Spots on the face: causes and treatments

Why do spots appear on the face?

The color of our skin depends largely on melanin.

Melanocytes produce this pigment and distribute it to other cells in the epidermis.

Sun exposure stimulates this system.

But inflammation, certain hormonal changes, medications, genetic predisposition, and other factors can also alter it.

That is why we can develop facial pigmentation through very different mechanisms.

Among the most common causes we find: melasma, solar lentigines, and post-inflammatory hyperpigmentation.

And telling them apart is essential before starting any treatment.

1. Melasma

Melasma typically produces brown or grayish areas, often symmetrical, particularly on the cheeks, forehead, and upper lip.

It is much more than a simple 'sun spot.'

Its origin is multifactorial.

Genetic predisposition, ultraviolet and visible radiation, hormonal factors, and other skin mechanisms are all involved.

It also has one very important characteristic: it tends to recur.

That is why we should understand melasma more as a chronic condition that needs to be managed than as a spot we eliminate once and forget about forever. Current international recommendations highlight precisely its recurrent nature and the need for a sustained strategy.

2. Sun spots on the face

Sun spots on the face very often correspond to solar lentigines.

They are pigmented lesions related to cumulative ultraviolet exposure.

They can also appear on the back of the hands, the décolletage, and other sun-exposed areas.

Unlike melasma, they tend to be more well-defined lesions.

Solar lentigines are benign and do not require medical treatment except for aesthetic reasons, but some pigmented lesions can look clinically similar to them.

That is why, before using a laser on an isolated lesion, we must be certain of its diagnosis.

3. Post-acne hyperpigmentation

A pimple disappears. But a brown mark remains.

This is especially common in certain skin phototypes and is called post-inflammatory hyperpigmentation.

Inflammation triggers alterations in the production and distribution of melanin.

This is why treating pigmentation alone without controlling active acne can become a vicious cycle: a lesion appears → it causes inflammation → it leaves pigmentation → another lesion appears → it leaves more pigmentation.

In these patients, we must treat both the cause and the consequence.

4. Irritation and procedures

The inflammation itself caused by overly aggressive cosmetics or certain procedures can produce or worsen pigmentation.

This point is especially important in patients with a tendency toward melasma or post-inflammatory hyperpigmentation.

More intensity does not necessarily mean better results.

Excessively irritated skin can end up becoming more pigmented.

And what about white spots on the face?

White spots on the face are a completely different problem.

Here we are not necessarily talking about an excess of melanin.

We can find different causes: vitiligo, post-inflammatory hypopigmentation, certain superficial infections, and other dermatological conditions.

That is why a depigmenting cream intended for a brown spot obviously makes no sense for an area that is losing pigment.

Once again: first we diagnose the color. Then we treat it.

How are facial dark spots treated?

There is no single treatment.

We can act through: photoprotection, topical treatments, chemical peels, certain procedures, and laser or light technologies, depending on the diagnosis.

And very often we combine several strategies.

Photoprotection is not optional

If we are trying to treat facial hyperpigmentation while continuing to stimulate pigment production on a daily basis, we are working in opposite directions.

That is why photoprotection is a fundamental part of the treatment.

In melasma, in addition to ultraviolet radiation, visible light can contribute to pigmentation.

For this reason, certain tinted sunscreens that incorporate iron oxides can be particularly interesting. The AAD recommends broad-spectrum protection with SPF 30 or higher and highlights the value of iron oxide-tinted sunscreens in melasma.

What is the best cream for facial dark spots?

This is probably one of the most frequently asked questions.

But simply searching for a cream for facial dark spots can lead us to completely different products.

Depending on the diagnosis, we can use active ingredients such as: azelaic acid, retinoids, hydroquinone in selected situations and under medical supervision, kojic acid, topical tranexamic acid, and other depigmenting agents.

In melasma, recent international recommendations continue to place hydroquinone-based combinations among the options with the strongest support, provided they are used in a regulated and supervised manner.

Therefore, the question should not be: 'What is the best cream to remove dark spots from the face?' But rather: 'What is the right cream for my type of spot?'

What about chemical peels?

Chemical peels can be used in certain pigmentary disorders.

Depending on the agent used and its depth, they can help improve pigmentation and skin texture.

But they are not without risks either.

An excessively aggressive peel can cause inflammation and, in predisposed patients, generate precisely what we were trying to treat: more hyperpigmentation.

In melasma, current consensus guidelines consider peels primarily as complementary tools within a combined treatment strategy.

Does laser remove dark spots?

Some, yes.

But here we must let go of a very widespread idea: 'I have a dark spot, therefore I need a laser.'

No.

Selected solar lentigines can respond very well to certain pigment lasers or light-based systems.

Melasma, on the other hand, is far more complex.

An overly aggressive treatment can cause inflammation, pigmentary rebound, or post-inflammatory hyperpigmentation.

The 2026 international consensus on melasma recommends reserving lasers mainly for refractory cases and within carefully selected treatment strategies.

Technology is no substitute for diagnosis.

What about tranexamic acid?

Tranexamic acid has become a valuable tool in certain patients with melasma.

It can be used via different routes, including topical and, in selected patients, oral.

However, oral treatment is not simply a cosmetic product.

It has contraindications and requires appropriate patient selection, particularly given the thromboembolic risk.

This is why we must never turn a medical treatment that may be genuinely useful into a universal recommendation for any facial pigmentation.

Can they be permanently eliminated?

It depends on the cause.

A specific solar lentigo can be successfully eliminated, although new lesions may appear over the years if sun damage continues.

Post-inflammatory hyperpigmentation can gradually fade.

Melasma, on the other hand, has a strong tendency to recur.

That is why I prefer to talk about: treating + controlling + preventing, rather than promising: 'eliminating forever'.

When should we study a spot before removing it?

Whenever there is any diagnostic doubt.

Especially if we have an isolated lesion that: has appeared recently, is growing, is changing in shape or colour, displays several colours, has irregular borders, bleeds, or simply behaves differently from the others.

A suspicious pigmented lesion should not simply be 'erased' with an aesthetic procedure.

It must first be diagnosed.

So, how do we choose the treatment?

In the consultation we follow an order.

First we identify the type of pigmentation.

Then we assess skin phototype, depth, distribution, personal history, sun exposure, inflammation, and previous treatments.

And only then do we choose the strategy.

For certain patients, it will be primarily home-based.

For others, we will combine topical treatment with procedures.

And for others, we may incorporate laser or other technologies.

Current recommendations for hyperpigmentation disorders emphasise precisely the need to individualise treatment according to the type of pigmentation, phototype, and depth of the pigment.

What I want you to remember

If you have spots on your face, don't start by asking: "What laser do I need?" Not even: "What cream do I need?"

Start by asking: "What type of spot do I have?"

Because a solar lentigo, melasma, and post-acne hyperpigmentation can look similar yet require completely different approaches.

Sun protection will be essential for many of them.

Afterwards, we can use creams, peels, or certain technologies when they are indicated.

But the order matters: first we diagnose. Then we treat. And finally we try to prevent the pigmentation from coming back.