Pigmentation & Hyperpigmentation

Melasma is a chronic pigmentation condition causing symmetrical brown or grey-brown patches on the face — most commonly the cheeks, forehead, upper lip, and chin. It is far more common in women (90%) and is strongly driven by sun exposure, hormonal factors (pregnancy — the 'mask of pregnancy' — combined oral contraceptive pills, and hormonal IUDs can trigger or worsen it), and genetics. It is not permanently curable — it has a strong tendency to recur. What works: consistent daily broad-spectrum sunscreen (the single most important treatment), topical hydroquinone (2-4% — effective but used in cycles to avoid paradoxical darkening), combination creams (hydroquinone + tretinoin + mild steroid — the Kligman formula, still the most evidence-backed combination), azelaic acid, and tranexamic acid (oral or topical, increasingly supported by evidence). Chemical peels and laser help but require careful selection in Indian skin tones — aggressive treatments can worsen pigmentation.

Post-inflammatory hyperpigmentation (PIH) — the dark marks left after acne, eczema, or skin trauma — is a normal skin healing response in people with darker skin tones, which contain more active melanocytes. Without any treatment, PIH fades over 6-24 months. With treatment, this timeline accelerates: consistent sunscreen use (essential — UV exposure significantly slows fading and can darken marks), topical retinoids (adapalene, tretinoin) normalise skin cell turnover and speed pigment dispersion, niacinamide (5-10% in serums or moisturisers) reduces melanin transfer and is well tolerated, and vitamin C (stable formulations, L-ascorbic acid or derivatives) has antioxidant and anti-pigment effects. Realistic expectation: 3-6 months of consistent use for significant improvement. Professional treatments (chemical peels, laser) accelerate results further but require dermatologist oversight — the wrong peel or laser setting on Indian skin tones can cause PIH itself.

Many are not. The Indian skincare market is flooded with products making 'fairness' or 'whitening' claims — including many that contain undeclared mercury (a neurotoxin), high-dose hydroquinone above legal limits, or potent steroids (betamethasone, clobetasol) not declared on the label. Mercury-containing creams cause kidney damage and neurological toxicity with long-term use. Inappropriate steroid use causes the well-documented topical steroid-damaged face syndrome. Safe active ingredients for hyperpigmentation: hydroquinone 2-4% (short-term, supervised), niacinamide, azelaic acid, tranexamic acid, alpha-arbutin, vitamin C (stable formulations), and topical retinoids. Products should list all ingredients. Avoid any product that shows dramatic lightening within days — this speed is only possible with high-dose steroids or other harmful agents. A dermatologist can recommend a safe, evidence-based regimen.

Vitiligo is an autoimmune condition where the immune system attacks melanocytes (pigment-producing cells), causing well-defined white patches that can appear anywhere on the body. Treatment aims to stop progression and restore pigment. Repigmentation treatments: narrowband UVB phototherapy (the most effective and well-tolerated option for widespread vitiligo — requires 2-3 sessions per week for 6-12 months), topical calcineurin inhibitors (tacrolimus, pimecrolimus — effective for face and neck, particularly in children), topical JAK inhibitors (ruxolitinib cream — newly approved, impressive early evidence). For localised stable vitiligo: surgical options (suction blister grafting, follicular unit transplant) can achieve excellent repigmentation. Ruxolitinib cream is available in some Indian centres and represents the most significant recent advance. Sunscreen is essential — vitiligo patches lack UV protection and sunburn significantly. Psychological support is as important as physical treatment in India given the social impact.

Practical checks: read the full ingredient list — if it's not listed, the product should be avoided. Avoid any product that claims dramatic results in less than 4 weeks without active ingredients being named. If a cream makes your skin very thin, causes easy bruising, develops stretch marks, or produces rebound redness when stopped — these are signs of undeclared steroids. Test strips (available online) can detect mercury in cosmetics. Regulatory status: in India, cosmetics containing more than 2% hydroquinone or steroids require a prescription — if you are buying them OTC, the product may be illegal or mislabelled. Reliable brands that list all ingredients clearly and conform to BIS standards are a safer starting point. The safest approach: consult a dermatologist, receive a prescription-grade regimen with named active ingredients and clear dosing instructions, and avoid unregulated marketplace cosmetics regardless of how many reviews they have.