There is one skincare complaint that seems to unite Indians across age groups, genders and generations: pigmentation. The brown mark left behind by a pimple, darkening around the mouth, uneven cheeks, or the pigmentation that appears during pregnancy and refuses to leave. Often, patients put it simply: “Doctor, my skin is clear, but it doesn’t look even.”
In India, pigmentation is one of the most underestimated, and poorly treated, skin concerns. The first instinct is often to reach for a fairness cream. But the more important question is: why is your skin producing excess pigment in the first place?
Hyperpigmentation is not one disease. It is an umbrella term for several conditions, and treatment depends on the cause. A pimple that heals and leaves a brown mark is often post-inflammatory hyperpigmentation. Symmetrical brown patches over the cheeks, forehead, nose or upper lip could be melasma. Sun exposure can cause individual brown spots or diffuse pigmentation, while hormonal changes, certain medications, irritation and aggressive skincare can also trigger excess pigment.
This is particularly relevant for Indian skin. Indians naturally have more active melanocytes and higher amounts of melanin. It also means our skin can respond to inflammation by producing pigment very efficiently.
A common complaint explains this. “My acne is gone, so why are the marks still there?” Acne and pigmentation are two different problems. When inflammation occurs, melanocytes can be stimulated to produce more melanin. So even after the acne disappears, the resulting brown mark can remain for months. Squeezing and picking pimples can make matters worse. You may think you are removing the pimple; your skin may be preparing a souvenir.
And then there is the sun. Ultraviolet radiation can stimulate pigmentation, while visible light can also worsen it, particularly in darker skin tones. Sunscreen matters even when you are not going to the beach.
Another common problem is attacking the skin. Someone develops pigmentation, buys a scrub, then a peeling serum, a strong acid, a fairness cream and finally a home remedy involving lemon. The skin becomes irritated, the pigmentation gets darker, and an even stronger product follows. If a product repeatedly burns or stings your skin, that is not proof that it is working. It may simply mean your skin is unhappy.
Melasma deserves special attention because it is among the most stubborn forms of facial pigmentation. It typically appears as symmetrical brown or grey-brown patches over the cheeks, forehead, nose or upper lip. Hormones can play a role, but sunlight and visible light are major triggers. Pregnancy, hormonal contraceptives and genetics can contribute too. Unlike a simple post-acne mark, melasma tends to return, so I prefer talking about long-term control rather than a “permanent cure”.
Treatment may include azelaic acid, retinoids, vitamin C, kojic acid and other pigment-modulating agents. Treatments such as hydroquinone may be appropriate for some patients under medical supervision. Chemical peels, microneedling or certain laser and light-based procedures may also be considered in selected cases. But more aggressive does not automatically mean more effective.
Tranexamic acid can help some patients with stubborn melasma, but oral tranexamic acid is not a casual supplement. A dermatologist should assess whether it is appropriate based on medical history and risk factors.
For pigmentation, believe in a boring routine: gentle cleansing, an appropriate pigment-control treatment, moisturiser if needed and tinted broad-spectrum sunscreen in the morning. At night, cleanse, use the recommended active and moisturise. And wait with patience. Pigmentation rarely responds overnight.
