Many women — and occasionally men — suffer from skin pigmentation that affects facial appearance and causes social discomfort. Melasma is the most common, affecting about 6 million women in the Arab region. The ClinicsJo Editorial Team reviews pigmentation causes and modern treatments.
Types of Skin Pigmentation
1. Melasma
Symmetrical brown patches on cheeks, forehead, chin, and upper lip. More common in women (90%), especially during pregnancy and hormonal phases.
2. Post-Inflammatory Hyperpigmentation (PIH)
Dark spots remaining after skin inflammation (acne, eczema, burns). Very common in dark skin.
3. Solar Lentigines
"Age spots" — brown patches from sun damage on face and hands.
4. Freckles
Hereditary, intensify with sun, fade in winter.
5. Acanthosis Nigricans
Dark velvety pigmentation in the neck and armpits — a sign of insulin resistance.
Specific Causes of Melasma
- Sun exposure (primary cause, even UVA through glass).
- Hormones: pregnancy ("mask of pregnancy"), birth control pills, hormone therapy.
- Genetics.
- Thyroid disorders.
- Certain medications and perfumes.
- Excess heat.
Diagnosis
- Clinical exam.
- Wood's Lamp: identifies pigment depth.
- 3D skin imaging.
- Hormone tests (thyroid, PCOS) when indicated.
Treatment: The Golden Rule = Protection + Lightening + Exfoliation
1. Sun Protection (Most Important)
- SPF 50+ broad-spectrum sunscreen daily, even in winter and indoors.
- Reapply every 2 hours when exposed.
- Mineral sunscreens (zinc oxide, titanium) outperform chemical ones for melasma.
- Hats and sunglasses.
- Avoid the sun between 10 AM and 4 PM.
2. Topical Creams
- Hydroquinone 2–4%: the traditional gold standard, inhibits melanin. Used for 3–6 months.
- Retinoids (tretinoin): accelerate cell turnover.
- Kligman's triple cream: hydroquinone + tretinoin + cortisone.
- Azelaic acid: pregnancy-safe.
- Kojic acid: natural and gentle.
- Arbutin, niacinamide, vitamin C.
- Cysteamine 5%: a modern cream, very effective.
3. Tranexamic Acid
A recent revolutionary discovery:
- Oral: 250–500 mg daily, highly effective for melasma.
- Topical: 3–5% cream.
- Intradermal microinjection: in-office.
4. Chemical Peels
- Glycolic acid 30–70%.
- Salicylic acid.
- Cosmelan (specialized melasma peel).
- TCA.
One session every 2–4 weeks, multiple sessions needed.
5. Laser and Light
Use cautiously in melasma due to irritation risk; safe options include:
- Low-fluence Q-Switched Nd:YAG.
- PicoSure.
- Fractional laser.
- IPL — for solar lentigines only.
6. Mesotherapy
Intradermal injection of a vitamin C, tranexamic acid, and glutathione cocktail.
Medical tip: Melasma recurs easily even after successful treatment. Lifelong daily sun protection is what separates recurrence from a clean complexion.
Common Mistakes in Pigment Treatment
- Using OTC lightening creams without prescription (may contain steroids or mercury).
- Skipping sunscreen.
- Aggressive exfoliation.
- Overusing topical vitamin C (causes irritation).
- Lack of patience — creams need 8–12 weeks to show results.
- Trying laser without accurate diagnosis (can worsen pigmentation).
Pigmentation Treatment Costs in Jordan
- Chemical peel session: JOD 50–150.
- Cosmelan session: JOD 200–400.
- Laser session: JOD 100–300.
- Mesotherapy session: JOD 80–150.
- Cysteamine cream: JOD 80–150.
Pigmentation in Pregnancy
The "mask of pregnancy" appears in 50–70% of pregnancies. Treatment is limited during pregnancy:
- ✅ Mineral sunscreen.
- ✅ Azelaic acid (safe).
- ✅ Niacinamide.
- ❌ Hydroquinone.
- ❌ Retinoids.
- ❌ Strong laser.
Many cases improve spontaneously 6–12 months after delivery.
For a safe, effective plan, book an appointment with a specialist dermatologist on ClinicsJo.
