Pigmentation and Melasma: Why It Happens and What Actually Helps
Why the type of pigmentation matters more than the treatment — and why the wrong move can make it worse.
By Dr Amber Halliday, MRCGP MBBS BSc (Hons) — GP & Aesthetics Doctor | Blue Bird Aesthetics, Worthing | Updated 2026
Pigmentation is one of the most common concerns I see, and one of the most frequently mistreated. The reason is simple: people — and some clinics — reach for a treatment before working out what kind of pigmentation they are dealing with. Get the type wrong, and you can make it worse.
This guide explains the main types, why telling them apart changes everything, and the calm, prepared approach that works.
The first job with pigmentation is not to treat it — it is to work out what kind it is. Get that wrong, and the wrong treatment can flare it badly.
— Dr Amber Halliday
Who This Guide Is For
- Anyone with dark patches, melasma, or sun spots they want to improve.
- People who have treated pigmentation before and seen it return.
- Anyone tempted by an aggressive treatment for stubborn pigment.
- Those wanting a doctor-led, safety-first approach in Worthing.
TL;DR — Key Takeaways
Short on time? Here’s the summary:
✓ Pigmentation has different types, and the type decides the treatment.
✓ Melasma and chloasma are usually symmetrical and fluctuate with sun and hormones; sun-damage pigment is fixed and often uneven.
✓ Some treatments make melasma worse — which is why diagnosis comes first.
✓ Proper treatment blocks the pigment-making cells and renews the deeper skin, with SPF throughout.
✓ The biggest mistakes are undertreating and neglecting sun protection.
✓ Aggressive treatment on unprepared skin can flare pigment and damage the barrier — we build up slowly.
1. Why the type matters more than the treatment
Pigmentation is not one condition. The two you most need to tell apart are melasma (and chloasma, its pregnancy-related form) and pigment from accumulated sun damage. They look similar to an untrained eye, but they behave very differently — and they respond very differently to treatment.
2. Melasma and chloasma vs sun-damage pigment
| Melasma / Chloasma | Sun-damage pigment | |
|---|---|---|
| Pattern | Often symmetrical across the face | Often patchy and uneven |
| Behaviour | Comes and goes; can fade out of the sun and flare in it | Fairly fixed; does not fade away on its own |
| Driven by | Sun and hormones (chloasma is pregnancy-related) | Cumulative UV exposure over years |
| Through the year | Fluctuates with the seasons and sun | Changes little; persists year-round |
| Aggressive treatment | Can make it significantly worse | May respond, but only on prepared skin |
Chloasma is the pregnancy-driven form of melasma — something I have first-hand experience of myself. It is very common, and it needs the same careful, sun-aware approach.
3. Why getting it wrong is risky
Melasma is heat- and inflammation-sensitive, so some of the very treatments people reach for — aggressive or heating ones — can flare it and leave it worse than before. That is why I will not treat pigment until I know what it is.
4. How I treat pigment properly
Done well, pigment management does two things at once: it switches down the melanocytes (the pigment-making cells) with the right melanin-blocking agents, and it renews the deeper layers of skin so the existing pigment is gradually grown out. Underpinning all of it is daily, non-negotiable SPF.
The three pillars
Block the pigment-making cells, renew the deeper skin, and protect with daily SPF. Miss any one and the result disappoints — or returns.
5. The biggest mistakes
Two stand out. The first is undertreating, and not respecting how much daily sun protection matters. The second is assuming that because melasma faded over winter, it has gone for good — it has not, and it will return with the sun unless it is managed.
6. Why prepared skin comes first
Aggressive is not the same as effective
On unprepared skin, an aggressive treatment often triggers a big, painful response and can damage your barrier — leaving you more exposed to infection, sun damage and long-term scarring. Skin must be prepped: hydrated, supported, and with the pigment cells calmed, then treatment is built up gradually. You cannot start at the maximum.
Your barrier is what protects you from everything that can harm your skin. I will not damage it chasing a quick result on pigment.
— Dr Amber Halliday
Frequently Asked Questions
What is the difference between melasma and sun spots?
Melasma is usually symmetrical and fluctuates with sun and hormones, often fading out of the sun. Sun-damage pigment is more fixed, often uneven, and persists year-round.
Can melasma be cured?
It is best thought of as managed rather than cured. With the right treatment and consistent sun protection it can be greatly improved, but it can return if protection lapses.
Will my pigmentation come back?
Melasma in particular can return with sun exposure, even after it fades in winter. Ongoing SPF and maintenance keep it under control.
Can I treat pigmentation at home?
Daily SPF and gentle, supportive skincare help, but stubborn or symmetrical pigment is easy to worsen with the wrong products. It is worth getting the type identified first.
Do peels or lasers help or harm pigmentation?
It depends entirely on the type. They can help sun-damage pigment on prepared skin, but heat and aggression can flare melasma, which is why diagnosis comes first.
Is pregnancy pigmentation (chloasma) permanent?
Often it improves after pregnancy, but sun exposure can keep it going. Diligent SPF and a gentle approach are key.
Why did my pigmentation get worse after a treatment?
Most often because the skin was not prepared, or because melasma was treated as if it were sun damage. Heat and aggression can worsen it.
How long does pigmentation treatment take?
Expect a course over several months, because it works by renewing the deeper layers of skin gradually. There is no overnight fix.
What is the single most important step?
Daily sun protection. Without it, no pigmentation treatment will hold.
The Takeaway
Pigmentation rewards patience and punishes shortcuts. The doctor-led approach is to identify the type first, prepare the skin, block the pigment cells, renew the deeper layers, and protect relentlessly with SPF.
If your pigment has resisted everything you have tried, the likely reason is that it was treated before it was understood. That is the part I would put right first.
If your pigmentation is bothering you, a consultation is the place to work out exactly what it is and how to treat it safely.
Ready to talk it through?
Book a calm, considered, commitment-free consultation in Worthing.
We’ll identify the type of pigmentation you have and prepare a safe, staged plan — with no pressure to proceed.
