Pigmentation and melasma – how TPRX works on uneven skin tone

Pigmentation spots are one of the most common reasons someone books an appointment with me. But "pigmentation" is not one thing – it is several different conditions that look alike in the mirror and behave completely differently in the skin. That is why two people can have the same treatment and get very different results. Here is why pigmentation appears, why it is so stubborn, and where TPRX fits in.

Three causes that look the same

Sun spots come from years of UV exposure and usually appear on the face, hands, neck and shoulders. They are harmless and do not need to be treated for medical reasons – evening them out is a cosmetic choice.

Marks after acne are not scars but pigment formed where the skin has been inflamed. If the pigment sits superficially it often fades on its own, although that can take up to a year. If it sits deeper it is considerably more resistant.

Melasma is hormonally driven and is often triggered by pregnancy, contraceptive pills or certain medications – with the sun amplifying it. It is the hardest of the three to treat.

Why pigmentation is so stubborn

What matters is how deep the pigment sits. Superficial pigment in the epidermis responds well to treatment and can be evened out relatively quickly. Pigment that has settled further down takes considerably longer, and some of it cannot be removed completely. That is also why I always want to do a skin analysis first – without knowing the depth, there is no way to say what is realistic for your skin.

How TPRX works on pigmentation

TPRX is a peel with a high concentration of trichloroacetic acid, but with one important difference from a classic peel: hydrogen peroxide in the formula moderates the acid's effect in the epidermis. That allows the treatment to work at depth without the skin frosting and without the visible flaking associated with strong peels. The formula also contains kojic acid, which inhibits the enzyme tyrosinase – the one that governs melanin production.

The treatment therefore works from two directions at once: it stimulates the skin's own renewal at depth and slows the formation of new pigment. All of it without needles and without abrasives, and most people do not experience it as painful. Many see immediate radiance after the very first session, but it is across a full course that the skin tone actually evens out.

What you can expect

One treatment takes 30 minutes, and I recommend a course of 4–6 treatments with 7–14 days in between. Expect the skin tone to even out gradually across the course rather than individual spots disappearing between two visits. If you want to combine the pigment work with firming and collagen formation, we also offer TPRX together with microneedling for the face and neck.

Melasma – what I do and do not promise

Melasma can be kept in check, but it is not cured. It may ease when the trigger disappears, but it can also remain for years, and the risk of it returning is high – particularly during the summer months.

The fact that TPRX works on melanin formation and causes no visible flaking is an advantage with melasma, where the skin readily responds to irritation with even more pigment. But I want to be clear: TPRX is not a cure for melasma, and the result requires maintenance. If you have melasma, I always do a skin analysis before we decide on intensity and intervals.

No result holds without sun protection

Sun makes the skin produce more pigment. It darkens the spots you already have and creates new ones. Use SPF 50 daily throughout the course and for at least three weeks after it ends, then continue with daily broad-spectrum protection. Without it, we are working against the wind.

When to contact healthcare instead

If you have a pigment spot that is new, that changes, darkens or becomes raised, that bleeds, or a wound that does not heal within a few weeks – contact your health centre or call 1177. Changes like these should be assessed by healthcare, not treated in a salon.

Not sure where to start?

Which treatment suits you depends on the cause and on how deep the pigment sits. Our guide to pigmentation treatments gathers all our options, from gentle to intensive. You are welcome to book a free skin analysis with me in Nynäshamn and we will look together at what is realistic for your skin.