Let’s Talk About Pigmentation: Causes, Fixes and Prevention
You've spotted something on your skin and you can't stop looking at it. A patch of uneven tone across your cheeks. A brown mark on your temple that wasn't there last summer. Dark spots left over from a breakout you had six months ago.
Pigmentation is one of the most common concerns we see at Equipoise. It's also one of the most Googled, most misunderstood, and most frustrating to treat without the right information. Here is our take on it.
What is Pigmentation?
Your skin colour is determined by melanin, a pigment produced by cells called melanocytes. When your skin is triggered, those cells go into overdrive and produce more melanin than usual. That extra melanin clusters in specific spots, creating areas that appear darker than the skin around them.
The trigger could be sun exposure, hormonal shifts, inflammation, or injury. Sometimes it's a combination of all of them. The result is what we broadly call hyperpigmentation.
The Five Types Worth Knowing
1. Sun Damage (Solar Lentigines)
Flat, brown spots that appear on areas of repeat sun exposure: the face, hands, chest, and shoulders. They're sometimes called age spots or liver spots, though age alone isn't the cause. Decades of UV exposure are. They tend to show up more visibly from your forties onwards, and they don't fade on their own.
2. Melasma
Larger, cloud-like patches across the cheeks, forehead, upper lip, and chin. Melasma is driven by hormones, which is why it often appears during pregnancy, while on the contraceptive pill, or during perimenopause. It can affect men too. What makes melasma particularly challenging is that it sits in the deeper layers of the skin. Treating the surface alone won't shift it. Sun exposure will bring it straight back. Any effective plan needs to address both.
3. Post-Inflammatory Hyperpigmentation (PIH)
The flat, dark mark left behind after the skin has been inflamed. A pimple. A rash. An insect bite. Even an aggressive facial. The skin produces excess melanin as part of the healing response, and the mark can hang around for weeks or months after the original injury has healed. PIH is particularly common in medium to deep skin tones.
4. Freckles
Genetically driven, and more common in people with fair skin and red or blonde hair. Freckles darken in summer and fade over winter as UV exposure changes. They're benign, but many people prefer a more even appearance, particularly as they change with age.
5. Seborrhoeic Keratoses
Raised, warty or waxy patches that become more common from middle age. They can look like pigmentation but they're a different animal entirely. Always worth having anything raised assessed by a professional, not just treated at home.
A note on safety: Any spot that is new, changing shape, changing colour, bleeding, or itching needs to be seen by a GP or dermatologist before any cosmetic treatment. At Equipoise, we take a thorough skin history at every consultation precisely because this matters.
Who Gets Pigmentation?
Almost anyone, but some people are more prone than others.
• Medium to deep skin tones (Fitzpatrick types IV to VI) have more active melanocytes, making post-inflammatory pigmentation especially common and often more intense.
• Hormonal changes during pregnancy, while using the contraceptive pill, or through perimenopause are a significant driver of melasma.
• Cumulative sun exposure over a lifetime is the single biggest factor in solar lentigines.
• A family history of melasma or freckling increases your likelihood considerably.
• Certain medications, including some antibiotics, anti-epileptics, and chemotherapy agents, can cause photosensitivity that leads to pigmentation.
• Skin conditions like acne, eczema, and psoriasis leave the door open for PIH every time they flare.
Knowing which category you fall into shapes every decision about treatment. What works for PIH is not the same as what works for melasma. Getting this wrong doesn't just waste money; it can make things worse.
What Actually Works?
At home
A few ingredients have solid evidence behind them for pigmentation. Vitamin C applied in the morning brightens and protects. Niacinamide reduces melanin transfer to the skin's surface. Alpha arbutin and tranexamic acid both work by blocking the enzyme that triggers melanin production in the first place. Retinol speeds up cell turnover, helping to fade marks faster.
SPF 50+ every single day. On cloudy days as well. Even indoors near windows. Without this, no treatment in the world will hold its results.
The Skin Moderne skincare range works well alongside Lira Clinical products for a targeted at-home protocol. We can recommend the right combination at your consultation.
In Clinic at Equipoise
• Lira Clinical Peels: a course of chemical peels using Lira Clinical's professional formulations to exfoliate, target melanin at the surface and deeper layers, and support the skin's renewal process.
• Skin Moderne Treatments: targeted skin treatments designed to address specific pigmentation concerns with precision, including post-inflammatory marks and uneven tone.
• LED therapy: supports the skin's healing response and reduces the inflammation that drives PIH.
• Medical-grade skincare: prescription-strength actives deliver results that over-the-counter products cannot match, used as part of a structured programme.
Pigmentation takes time. Most of it has been building for years. A realistic timeline for noticeable improvement is 8 to 12 weeks with consistent at-home care and a course of in-clinic treatment. Results that hold require ongoing maintenance.
Book Your Consultation
The right treatment plan starts with understanding what type of pigmentation you have and what's driving it. That's not a question Google can reliably answer for your specific skin.
This month at Equipoise we're offering a complimentary skin analysis with every consultation. We'll map your pigmentation, explain what we're seeing, and walk you through options that suit your skin and your life. Valued at $85 and redeemable on product on the day, so it pays for itself before you've even left.
More skin reading on our Blog page, and if you're in Auckland and want to talk through what's going on with your skin, get in touch, we're happy to help you figure out where to start.
Alternatively, head over to our online store for some skincare retail therapy (we have some beautiful gift ideas too)!