Pigment spots and melasma.

Sun spots (lentigines): sharply defined brown spots on face, hands, décolleté – the result of years of UV exposure. They are harmless, but for lay people hard to distinguish from early skin cancers: every new, growing or irregular spot belongs with a dermatologist.

Melasma: patchy, blurred brownish areas on forehead, cheeks, upper lip, mostly in women. Triggered by hormones (pregnancy, the pill), UV light and heat, with a genetic tendency. Melasma is chronic and prone to relapse – every therapy is management, not a one-off fix.

Post-inflammatory hyperpigmentation: dark marks after acne, injuries or treatments, more common in darker skin types. Usually fade within months – faster with sun protection and lightening agents.

Basis of every therapy – sun protection: without daily SPF 50 with high UVA protection (and, for melasma, with iron oxide against visible light) every treatment is futile. That is not caution but the main effect.

Proven agents: tranexamic acid (topical or orally on prescription) for melasma; azelaic acid 15–20 %; retinoids; vitamin C; niacinamide; hydroquinone only for a limited time on prescription. Combinations work better than single agents. First effects after 8 to 12 weeks.

Procedures: mild chemical peels and microneedling (with tranexamic acid) can support. Aggressive lasers and strong peels often worsen melasma through inflammation and heat – so stay conservative with melasma. For sun spots a laser in dermatological hands is the most effective option; VIVA DERM refers for that.