Dark Spots on Face: Causes (Melasma, Sun, PIH) and Dermatologist Solutions

Common Causes of Facial Hyperpigmentation

1. Sun Exposure (Solar Lentigines): UV-induced melanin overproduction; nose, cheeks, forehead. Cumulative.
2. Melasma: Symmetric brown-gray patches (forehead, cheeks, upper lip). Triggers: hormones (OCP, pregnancy), UV, genetics, heat. "Mask of pregnancy."
3. Post-Inflammatory Hyperpigmentation (PIH): Dark marks after acne, eczema, psoriasis, burns, procedures. More common in darker skin tones (Fitzpatrick IV–VI).
4. Age Spots (Liver Spots): Chronic UV exposure; face, hands, arms; >40 yrs typically.
5. Drug-Induced: OCP, HRT, antimalarials, amiodarone, minocycline, phenytoin.
6. Congenital: Café-au-lait macules, nevus of Ota/Ito.

Dermatologist Approach

• Diagnosis: Wood's lamp, dermoscopy, biopsy if uncertain.
• Topicals: Hydroquinone (gold standard), retinoids, azelaic acid, kojic acid, vitamin C, niacinamide, cysteamine, tranexamic acid.
• Procedures: Chemical peels, laser (Q-switched, picosecond, fractional), IPL, microneedling.
• Sun protection (non-negotiable): Broad-spectrum SPF 30+ daily, reapply, hats, shade.

Key Principle

Treatment must match etiology. Melasma ≠ sun spots ≠ PIH. Maintenance is lifelong for recurrent types.