Dark spots on face: causes, types and what fades each one

Most dark spots on the face are one of three things: sunspots (solar lentigines), melasma, or post-inflammatory hyperpigmentation, the brown marks left behind after acne, a rash or an injury. They look similar, but they have different triggers and respond to different treatments, so naming the spot correctly is the first step to fading it.

Daily sun protection helps all three. Beyond that, sunspots respond well to procedures such as cryotherapy and laser, while melasma and post-inflammatory marks are usually treated with prescription creams and patience [1][2][3].

One caution: if a spot is new, changing or looks different from the rest, a dermatologist needs to see it in person. We explain the warning signs below.

Key takeaways

- Sunspots, melasma and post-inflammatory hyperpigmentation (PIH) are the most common causes of dark spots on the face.

- Sun protection is the foundation for all of them; for melasma, a tinted sunscreen with iron oxides also blocks visible light [4].

- Hydroquinone is not allowed in cosmetics for skin lightening in the EU [5]; on the skin it is a medicine, and in Spain stronger strengths need a prescription [14].

- Sunspots often respond best to cryotherapy or laser; melasma tends to come back and needs maintenance [1][2].

- A spot that is changing in size, shape or colour needs an in-person dermatologist visit, not an online consultation.

What causes dark spots on the face?

Brown spots appear when pigment cells (melanocytes) produce more melanin in one area, or when there are more of these cells.

Sunspots (solar lentigines)

Sunspots, also called age spots or liver spots, are flat, well-defined brown marks caused by years of cumulative ultraviolet (UV) exposure. They appear on the face, the backs of the hands, the forearms and the shoulders, usually from middle age onwards and mostly in fair skin [1]. They do not fade much on their own.

Melasma

Melasma shows up as larger, blotchy patches of light to mid brown, typically on both cheeks, the forehead, the upper lip and the chin, in a fairly symmetrical pattern. It mainly affects women and is linked to sunlight, visible light, hormones (pregnancy, the contraceptive pill) and genetic predisposition [2]. It is a chronic condition that often relapses, especially in summer. For a deeper look, see our article on melasma causes and treatment.

Post-inflammatory hyperpigmentation (PIH)

PIH is the mark left behind after the skin has been inflamed: an acne spot, eczema, a burn, a cut or an irritating cosmetic procedure. It is more frequent and more intense in darker skin types [3]. It often fades slowly over months once the inflammation stops, but sun exposure and picking can keep it going.

Freckles and seborrhoeic keratoses

Freckles are small, light brown spots that appear in childhood in fair-skinned people and darken in summer. Seborrhoeic keratoses are common, harmless growths that start flat but become raised, rough and "stuck-on" with time. Neither responds to fading creams, and a seborrhoeic keratosis should be confirmed by a doctor.

Sunspots, melasma or PIH: how to tell them apart

The table below summarises the typical features of each type. It is a guide, not a diagnosis, and you can have more than one type at once.

Feature	Sunspots (solar lentigines)	Melasma	Post-inflammatory hyperpigmentation
Look	Flat, round or oval, sharp edges, uniform brown	Blotchy patches with irregular, map-like edges	Flat marks in the shape of the previous spot or injury
Usual location	Face, back of hands, forearms, shoulders	Cheeks, forehead, upper lip, chin, often symmetrical	Wherever the skin was inflamed (often jaw, cheeks)
Main triggers	Years of cumulative UV exposure	UV and visible light, hormones, genetics	Acne, eczema, burns, picking, irritating treatments
Who gets it	Middle-aged and older adults, mostly fair skin	Mostly women	Anyone, more intense in darker skin
What fades it	Cryotherapy, laser, topical retinoids [1]	Strict sun protection, hydroquinone, triple combination, azelaic acid [2]	Treating the cause, sun protection, topical lighteners [3]
Tends to return?	Not if removed, but new ones can appear	Yes, often	Rarely, unless the inflammation comes back

If you are not sure which type you have, a doctor can usually tell from the pattern and history.

Sun protection comes first

No treatment for pigmentation works well without photoprotection, because UV light keeps stimulating melanin production [2]. Use a broad-spectrum, high-protection sunscreen every morning (the melasma trial below used SPF 50 or higher [4]), reapply it when you are outdoors, and add a hat and shade in strong sun.

