Dark Spots on the Face: Hyperpigmentation Treatment

Hyperpigmentation is an area of skin that is darker than the skin around it: it contains excess melanin, the pigment that gives skin its colour. Yet "brown" only describes what you see. The same brown colour can come from the sun, inflammation or hormones, and the diagnosis is based on how the spot has developed and on an examination of the skin, not on its colour.

The sun causes flat spots to appear on frequently exposed areas, including the face and hands. Solar lentigines, also called age spots, are one example. A pimple, irritation or injury, on the other hand, can leave a darker spot: this is post-inflammatory hyperpigmentation. When the mark left after a pimple is flat, it is generally not a scar. An acne scar can be indented or raised, and its colour can fade while the indentation or raised area remains.

When a skin condition such as acne or eczema is perpetuating the marks, it is treated before the pigmentation. During the assessment, mention any medication suspected of causing spots: do not stop taking any medication without the advice of the person who prescribed it.

Calling your marks "freckles" is no substitute for a skin examination: colour alone is not enough to identify the cause. Nor is a brown discolouration under the eye, described as pigmented dark circles, enough to tell what causes it. Before choosing a treatment, its nature needs to be clarified.

For some age spots, a cream or lotion can help, but it requires regular application: improvement takes weeks or months. This timeline does not apply to every cause of pigmentation. Vitamin C is one example of an ingredient used in cosmetics, but its name says nothing about the whole formula. What matters is the cause of the spot, how well your skin tolerates it and the other products you use.

A cream does not eliminate an ongoing cause, and a stronger formula or several layered active ingredients do not guarantee a faster result. A product that burns or stings irritates the skin and can create new spots: choose a well-tolerated formula and have your routine reviewed as soon as your skin reacts. During pregnancy or breastfeeding, have a health professional check the ingredients and treatments being considered. Some spots need treatments prescribed during a consultation, which require a separate assessment.

A peel removes the surface cells of the skin, which contain pigment. It therefore works only on the surface and does not automatically treat every cause of spots. It can also worsen pigmentation, lighten the skin too much or leave a scar. If you have dark skin or your skin tends to develop lasting marks after irritation, this reaction matters when choosing a peel: a peel that injures the surface of the skin can intensify post-inflammatory hyperpigmentation. If you are considering a depigmenting mask, have its ingredients and its place in your routine checked before applying it; the mask's name is not enough to know whether it is appropriate for your skin.

CARE MD offers intense pulsed light, or IPL, for pigmented spots on the face. IPL is not a laser: it emits light covering several wavelengths, whereas a laser emits a specific wavelength, which is absorbed and then converted into heat in the targeted tissue. IPL can be considered for certain pigmented lesions, including solar lentigines. The choice depends on the diagnosis, skin colour and the parameters chosen. On dark skin, hyperpigmentation is possible; adjusting the settings does not eliminate this risk. IPL is not a universal solution.

For melasma or a mark left by a pimple, greater caution is needed: a procedure that injures the epidermis can worsen post-inflammatory hyperpigmentation, and superficial pigment does not respond the same way as deep pigment. Which approach is appropriate is determined during the assessment. The same pulsed light is also used for facial photorejuvenation, which has a different goal from fading a spot.

CARE MD also offers the fractional CO2 laser, a resurfacing technique. Its energy is absorbed mainly by the water in the tissues, not by melanin: it creates small, controlled injuries whose repair renews the skin. For spots, its benefit is therefore not a given. The fact that it is offered is not enough reason to choose it for a spot: its suitability is evaluated during the assessment. Your skin tone and how your skin reacts after irritation also matter when choosing a treatment; a procedure that injures the surface of the skin can worsen post-inflammatory hyperpigmentation.

Microneedling involves making small punctures in the skin with needles. The repair that follows can stimulate collagen and improve the appearance of some scars, fine lines or uneven texture. Improving texture is a different goal from fading a spot: the effect on pigment is not a given and depends on the cause.

After the session, the skin can darken or lighten, with redness, a burning sensation and swelling. Some devices have not been studied on dark skin. Mention any tan, sunburn, infection or active pimples before the session.

Your skin tone matters in every choice, whatever the treatment. On dark skin, marks after inflammation are more common, darker and longer-lasting, and an irritating procedure can intensify pigmentation or leave a lighter area. Three other factors also matter when choosing a treatment: a recent tan, how your skin has reacted to previous treatments and your history of marks after a pimple or irritation. Discuss them before the treatment: adjusted settings do not guarantee safety.

The risks differ from one treatment to another:

A broad-spectrum sunscreen protects against UVA and UVB; aim for an SPF of 30 or higher. For spots, a tinted sunscreen containing iron oxides adds protection against visible light, which complements UV protection without replacing it. A tint suited to your skin tone avoids a white cast, and a non-comedogenic formula is more appropriate for oily skin.

Apply it generously and evenly, as directed on the label, at least fifteen minutes before sun exposure. Use about one teaspoon for an adult's face and neck. Outdoors, reapply it at least every two hours, and more often after sweating, swimming or drying off with a towel. Even a water-resistant product needs to be reapplied after swimming or heavy sweating.

The time it takes depends on the cause and the depth of the pigment. Once the cause is under control, some spots that are a few shades darker than your skin fade in six to twelve months, and deeper pigment can persist for years. This timeframe describes the natural course of these spots, not the length of a treatment. The number of sessions and maintenance are decided during the assessment, depending on the spot and the treatment chosen.

A spot can come back: melasma often returns when treatment stops, sun spots sometimes reappear, and the sun or new inflammation causes new ones to form. The result varies from person to person, and complete disappearance is not guaranteed.

To prepare your questions, you can note when the spots appeared and whether they followed a pimple, irritation, sun exposure or a hormonal change. A list of your skin care products, treatments and medications, along with photos showing how the spots have evolved, can help you explain what has changed. Also think about your reactions to previous treatments.

CARE MD offers a Global Aesthetic consultation. Before any procedure, the nature of the spot, what you would like and the limitations of the options need to be discussed with the doctor; not treating can also be a choice. If a first conversation takes place remotely, it does not replace an in-person examination before a treatment is chosen. Before a laser treatment, ask whether this technique is appropriate for your skin, what after-effects to expect, what follow-up is needed and which risks to discuss. You can ask our professionals your questions, in particular to find out who will perform the treatment being considered.