Dark spots on the skin: why they appear and how they clear
Not all spots are the same, and they are not treated the same way. The first thing is knowing which one you have — everything else follows from that.
“Spots” is not one thing
“Spot” is what the patient sees; to a dermatologist it is several different diagnoses, with different causes and treatments that have nothing to do with each other. The ones seen most here:
- Melasma. Brown patches on the cheeks, forehead and upper lip. It has a hormonal component and gets worse with sun and with heat.
- Sun spots. They show up over the years on the face, chest, arms and hands. They are the accumulated bill for exposure.
- Marks left after a breakout. What acne or an insect bite leaves behind as it heals. They are not scars and they usually fade on their own, though slowly.
- Dark patches on the neck and underarms. Acanthosis nigricans: darker, velvety skin. It is often the first visible sign of insulin resistance.
- White patches. These can be vitiligo, a fungus or the aftermath of something else; they are told apart in the office, not by eye.
Why telling them apart matters
Because the right treatment for one makes the other worse. An aggressive peel on active melasma can inflame the skin and leave it darker than it was. A poorly chosen laser on brown skin can burn.
That is why the first visit is an assessment: the skin is examined with light and with a dermatoscope, your phototype is recorded —how light or dark your skin is and how it reacts to sun— and the plan comes out of that.
How it is treated here
- Treatment at home. Lightening agents chosen for your type of spot and your type of skin.
- In-clinic procedures. Chemical peels, SmartPICO laser or pulsed light, depending on the case and always after an assessment.
- Sun protection, every day. This is not filler advice: without it, whatever lightens goes dark again.
- Treating the cause. If there is something hormonal or metabolic behind it, that is assessed in the same clinic.
How long it takes
It depends how deep the pigment sits. Surface marks usually improve in weeks; melasma is worked on for months and is controlled, not cured in one go. Anyone promising to remove melasma in a single session is selling you something.
Frequently asked questions
Do spots go away for good?
Sun spots and marks from a breakout usually lighten durably. Melasma is different: it is controlled and tends to come back with sun, heat and hormonal changes, so it needs maintenance. Saying so up front avoids the disappointment six months in.
Do drugstore creams work?
Some help as support, but none of them can tell which kind of spot you have. What usually happens is three or four tried on your own, an irritated face, and a darker spot than before.
Can I have laser treatment if my skin is brown?
Yes, but not with just any device or any setting. That is why your phototype is determined before the first session: it is what decides the energy used.
Does pregnancy have anything to do with it?
Yes. Melasma often appears or worsens during pregnancy and with hormonal contraceptives. Several treatments cannot be used while pregnant, so it is handled differently.
I have dark patches on my neck — is that dirt?
No, and scrubbing makes it worse. Acanthosis nigricans is a sign on the skin of something metabolic underneath, and it is worth looking into: that consultation happens in this same clinic.
Shall we take a look?
An assessment tells you what you have and what to do about it. Message us on WhatsApp.
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