For melasma, visible light also matters. In a randomised, double-blind trial of 68 people with melasma, all using 4% hydroquinone, those who used a sunscreen containing iron oxides (which absorb visible light) improved more after 8 weeks than those using a UV-only sunscreen: 15% greater improvement in severity scores and 28% greater improvement in colour measurements [4]. Tinted sunscreens provide those iron oxides.

Prescription creams that fade dark spots

Creams work best for melasma and PIH. For sunspots they are an option when a procedure is not wanted, and they can help keep results after a procedure [1].

Hydroquinone

Hydroquinone reduces melanin production and remains one of the best-studied treatments for melasma [2]. In the EU it cannot be used in cosmetics for skin lightening: the Cosmetics Regulation only allows it in artificial nail systems for professional use [5]. On the skin it is a medicine, not a cosmetic: in Spain, 2% creams are authorised medicines sold in pharmacies without a prescription, while stronger strengths and pharmacy-made creams need a prescription [14]. A doctor or pharmacist can advise whether it suits you.

Doctors prescribe it in limited, supervised courses rather than indefinitely. It can cause irritation and redness, and it is generally avoided in pregnancy and breastfeeding as a precaution. You can read more in our hydroquinone guide for dark spots and on the hydroquinone cream page.

Triple combination

The triple combination pairs hydroquinone with tretinoin and a mild corticosteroid. In a randomised trial in 260 Asian adults with moderate to severe melasma, 64.2% of people using the triple combination reached "none" or "mild" severity at 8 weeks, compared with 39.4% using hydroquinone alone [6]. Side effects were more frequent with the combination (48.8% versus 13.7%), although most were mild [6]. Details on how it is used are on our combination formula page.

Azelaic acid

Azelaic acid lightens pigment and also calms inflammation, which makes it useful when PIH follows acne [3]. At 15% it is a prescription medicine in Spain [8]. It is usually well tolerated, with mild stinging at first, and the product information advises particular caution in pregnancy [8].

Topical retinoids

Tretinoin and adapalene speed up skin cell turnover and help fade sunspots and PIH [1][3]. Tretinoin is prescription-only and is contraindicated in pregnancy and in women planning a pregnancy; it can also cause irritation, dryness and sun sensitivity, so it is applied at night with daily sunscreen [7].

With every cream, results build slowly. Trials usually judge progress after about 8 weeks, not after a fortnight [4][6], and if your skin becomes very irritated, contact your doctor or pharmacist, because irritation itself can cause new PIH [3].

A doctor reviews your case and decides whether a prescription cream is appropriate, which one, and for how long. Reading about a medicine is not a reason to use it.

Tranexamic acid and in-clinic procedures

Tranexamic acid

Tranexamic acid has been studied for melasma as tablets, as injections and as a topical product. A 2024 meta-analysis of 22 randomised trials with 1,280 patients found it reduced melasma severity, with the oral form showing the largest effect, but the studies were very heterogeneous and long-term safety needs more research [9]. Reported side effects included stomach upset and menstrual changes [9].

Oral tranexamic acid affects blood clotting, so it is something a dermatologist or GP assesses in person, checking your personal and family history of clots before considering it. It is not offered through an online topical consultation.

Procedures for sunspots

For solar lentigines, an expert consensus rated cryotherapy as first-line treatment, with good evidence that lasers are also effective [1]. They are done in a clinic and can leave lighter or darker marks, so they are best done by a dermatologist.

Procedures for melasma

Chemical peels and laser or light devices have mixed results in melasma, are not better than creams, and carry a higher risk of side effects, including PIH [2].

When a dark spot might be a mole that needs checking

Melanoma can look like a dark spot, and doctors use simple rules to decide which spots need a closer look.

The ABCDE rule

The ABCDE rule lists features that should prompt a skin check [10][11]:

• A, Asymmetry: one half of the spot does not match the other.
• B, Border: the edge is irregular, scalloped or poorly defined.
• C, Colour: several shades of brown, black, red, white or blue in one spot.
• D, Diameter: usually larger than 6 mm, although melanomas can be smaller.
• E, Evolving: any change in size, shape, colour, surface (such as bleeding) or symptoms (such as itching).

The "E" was added because change over time is one of the most important warning signs [10].

The ugly duckling sign

Most of a person's moles look like one another. A spot that looks different from all your others, the "ugly duckling", deserves attention even if it does not tick the ABCDE boxes [12].

