Not all dark patches are the same, and they do not all respond to the same treatment. Learn what causes pigmentation, which treatments have the best support, and what to avoid.
Skin colour comes from melanin, a pigment made by cells called melanocytes. When these cells make too much melanin in one area, or release it unevenly, you see dark spots, patches, or an uneven skin tone. This is called hyperpigmentation.
Hyperpigmentation can affect anyone, but it is more common, and can last longer, in people with darker skin tones. The most important step is to work out which type you have, because the best treatment for a post-acne mark is not the same as the best treatment for melasma.
| Type | What Causes It | What It Looks Like | What to Expect |
|---|---|---|---|
| Post-inflammatory hyperpigmentation | Skin injury or inflammation, such as acne, eczema, burns, insect bites, or irritating products | Flat brown or grey marks where the skin was inflamed | Temporary, but can last longer in darker skin; shallow marks often fade over 6 to 12 months |
| Sun spots (age spots) | Years of sun exposure | Well-defined brown spots on the face, hands, shoulders, and other exposed areas | Often respond to treatment, but new spots appear without sun protection |
| Melasma | Sun and visible light, hormones (pregnancy, some contraceptives), and family history | Brown or grey-brown blotchy patches, often on both cheeks, forehead, and upper lip | Long-term and slow to respond; often returns, especially with sun exposure |
| Freckles | Genetics and sun exposure | Small, light brown spots that darken in the sun | Harmless; they tend to fade with less sun and return with more |
| Deeper (dermal) pigmentation | Pigment sitting in the deeper skin layer, sometimes after injury or with certain medicines | Slate-blue or grey patches | Harder to treat and can take years to fade, even with treatment |
Note: Melasma can be epidermal (in the top layer), dermal (deeper), or mixed. Epidermal melasma usually responds best, dermal melasma usually responds poorly, and mixed melasma, the most common kind, often improves only partly. A dermatologist can help work out which you have.
Whatever you are treating, nothing else works well without sun protection. Ultraviolet rays darken existing patches and trigger new ones, and visible light can worsen dark spots and melasma too.
Treatment usually combines sun protection, one or more skin-lightening ingredients, and sometimes procedures. Results are gradual, and combinations often work better than a single product.
| Treatment | Best For | Things to Know |
|---|---|---|
| Daily tinted sunscreen | Every type of pigmentation | The essential base of all treatment; not optional |
| Azelaic acid | Post-acne marks, melasma, uneven tone | Often gentle enough for long-term use; may cause mild tingling at first |
| Vitamin C | Dark spots and dullness | Can fade existing spots and slow melanin production; may irritate sensitive skin |
| Retinoids (tretinoin, adapalene, retinol) | Post-acne marks, sun spots, texture | Can cause dryness and irritation; start slowly and avoid pregnancy use unless a doctor advises otherwise |
| Kojic acid, arbutin, niacinamide, cysteamine | Mild to moderate dark spots and uneven tone | Results vary; usually used in combination with other treatments |
| Hydroquinone (prescription strength) | Stubborn dark spots and melasma | Prescribed and monitored by a dermatologist, usually for a limited period |
| Triple combination cream (hydroquinone, tretinoin, and a mild steroid) | Melasma | Considered the most effective topical option for melasma; must be used only as directed |
| Oral tranexamic acid | Selected cases of melasma | Prescription-only; needs a medical history check, including for clotting problems, and doctor supervision |
| Superficial chemical peels (glycolic, salicylic, and similar acids) | Surface pigmentation and post-acne marks | Needs expert selection; can worsen pigmentation if too strong |
| Lasers, IPL, and microneedling | Selected sun spots and some other marks | Can worsen pigmentation or trigger relapse, especially in melasma and darker skin; only by an experienced dermatologist |
Note: Prescription medicines and procedures should be chosen by a dermatologist after examining your skin. Products that suit one person or one type of pigmentation may not suit another.
Dark marks left behind after acne, eczema, or an injury are known as post-inflammatory hyperpigmentation. They are not scars, and they usually fade with time and the right care.
Melasma is a long-term condition. It affects about 1 in 100 people worldwide, mostly women, and is more common in people with medium to darker skin tones. It is slow to respond, and treatment works best in two phases: an active treatment phase, followed by a long maintenance phase to keep it from coming back.
Even after a good result, melasma often returns with strong summer sun. Lifelong sun protection is part of the treatment, not an extra.
Tip: Take a photo of the affected area once a month in the same room and lighting. Progress is slow and easy to miss day to day, and photos also help your dermatologist judge what is working.
Many unregulated "fairness" or whitening creams promise quick results. Some contain undisclosed steroids or mercury, and some may cause lasting harm. Be cautious of:
Warning: Do not use steroid or "whitening" creams on your face for long periods without medical advice. Misuse can thin the skin, trigger acne-like breakouts, and cause pigmentation to rebound worse than before. Stop and see a dermatologist if your skin becomes sore, thin, or darker.
Book a consultation if any of these apply:
Warning: Not every dark spot is harmless pigmentation. See a doctor promptly if a spot is growing, changing in colour or shape, has uneven edges or several colours, bleeds, itches, or does not heal.
Can pigmentation be cured completely? Some marks, such as post-acne spots, often fade fully over time. Melasma is long-term and usually needs ongoing care, because it often returns. No treatment can guarantee complete or permanent clearance.
How long does pigmentation treatment take to work? It varies by type and depth. Shallow dark spots can take 6 to 12 months to fade, and deeper pigmentation can take years. Topical treatments generally need weeks to months of steady use before you see a difference.
Is hydroquinone safe? It is a widely used treatment, but it is best used in the strength and for the length of time your dermatologist advises. Using high-strength products without supervision, or for too long, can cause side effects.
Are lasers safe for melasma? Lasers and similar devices can worsen melasma or trigger relapse, especially in darker skin. They should only be considered by an experienced dermatologist, often after preparing the skin with a pigment-reducing treatment.
Will melasma from pregnancy go away? It can fade for some people after pregnancy, but it can also persist or come back. Strict sun protection and a dermatologist's advice help, and some treatments are not suitable during pregnancy or breastfeeding.
Do I really need sunscreen if I am already using a lightening cream? Yes. Without sun protection, pigmentation usually returns or worsens, no matter how good the cream is.
If pigmentation is bothering you, do not wait for it to get worse or reach for an unregulated cream. Book a consultation with a dermatologist to identify the type of pigmentation and plan a safe, realistic treatment. For more on caring for your skin, read our guides on building a simple daily skin care routine and sun protection for healthy skin.
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