1 Two conditions, one word
Patients rarely arrive saying "I have melasma" or "I have post-inflammatory hyperpigmentation". They say they have pigmentation, dark patches, or an uneven tone — and in the mirror the two conditions can look very much alike: brown areas on the face, darker in summer, resistant to the creams tried so far.
Under a dermatoscope, and in how they behave over months, they are different diseases. Melasma is an ongoing over-activity of the pigment-producing cells in specific areas of the face, driven by hormones, heat and light. Post-inflammatory hyperpigmentation (PIH) is the pigment left behind after an injury to the skin — a pimple, a rash, a burn, friction, a procedure — that the skin then slowly clears.
One is a process that is still running; the other is the mark of a process that has finished. Almost every practical difference in treatment follows from that.
2 How to tell them apart
Pattern is the first clue. Melasma is symmetrical: both cheekbones, both sides of the forehead, the upper lip, sometimes the chin, in irregular map-like patches with a fairly defined edge. PIH is wherever the injury was — a cluster of small marks where acne has been, a line where a wound healed, a patch where a rash sat — and it is rarely symmetrical unless the trigger was.
History is the second. Melasma commonly starts in the twenties to forties, often with pregnancy or a change in contraception, and worsens noticeably in summer or with heat. PIH follows something you can usually name — a bad breakout, a waxing burn, a reaction to a product.
Behaviour is the third. PIH gradually fades on its own over months, faster with treatment. Melasma does not fade on its own; it waxes and wanes with sun and hormones and relapses when treatment stops.
At consultation the dermatologist adds a Wood's lamp or dermatoscope, which helps judge how deep the pigment sits — epidermal pigment responds faster than dermal — and looks for other conditions that mimic both, such as lichen planus pigmentosus or pigmentation caused by cosmetics or medication.
3 Why post-inflammatory pigmentation is the easier one
PIH is a residue. Once the inflammation that caused it has stopped, the skin's own turnover clears the excess pigment over months — three to six for epidermal marks, longer for deeper ones. Treatment speeds that up: prescription lightening creams, glycolic or mandelic peels, and low-fluence Q-switched laser toning, together with daily sunscreen so the marks do not darken while they fade.
The critical step is stopping the cause. Post-acne marks keep appearing while acne is active, so acne treatment comes first or alongside; marks from friction or a product stop when the friction or the product does. Treat the trigger and PIH is one of the more satisfying things to treat: it responds to a defined course and, with sun protection, stays away.
On Indian skin the one caution is not to over-treat. Strong peels and high-energy lasers can themselves cause PIH — the treatment creating the very thing it was meant to remove — which is why strengths here are moderate and increased gradually.
4 Why melasma needs a different strategy
Melasma is not a residue; the pigment cells are still over-producing. Three things follow.
First, triggers matter more than any procedure. Daily broad-spectrum SPF 50 — ideally tinted with iron oxide, because visible light drives melasma as well as UV — is the treatment, not an accessory. Heat is an independent trigger, which matters in a Delhi-NCR summer. Hormonal contraception is worth reviewing with your gynaecologist.
Second, gentleness beats strength. Aggressive lasers, IPL and strong peels frequently make melasma worse, sometimes permanently. The plan uses prescription lightening creams as its backbone — with planned breaks to avoid rebound — plus gentle repeated peels, low-fluence Q-switched laser toning in suitable patients, and oral tranexamic acid for resistant cases after screening.
Third, there is no finish line. Melasma is lightened and controlled, then maintained indefinitely with sunscreen, a maintenance cream and periodic reviews. Patients who are told this at the first visit do well; patients who are promised a cure are disappointed by the following summer.
5 What about the creams sold for "fairness"?
Many over-the-counter fairness creams sold in India contain unlabelled potent steroids, high-strength hydroquinone or both. They lighten quickly — which is why people keep buying them — and then cause rebound pigmentation, thinning of the skin, visible blood vessels, acne and, in melasma, a worse baseline than before.
If you have been using one, do not stop abruptly and do not switch to another; taper and replace it under supervision. Prescription lightening agents use the same active ingredients at known strengths, for defined periods, with breaks — that is the difference between treatment and harm.
6 What to do next
If your pigmentation is symmetrical, worsens in summer and has not faded in a year, treat it as melasma until a dermatologist says otherwise — and expect a long-term plan. If it maps onto old acne, a rash or an injury and is slowly fading, it is probably PIH and the priority is stopping the trigger and protecting it from sun while it clears.
Either way, the first useful step is a diagnosis, not a product. Our Melasma Treatment page explains the long-term plan; our Pigmentation Treatment page covers post-inflammatory marks, sun spots and uneven tone; and Laser Toning describes the one laser approach we use for both.
Dr. Anshul Choudhary is a highly trained dermatologist specialising in advanced skin treatments, with more than 10 years of experience. She designs a customised plan for every patient, focused on authentic well-being. She believes in a holistic approach for better outcomes, and treats every patient with passion and compassion.
Frequently Asked Questions
Melasma is usually symmetrical — both cheeks, the forehead, the upper lip — with patchy, map-like borders, and it darkens in summer or with hormonal change. Post-inflammatory hyperpigmentation sits exactly where a spot, rash or injury was, is not symmetrical, and slowly fades. A dermatologist confirms it with a Wood's lamp or dermatoscope.
Technically yes — both involve excess melanin — but melasma is an ongoing over-activity of pigment cells driven by hormones and light, whereas post-inflammatory hyperpigmentation is the residue of a past injury. That difference is why they are treated and maintained differently.
Many of the tools overlap — sunscreen, prescription lightening creams, gentle peels, laser toning — but the strategy differs. Post-acne marks respond to a defined course and then stay away; melasma needs gentler settings, longer timelines and indefinite maintenance, and can be worsened by aggressive treatment.
If it was melasma, relapse without maintenance and daily sunscreen is expected, because the tendency remains. If it was post-inflammatory pigmentation, recurrence usually means the trigger — acne, friction, a rash — is still active and needs treating.
Our doctors treat this at the clinic in Gaur City 2, Greater Noida West.
Melasma Treatment at Lavanayam →