Lentigo maligna

Lentigo maligna is an early form of melanoma confined to the top layer of skin. It usually appears on sun-damaged facial skin in people over 60, and at first it can look like an ordinary sunspot that slowly grows and becomes uneven in colour [13]. It may progress to invasive melanoma, and the diagnosis is confirmed by a skin biopsy [13]. This is why a changing "sunspot" should not be treated with creams without an examination.

When to see a doctor

See a dermatologist in person, not online, if any of these apply:

• A spot is new, or is growing or changing in size, shape or colour [11].
• A spot has several colours, an irregular edge, or looks different from your other moles.
• A spot bleeds, itches, crusts or does not heal.
• A "sunspot" is getting larger or darker over months.
• A spot is raised, rough or lumpy and you are unsure what it is.

Hi Doctor offers topical treatment only and cannot diagnose a changing mole online, so these situations need a face-to-face visit, where the dermatologist can use a dermatoscope and take a biopsy if needed.

For flat, stable pigmentation that matches melasma or PIH, an online consultation is a reasonable starting point. On Hi Doctor, a doctor licensed in Spain reviews your questionnaire, usually replying in under 2 hours on average, and decides whether a topical treatment is suitable. You can see the steps on how it works and the full range of skin conditions on our dermatology page.

Sources

1. Ortonne JP, Pandya AG, Lui H, Hexsel D. Treatment of solar lentigines. J Am Acad Dermatol. 2006;54(5 Suppl 2):S262-71. doi:10.1016/j.jaad.2005.12.043. https://pubmed.ncbi.nlm.nih.gov/16631967/
2. McKesey J, Tovar-Garza A, Pandya AG. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol. 2020;21(2):173-225. doi:10.1007/s40257-019-00488-w. https://pubmed.ncbi.nlm.nih.gov/31802394/
3. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20-31. https://pubmed.ncbi.nlm.nih.gov/20725554/
4. Castanedo-Cazares JP, Hernandez-Blanco D, Carlos-Ortega B, Fuentes-Ahumada C, Torres-Álvarez B. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatol Photoimmunol Photomed. 2014;30(1):35-42. doi:10.1111/phpp.12086. https://pubmed.ncbi.nlm.nih.gov/24313385/
5. Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products, Annex III, entry 14 (hydroquinone: artificial nail systems, professional use only). https://eur-lex.europa.eu/eli/reg/2009/1223/oj
6. Chan R, Park KC, Lee MH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. 2008;159(3):697-703. doi:10.1111/j.1365-2133.2008.08717.x. https://pubmed.ncbi.nlm.nih.gov/18616780/
7. AEMPS, CIMA. Ficha técnica: tretinoína 1 mg/g crema (nregistro 60142), sections 4.3 and 4.4. https://cima.aemps.es/cima/dochtml/ft/60142/FT_60142.html
8. AEMPS, CIMA. Ficha técnica: ácido azelaico 150 mg/g gel (nregistro 65365), sections 4.1 and 4.6. https://cima.aemps.es/cima/dochtml/ft/65365/FT_65365.html
9. Calacattawi R, Alshahrani M, Aleid M, et al. Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials. J Dermatolog Treat. 2024;35(1):2361106. doi:10.1080/09546634.2024.2361106. https://pubmed.ncbi.nlm.nih.gov/38843906/
10. Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA. 2004;292(22):2771-6. doi:10.1001/jama.292.22.2771. https://pubmed.ncbi.nlm.nih.gov/15585738/
11. American Academy of Dermatology. What to look for: ABCDEs of melanoma. https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes
12. Grob JJ, Bonerandi JJ. The 'ugly duckling' sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol. 1998;134(1):103-4. doi:10.1001/archderm.134.1.103-a. https://pubmed.ncbi.nlm.nih.gov/9449921/
13. Karponis D, Stratigos IA, Joshy J, et al. Lentigo maligna: a review. Clin Exp Dermatol. 2024;49(3):218-225. doi:10.1093/ced/llad394. https://pubmed.ncbi.nlm.nih.gov/37966718/
14. AEMPS, CIMA. Authorised medicines containing hydroquinone in Spain (2% presentations without prescription; 4% with prescription), checked 15 October 2026. https://cima.aemps.es/cima/publico/lista.html?pa=HIDROQUINONA