Melasma, Freckles, or PIH? How to Identify Your Pigmentation Disorder

Pigmentation issues are often discussed as a single topic during consultations — clinically, however, there are three quite different types, and each requires different treatments. Choosing a "stronger" treatment without knowing which pigmentation type you have can, in the worst case, make the skin worse. This guide helps you identify your type — and pick the right treatment.

In short:

• Three pigmentation types: Melasma (hormonal), Freckles/Lentigines (genetic or sun-induced), PIH (after inflammation)
• For melasma, no microneedling — it can spread pigmentation further
• During active acne, only Detox Purifying — no invasive treatments
• Sun protection is the single most important measure for all three types
• In the Skin Analysis consultation we identify your pigmentation type before any treatment

Melasma: Hormonal Pigmentation

What does it look like? Melasma appears as symmetrical, patchy discoloration — typically on both cheeks, forehead, and upper lip at the same time. Edges are blurred, and the affected areas are larger than typical pigment spots. Colour: brownish or greyish-brown.

What causes it? Melasma is a hormonally triggered hyperactivity of melanocytes — the pigment-producing cells. Typical triggers are pregnancy (hence sometimes "pregnancy mask"), birth-control pills, hormone replacement therapy, or hormonal shifts. UV light, heat, and — often underestimated — blue light from screens worsen melasma.

What helps? Gentle superficial peels, niacinamide and mild azelaic acid care, high-quality physical sun protection. The single most important lever is consistent sun protection — without it, no treatment works lastingly. Brightening Care in its gentle, adapted form is appropriate here.

What doesn't help — or actively makes it worse? Microneedling is contraindicated for melasma. The controlled micro-injuries can, in hormonally over-active pigment cells, spread the discoloration further across the face. Intensive acid peels in the active phase and lasers without medical supervision are similarly problematic.

Freckles and Lentigines: Genetic or Sun-Induced

What do they look like? Small brown spots on the face, shoulders, and back of the hands. Freckles (ephelides) often appear from childhood, are sharply defined, and fade in winter and darken again in summer. Lentigines ("age spots") result from years of UV exposure, are slightly larger, more uniformly pigmented, and usually permanent.

What causes them? Freckles are genetic — people with light skin types are particularly prone. Lentigines develop from cumulative sun exposure over years.

What helps? Brightening serums with vitamin C or arbutin, gentle superficial peels, high-quality sun protection. For individual stubborn lentigines, a targeted Plasma Pen treatment is possible — point vaporization of the pigmented tissue. Microneedling (Bright Face) is also appropriate for this pigmentation type — unlike with melasma — because there is no hormonal component reinforcing the pigmentation.

Important note: Lentigines can in rare cases be confused with skin changes that should be assessed medically. Unusually fast-growing, asymmetrical, or colour-changing spots belong in dermatological care.

PIH: Post-Inflammatory Hyperpigmentation

What does it look like? Dark, clearly localised spots in places where inflammation previously sat — typically on healed acne sites, wounds, after burns, or laser treatments. Colour and depth vary strongly with skin type.

What causes it? During the inflammatory phase, the skin activates melanin production for protection and repair. After healing, some pigment remains visible. In darker phototypes (4–6), PIH is more pronounced and can last months to years.

What helps? Mild peels, vitamin C, azelaic acid, tranexamic acid, light retinol care, good hydration. Important: manipulating the original inflammation (squeezing, scratching) significantly worsens PIH.

Important for acne patients: During active acne we only perform Detox Purifying. Microneedling, RF, and plasma therapy on inflamed skin can spread bacteria and reactivate inflammation. Only once the acne has subsided and only marks remain, are further treatments such as Brightening Care or targeted Plasma Pen on pigment spots appropriate.

Quick Diagnosis: Which Type Do You Have?

Comparison: price and duration of treatments

Question	Suggests…
Symmetrical on both cheeks?	Melasma
Appeared after pregnancy / the pill?	Melasma
Sharp, small spots?	Freckles or lentigines
Present since childhood?	Freckles
On healed acne sites?	PIH
Fades in winter?	Freckles (rarely melasma)
Pronounced in darker skin types?	PIH
Spreading across the face?	Melasma (hormonal component)

This table doesn't replace a skin analysis but gives orientation. In the Skin Analysis consultation we identify the type and define a tailored treatment plan.

What All Three Types Have in Common

Three constants apply regardless of pigmentation type:

1. Daily sun protection — physical filter with SPF 30–50, also in winter and indoors. UV light worsens every form of pigmentation.
2. Patience — pigment treatments work slowly. First changes take weeks, visible results take months.
3. Consistent care — a single treatment is rarely enough. A series of 4–6 sessions plus appropriate home care is the rule.

When to See a Dermatologist

Pigmentation issues are cosmetically treatable, but some findings belong in medical practice:

• Asymmetrical, fast-growing, or colour-changing spots
• Areas that itch, bleed, or develop crusts
• Pigment changes under medications (e.g., certain antidepressants, photosensitizers)
• Very pronounced melasma that doesn't respond to cosmetic treatment

In the consultation we assess whether medical clarification is appropriate before treating.

Pigmentation Frankfurt: The Next Step

Pigmentation issues are treatable — but only with the right diagnosis at the start. In our Frankfurt studio, we begin every pigment treatment with a Skin Analysis, identify your pigmentation type and skin condition, and define a plan that fits your skin — not a standard program. Book your appointment and let us choose the right program together.