Most often we think that pigmentation occurs due to sun exposure only. Well it's not completely true. Freckles, melasma age spots and many other pigmentary changes are part of the aging process. As we age the normal cell turn over mechanism that produces healthy cells slows down. Eventually there will be more pigment cells that surfaces rather than the healthy cells. Sun exposure, hormonal, genetic influences and certain drugs can augment this process.

Pigmentary changes most often start around mid 30's. It increases with age. It may be more common in women due to hormonal influences (child birth, oral contraceptive pills).

Excessive sun exposure (golfing, diving, sun bathing, etc) accelerates the pigmentary conditions through the formation of new melanocytes (pigment cells) which protects the skin from the UV rays. With continuous exposure to UV rays, the rate of melanocyte formation overtakes the rate of skin shedding and this leads to freckles, melasma, solar lentiges, etc. If there is family history of melasma or freckles, it accentuates the process even faster.

Pigmentation that is hormonally influenced normally appears during pregnancy or while on oral contraceptive pills. In some individuals the pigmentation disappears after child birth or once they have stopped the pills. However in most individuals, the pigmentation remains.

Post inflammatory hyperpigmentation (PIH) occurs following a trauma or inflammation to the skin, e.g. after post acne, chemical burns, LASER burns, thermal injury to the skin etc. The inflammatory process induces melanocyte growth which causes the discoloration at the site of injury.