Pigment is the skin remembering what happened to it. Sun. Hormones. A spot squeezed in haste. We listen to the memory, then treat it where treating is wise.
Pigmentation does not arrive as one thing. Each type has its own cause, depth and conversation with treatment. The plates below catalogue the patterns we see most often in Indian skin.
The hormonal map
Symmetric brown patches across the cheeks, forehead and upper lip. Pigment that reads hormones like a barometer — triggered by pregnancy, contraceptives, or thyroid imbalance.
The sun's ledger
Discrete, well-defined brown spots on cheekbones and temples — the skin's slow accounting of every unprotected hour outdoors. Also called solar lentigines.
Footprints of healed harm
Brown marks following acne, eczema or any inflammation. The skin remembers an injury long after it heals — particularly in Indian skin, where inflammation marks readily.
A genetic dusting
Fine, golden-brown stippling across the nose and cheeks — genetic, sun-responsive. They darken in summer, fade in winter; not pathological, but treatable if undesired.
Periorbital shadow
A composite — pigment, blood vessels, hollowing of the tear-trough. Examining which of the three is dominant determines whether we treat with topicals, PRP, or filler.
A ring around the mouth
Darkening around the lips, often misread as a moustache shadow. Driven by friction (waxing, threading), hormones, or sun — usually a combination needing patience.
Depth determines difficulty. The same brown mark — superficial or deep — requires very different work, and very different patience. Examination under a Wood's lamp settles it.
Pigment sits in the upper layer of skin — freckles, sunspots, post-inflammatory marks. Responds well, and relatively quickly, to topicals and gentle resurfacing.
Pigment in both layers — most cases of melasma sit here. Responds, but slowly, to combined oral, topical and energy-based treatment. Sun protection is non-negotiable.
Pigment within the dermis itself — long-standing PIH, nævus of Ota. Requires the careful use of specific lasers; not all pigment in this layer can be removed.
For every persistent mark, there is a cause keeping it persistent. The work begins with calming the trigger, not bleaching the surface.
Of pigmentation in Indian skin is triggered or worsened by ultraviolet exposure — including, crucially, the UV that passes through window glass. Daily SPF is half the prescription.
Of melasma cases are linked to pregnancy, oral contraception, or thyroid changes. Treating the skin without addressing the hormonal trigger is treating a symptom in isolation.
Indian skin is up to three times more likely to mark following acne, eczema or any injury. The discipline is not to provoke — through harsh actives or aggressive treatment.
Of post-treatment darkening can come from ordinary daylight — not just UV. We protect against visible light too, using tinted sunscreens with iron oxide.
Before any laser, peel or topical, we identify what is keeping the pigment present — UV, hormones, friction, inflammation. Without that, every result is temporary.
Cause before effectA considered routine — gentle tyrosinase inhibitors, a vitamin C in the morning, a retinoid at night, and a sunscreen worn like a watch. The boring parts do most of the work.
Topical-ledQ-switched and pico lasers, fractional resurfacing, and chemical peels — used selectively, not as the opening move. The wrong laser at the wrong moment will make Indian skin darker.
Energy-based · only when wiseWe don't bleach skin into submission. We listen to what the pigment is recording — sun, hormones, friction — and we treat that conversation first.— Dr Shivali SethiMBBS · DDVL · FACSI
The first consultation includes examination under a Wood's lamp so we can map depth, not just colour. The plan that follows is sequenced over months — and we will tell you when to stop.
