Can Hyperpigmentation and Melasma Be Treated?

This information was provided by Dr Burt Jooste and Dr Xen Ludick, co-owners of Longevity Centre and The IV Doctors. All treatments are indicated for all skin types unless otherwise specified. 

With so many names and quick-fix promises being thrown around when it comes to Hyperpigmentation or melasma (due to hormonal changes), it’s easy to be misled. First, let’s provide accurate information so you understand what it is, and how it can be treated effectively. 

Hyperpigmentation implies uneven discolouration of the skin and is caused by to excess natural skin pigment, or melanin, being deposited into certain parts of the skin.

The term “melasma” implies a hormonal component. It is a very complex process which in turn, can make treating it very complicated.

Melasma can be due to hormonal changes during pregnancy or from sun exposure. Women are much more likely than men to develop this condition.

How does it happen?

Your skin has 3 main layers. The top two layers (epidermis and dermis) are devised into further layers. For the sake of keeping it simple, we will refer to these two layers only.

The epidermis is the thinner of the two and contains all your skin cells. The dermis is thicker and includes all the structures of the skin, i.e. sweat glands, oil glands, hair follicles and some tiny blood vessels to name a few. There is a very thin junction in-between these two layers called the basal layer. This area has two main functions: to produce new skin cells for the epidermis and to produce natural skin pigment for these cells.

The cells that produce pigment are called melanocytes. They are generally “relaxed” and only produce pigment when needed (sun exposure) to try and protect your skin against sun damage. This is how you tan. So, tanning is a defence mechanism against UV sun exposure.

If we damage the melanocytes, they tend to become hyperactive. They tend to “think” that they should be producing excess melanin even without sun exposure.

The bad news is that the damage is irreparable and will probably continue forever. It is for that reason that we say melasma cannot be cured. It can be treated and managed but not cured. If one chooses not to address it, the discolouration can become so vast that no treatment can even manage or control it.

There are many ways that the melanocyte can be damaged, but these are the top 6 ways:

  1. Sun exposure. Most of our sun damage occurs before the age of 20.
  2. Hormonal fluctuations. This includes puberty but also pregnancy and menopause.
  3. Oral contraception is a big one. So are drugs like Tretinoin (commonly used for acne), some antihistamines, antibiotics and supplements like St John’s Worth.
  4. Skin conditions like eczema or psoriasis and damage due to injury from acne or trauma.
  5. Systemic conditions like thyroid dysfunction or diabetes.
  6. Gut bacteria imbalances aka “Dysbiosis”.

As you can see, most of the time it is caused by more than one factor. It is also because of this that hyperpigmentation is a dynamic condition. In other words, it almost always returns at some stage, as the damaged melanocyte cannot be fixed/healed.


To manage hyperpigmentation, three elements must be incorporated to have the best chance of successfully removing the excess pigment.

  • Protect: Protection is vital. This implies protection against any element that can stimulate an already overactive melanocyte. A medical grade UV protection product is critically important. We prefer to use a product that can also protect against the harmful effects of infra-red radiation and heat too (laptops, TV’s, hair dryers, saunas and steam rooms, environmental heat etc.) as these also stimulate the melanocytes. For clients on an oral contraceptive, a strong oral antioxidant and liver detoxifier is also an excellent way to support and protect your skin.
  • Subdue/Suppress: We must calm the melanocytes down. We must convince them to produce only natural pigment. Not more, not less, just normal pigment. We use very specific medical skincare products to achieve this. It takes approximately 2-4 weeks to calm the melanocytes down. This period is referred to as “prepping the skin”.
  • Treat: There are multiple treatments available to help lift the pigmentation from the skin cells. There are two main categories: skin peels and light-based treatments/lasers (there are more, but these are the main ones). There is no one size fits all. In some individuals, superficial peeling works perfectly. In others, lasers are better. These options will be discussed upon consultation with an IV Doctor as well as other alternatives.

Can Hyperpigmentation and Melasma Be Treated?


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