- Post-inflammatory hyperpigmentation (PIH) – after acne, irritation, picking
- Solar lentigines (sun spots) – from UV exposure
- Melasma – hormonally influenced pigment patches
- Symmetrical brown/gray patches
- Commonly on cheeks, upper lip, forehead
- More common in women
- Often worsens with heat, sun, pregnancy, birth control, or hormonal shifts
- UV radiation
- Inflammation
- Hormones
- Barrier disruption
- Vascular changes
- Dermal inflammation
- Increased melanocyte sensitivity
- Heat triggers (not just UV)

