It often appears gradually. A patch on one cheek, then the other. A shadow across the upper lip. A band across the forehead. It's symmetrical in a way that most skin concerns aren't — which is one of the first clues that it's systemic rather than surface.
Melasma and hormonal hyperpigmentation are among the most frustrating skin concerns to treat topically, because the driver isn't at the surface. Brightening serums can fade what's visible, but if the internal signal is still active, the pigment continues to be produced.
What causes persistent pigmentation
Melanin is produced by melanocytes — cells in the skin that respond to several signals, including UV exposure, inflammation, and hormones. Oestrogen directly stimulates melanocyte activity, which is why hyperpigmentation is so closely associated with high-oestrogen states: pregnancy, combined oral contraceptives, and perimenopausal fluctuations.
When oestrogen is elevated or dominant, melanocytes are chronically over-stimulated. Even modest sun exposure — levels that wouldn't trigger pigmentation in a lower-oestrogen baseline — can produce significant darkening. This is why sun protection is always part of the management, but why it's also insufficient on its own if the hormonal driver remains.
The pregnancy and contraception link
Melasma during pregnancy is extremely common — it's sometimes called the "mask of pregnancy" — and typically resolves after delivery as oestrogen normalises. But for some people, it persists. And for those who develop it on the combined pill, it can worsen and may not fully resolve after stopping.
This persistence reflects the degree to which oestrogen primed the melanocytes. The exposure period, the oestrogen levels involved, and the individual's baseline melanocyte sensitivity all influence how long pigmentation lingers.
Why topical brighteners have limits
Tyrosinase inhibitors — the category that includes vitamin C, kojic acid, azelaic acid, and prescription hydroquinone — slow melanin production. They work while you're using them, and they can meaningfully lighten existing pigment over time.
But if you stop using them, and the hormonal driver is still active, pigmentation returns — often faster than it faded. This is the cycle many people with hormonal melasma recognise: months of diligent brightening, visible improvement, then a summer or a stressful period or a hormonal shift, and it's back.
The most sustainable results come from addressing the underlying hormonal picture alongside topical treatment — understanding whether oestrogen dominance is driving the pattern, and what supports a better balance.
Pattern Note
Hormonal hyperpigmentation and melasma are most commonly associated with B-Type (Empathic Radiant / Oestrogen Dominant) patterns. B-Types have skin that responds strongly to oestrogen fluctuations — including through melanin activity. The quiz maps whether this is your dominant pattern.
Take the quiz — discover your skin code →Related
Educational only. This content is for informational purposes and does not constitute medical advice, diagnosis, or treatment. Skin patterns vary between individuals. If you have concerns about a skin condition, consult a qualified healthcare professional.