daily sun protection is also an important part of managing pigmentation. Even as existing marks fade, sun exposure can deepen the colour again. Use broad-spectrum SPF50+ sunscreen alongside protective clothing and shade. For melasma, I also discuss tinted sunscreen containing iron oxides, which can help protect against visible light that may aggravate the condition.
Where laser or light-based treatment is appropriate, I prescribe according to the diagnosis, skin tone, treatment history and risk of further pigmentation. Settings and treatment intervals require the same consideration as the technology itself.
I discuss these factors in further detail in Which Laser Treatments Can Suit Pigmentation in Asian Skin?.
A Clear Diagnosis Guides a Precise Prescription
Pigmentation treatment begins with understanding what the colour represents and how your skin is likely to respond.
That allows me to explain the improvement we are working towards, the limitations of treatment and the maintenance your particular condition may require.
If you are uncertain whether you have melasma, sunspots, post-acne marks or several concerns together, a pigmentation consultation with Dr Shammi provides the opportunity to establish the diagnosis and develop an individual treatment plan.
General information only. This article does not replace an individual medical assessment. Treatment suitability, risks and outcomes vary between clients.
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