Sun spots. Age spots. Acne marks. Freckles. All dark spots are NOT alike, and neither are their treatments.
Wondering what kind of spot you're seeing? More likely, you want to know how to treat it...read on.
(Need a brush-up on discolorations and how they form? Flip over to "Skin Basics: What Is Hyperpigmentation?" and get the inner scoop on spots.)
You probably know this already but it can’t be said enough: Any spot that is larger than 6mm (a quarter inch), changes size over time, has different colors within the spot, or seems unusual looking should be checked out by a doctor.
PHOTOAGING I: DARK SPOTS, SUN SPOTS, SOLAR SPOTS, AGE SPOTS
These are the classic "dark spots," known by derms as photoaging (aging caused by light, specifically UV rays). They tend to be loners, appearing just one at a time. They're normally brown or black in color, more or less circular, and up to 2mm or more (an eighth of an inch) in diameter. Unlike some other kinds of hyperpigmentation that may fade over time, these spots stick around.
While dark spots can form at any time, most people will start to see them in or after their mid-thirties when melanin production may kick into overproduction.
PHOTOAGING II: UNEVEN SKINTONE, DARK PATCHES, DISCOLORATION
If you're seeing larger areas of discoloration that are not the same on both sides of your face (especially if you're not pregnant), you could be experiencing hyperpigmentation driven by UV damage. The uneven skintone is caused by a similar action to what creates dark spots, but the melanin is dispersed over a wide area instead of concentrated into a single spot.
Wear. Sunscreen. Every. Day. Because UV damage is the primary cause of photoaging, shielding skin from stray rays is always your best starting point. It can make a big difference for preventing multiple kinds of hyperpigmentation.
To erase spots, dial back discoloration, and brighten up your skin, you have a world of options. Because dark spots and uneven skin tone are related to photoaging, they tend to respond well to therapies. There are variations on the theme, but most treatments work by breaking up the visible concentrations of melanin into smaller and smaller bits, which can then be cleared away by the skin's normal renewal actions.
At the Clinic: For the most aggressive approach, head to your dermatologist's office or a med spa. After looking at your skin, the clinician will recommend an in-office treatment such as lasers, microdermabrasion, IPL (Intense Pulsed Light), or an acid peel—all carry varying risks, discomfort levels, side effects, recovery times, and associated costs. We recommend working with an experienced derm, especially if you have a darker skintone, because some common treatments can actually increase hyperpigmentation in darker skin (or, alternatively, cause unwanted lighter areas called hypopigmentation) unless the right approach is used.
ACNE MARKS, PIH (POST-INFLAMMATORY HYPERPIGMENTATION)
For some, especially those with Black skin or other deeper brown skin tones, even small pimples, bug bites or skin irritation can leave behind dark spots known as PIH, or post-inflammatory hyperpigmentation. These spots form because inflammation itself can trigger excessive melanin production and concentration. Acne marks and PIH will likely fade over time, but it could be awhile, depending on your skin.
Treatment for acne marks and PIH is generally the same as that for dark spots, and can be handled at a derm office, spa or at home.
Freckles are usually pretty small, 2mm or less, and are mostly red or brown, though their color can vary widely and can be dependent on the underlying skin tone. They tend to appear in groups, with a bunch of individual freckles spreading over a given area.
The latest research shows that, unlike other types of spots, freckles are genetic. No gene, no freckles. If you do have the gene, UV rays flip on the freckle-producing-switch—which is why consistently wearing sunscreen and staying indoors can keep the specks subdued; (this explains why many people have more freckles in summer).
Because their appearance is rooted in your genes, freckles are among the hardest type of spots to treat. Dermatologists may suggest some options, but hey, freckles are adorable. 🤷♀️ It’s up to you.
If you see broad, matching patches that are darker than your normal skintone, or an area that looks like freckles where you don't normally have them, you may be experiencing melasma. Melasma loves symmetry, so the pattern will typically be the same on both sides of your face.
Because it is often linked with hormonal fluctuations, melasma is commonly known as the "mask of pregnancy." No surprise, it can also be brought on by birth control pills or hormone therapy/HRT. While melasma is much more common in women than men, this poorly understood condition is occasionally triggered by UV exposure, so can affect people of all genders and skin tones.
Melasma frequently fades on its own once the hormones revert to normal. If you want faster results, especially if you are pregnant, you should speak with your doctor.
OTHER SKIN ISSUES (REDNESS, IRRITATION/SENSITIVITY, SCARS, DRYNESS, ROSACEA, ECZEMA)
Skin discoloration doesn't only come in the form of dark spots. Redness and sallowness are common frustrations for some skin tones; keloids and irritation from product use affect others.
Different concerns have their own causes, and some, such as rosacea and eczema, should be discussed with your dermatologist. To help soothe red, sensitive skin, look for products specifically created to be gentle and free of potential allergens. And getting into the habit of using a high-quality skincare regimen that includes moisturizer and SPF (cheat sheet: check out the Ourself regimen to reduce hyperpigmentation) can keep skin hydrated and healthy looking.