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Sun Spots, PIH, or Melasma? Pigment Is Not One Laser Problem

Brown pigment can mean solar lentigines, post-inflammatory hyperpigmentation, melasma, or something else entirely. The diagnosis changes whether IPL, picosecond/Q-switched laser, resurfacing, topical treatment, or no cosmetic laser makes sense.

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Editorial graphic distinguishing sun spots, post-inflammatory hyperpigmentation (PIH), and melasma.

“I want the brown spots lasered off” sounds wonderfully efficient. Pigment is rarely that cooperative.

Solar lentigines, post-inflammatory hyperpigmentation and melasma can all look brown on the face and require different treatment logic. A laser or IPL platform can target pigment without explaining why that pigment is there. That missing diagnosis is where expensive mistakes begin.

Comparison

Where the choice actually differs

Three kinds of brown, three different plans
OnSun spotsPost-inflammatory hyperpigmentationMelasma
Why the pigment is thereCumulative ultraviolet exposureThe aftermath of inflammation or injury — acne, eczema, burns, picking, proceduresA chronic acquired condition influenced by light exposure and hormones
What has to happen firstA clinician confirms the lesion is benign and appropriate for cosmetic treatmentEstablish whether the inflammation is still activeSun protection and trigger management, which no machine replaces
What treatment can doSelected pigment lasers or IPL can be effectiveCan improve pigment in one context and provoke more of it in anotherUsed in selected cases, usually as part of combination therapy
The risk that mattersTreating a new or changing lesion as a decorative inconvenienceMore pigment, and more consequence in darker skinRecurrence over years, and any language that promises erasure
Where the evidence landsEffective for genuine lentigines, with device choice following skin toneDepends on skin tone, the original trigger and how aggressive the treatment isInconsistent. A 2026 review found low-fluence Q-switched 1064-nm Nd:YAG improved on subgroup analysis while picosecond and fractional subgroups did not outperform controls

What changes the answer: A platform can target pigment without ever explaining why that pigment is there. Pico is a pulse duration, not a diagnosis.

That the reviews disagree is not useless. It tells you the answer depends on modality, settings, combinations, study design and patient selection.
Which brown is it: a two-question split with one gate in front of itA decision tree. A gate across the top: if any lesion is new, changing, irregular or otherwise concerning, it needs evaluation and nothing below applies. Then question one: did the pigment appear where the skin was inflamed or injured, such as acne, eczema, a burn, picking or a procedure? Yes leads to post-inflammatory hyperpigmentation, where the first step is establishing whether the inflammation is still active. No leads to question two: is it a discrete spot with an edge, or a broad patterned patch that has returned for years? A discrete spot leads to sun spots, where the first step is confirming the lesion is benign and appropriate for cosmetic treatment. A patch leads to melasma, where the first step is sun protection and trigger management, which no machine replaces. A footnote adds that freckles recur with sun, a nevus needs a diagnosis rather than a cosmetic plan, and one face can carry more than one of these.Which brown is it?Two questions. Neither of them is “which laser do you have?”First: is any lesion new, changing, irregular or otherwise concerning?Then it needs evaluation, not a laser, and nothing below this bar applies yet.Did it appear where the skin was inflamed or injured — acne, eczema, a burn, picking, a procedure?yesnoa spota patchIs it a discrete spot with an edge — or a broad, patternedpatch that has been coming back for years?Sun spotssolar lentiginesFirst: confirm the lesion isbenign and appropriate forcosmetic treatment.Melasmachronic, and it recursFirst: sun protection andtrigger management. Nomachine replaces those.PIHthe aftermath of injuryFirst: establish whetherthe inflammation is stillactive.Freckles recur with sun. A nevus needs a diagnosis, not a cosmetic plan. Faces carry more than one of these.The device conversation begins in the box you land in. Not before it.
Two questions sort almost all of it, and neither is about the machine. A clinic that cannot say which of these three boxes you are in is not yet in a position to recommend anything.

Sun spots are the easiest version of this, and still not automatic

Solar lentigines, commonly called age spots or sun spots, are localized areas of increased pigment associated with cumulative ultraviolet exposure. When a qualified clinician has confirmed that a lesion is benign and appropriate for cosmetic treatment, selected pigment lasers or IPL can be effective options.

The key phrase is confirmed that the lesion is appropriate for cosmetic treatment. A new, changing, irregular or otherwise concerning pigmented lesion should not be treated as a decorative inconvenience before it has been properly evaluated.

For genuine lentigines, treatment may involve IPL, Q-switched or picosecond systems, or other wavelength-specific approaches depending on skin tone and device availability. The best choice is not automatically the newest pico platform.

With PIH, the pigment is the receipt for something else

PIH appears after inflammation or injury — acne, eczema, burns, picking, procedures. The dark mark is a record of something that has already irritated the skin, which is precisely why the next thing done to that skin is not a neutral act.

