Melasma and post-inflammatory hyperpigmentation are common pigmentary skin diseases, mainly manifested as hyperpigmentation on the face or other exposed areas, which seriously affect the appearance and quality of life of patients. The pathogenesis of melasma and post-inflammatory hyperpigmentation involves factors such as ultraviolet exposure, endocrine disorders, genetic factors, inflammatory reactions, and abnormal proliferation of melanocytes. Traditional treatment methods in the past included topical whitening agents, chemical peels, physical therapy, and laser therapy. Although laser therapy can effectively break down melanin, it may cause side effects such as skin inflammation, rebound hyperpigmentation, and damaged skin barriers during the treatment period, affecting the stability of the curative effect. As one of the external treatment methods in traditional Chinese medicine, Chinese medicine fumigation has the effects of clearing heat and removing toxins, activating blood and resolving stasis, and expelling wind and dispersing lumps. By acting on the skin with medicinal steam, it can promote local blood circulation, improve microcirculation, enhance the skin barrier function, and help to inhibit the over-activation of melanocytes, which has received extensive attention in the treatment of skin diseases. In recent years, the combined treatment of laser therapy and Chinese medicine fumigation has been proposed as a new treatment model, which can respectively exert the therapeutic effects of laser in breaking down melanin and Chinese medicine fumigation in regulating skin quality, so as to improve the curative effect and reduce side effects. Therefore, this review will systematically summarize the pathogenesis of melasma and post-inflammatory hyperpigmentation, the limitations of conventional treatments, the action mechanism of the combination of laser and Chinese medicine fumigation, and the progress of clinical research, with a view to providing theoretical basis and practical guidance for clinical treatment.