Another inflammatory procedure can improve pigment in one context and provoke more of it in another. Four things decide which: skin tone, the original trigger, whether the inflammation is still active, and how aggressive the treatment is. The third one decides the booking. Treating a mark while the process that made it is still running is how people end up with two.

In darker skin, PIH risk becomes particularly important because greater epidermal melanin can increase the consequences of thermal or light-based injury. A provider should be able to explain why a device is worth that trade rather than treating every brown mark as a laser target.

Why “pigment removal” language gets dangerous around melasma

Melasma is a chronic acquired pigmentary condition influenced by factors including light exposure and hormones. It is common in medium and darker skin tones and can persist or recur for years.

Sun protection is foundational. The American Academy of Dermatology specifically notes that melasma treatment plans include sun protection, and visible light may also matter for some patients. A machine cannot replace the ongoing trigger-management part of the plan.

Laser and light treatments can be used in selected melasma cases, often as part of combination therapy, but the literature is inconsistent enough that “laser for melasma” should never sound like a straightforward pigment-erasing service.

A 2026 systematic review and meta-analysis found low-fluence Q-switched 1064-nm Nd:YAG showed statistically significant improvement in subgroup analysis, while picosecond and fractional laser subgroups did not significantly outperform controls in that analysis. Other systematic reviews have reported benefit with picosecond or combination approaches. Two bodies of evidence, two answers, and the gap between them is not noise: it is the wavelength, the fluence, whether anything was combined with it, and who was enrolled. So the honest version of “laser for melasma” arrives with four conditions attached, and nobody prints four conditions on a menu.

A trillionth of a second is a specification, not a target

Picosecond lasers deliver very short pulses and can be used for tattoo pigment and selected pigmentary concerns. “Pico facial” has also become marketing shorthand for a broad category of treatments.

The device may be technically sophisticated. The question remains ordinary: what pigment is being treated, what wavelength is being used, and what evidence supports that indication in your skin?

A picosecond laser that is excellent at one target does not become a universal complexion corrector because the pulse is measured in trillionths of a second.

IPL can be excellent for photodamage and still be wrong for your pigment

IPL and BBL can improve selected sun-related pigment and vascular changes. They also deliver broad-spectrum light that can interact with epidermal melanin.

For discrete sun damage in an appropriate skin type, that can be a useful match. For melasma or PIH-prone skin, the risk-benefit calculation can be different. Recent tanning makes it different again.

This is why the phrase “photofacial for pigmentation” needs a second sentence.

Resurfacing treats texture and pigment differently

Fractional CO₂, Er:YAG and nonablative fractional lasers may improve aspects of photodamage and dyschromia while primarily being used for resurfacing and remodeling. They should not be chosen because you want a brighter complexion. That is a wish, not an indication.

If texture, scars and pigment are all present, combination treatment may make sense. It may also compound recovery and pigment risk. Ask which problem each component is intended to solve.

What the three-way split leaves out

The tree above sorts most faces. It does not sort all of them, and three categories sit outside it:

  • Freckles and ephelides: genetically influenced pigment that may simply return with sun exposure, which makes “removal” an odd word for it.
  • Nevi and other lesions: these may require diagnostic assessment rather than cosmetic treatment at all, and that is a different appointment with a different person.
  • Mixed pigment: more than one process can coexist on one face, and a plan built for the most visible one can make the quieter one worse.

If the clinic cannot tell you which category it believes it is treating, the laser discussion is premature.

Questions that matter more than “Which laser do you use?”

  • What is the diagnosis or working diagnosis for this pigment?
  • Do any lesions need evaluation before cosmetic treatment?
  • Is this melasma, PIH, sun-related pigment or a mixture?
  • What exact device, wavelength and settings family are you considering?
  • How does my skin tone and history of dark marks change the risk?
  • What is the chance of rebound pigmentation or PIH?
  • What sun and visible-light protection is part of the plan?
  • Will topical treatment or trigger control be necessary before or after the procedure?
  • What would make you choose not to use a laser or IPL?

Pigment is a description, not a diagnosis

Sun spots can be satisfying laser targets. PIH requires respect for the inflammation that created it. Melasma is a chronic pigment disorder that can punish simplistic treatment plans. The device comes after that distinction, not before it.

The machine may remove pigment. Good judgment decides whether that pigment should be targeted in the first place.

Evidence check: Moderate

Evidence level: moderate for selected laser/light treatment of benign pigmentary concerns; mixed and modality-dependent for melasma. Recurrence and PIH risk materially affect real-world outcomes.

Sources reviewed August 8, 2026:

This article is educational. New, changing or unexplained pigment should be appropriately evaluated rather than assumed to be benign cosmetic discoloration.