Uneven skin tone is one of the most common reasons people come to see a dermatologist, and one of the most frustrating to treat on your own. Products that clear one person’s spots do nothing for another’s. Treatments that work for months can be undone by a single summer.
The reason is almost always the same: dark spots are not one condition. Several distinct processes produce excess pigment; they have different triggers and respond to different treatments. Working out which one you have is not a preliminary step. It is the step that determines whether anything else works.
What Causes Dark Spots on Skin? The Short Answer
Dark spots, known medically as hyperpigmentation, occur when melanocytes produce excess melanin in a localised area. The three most common types are solar lentigines, caused by cumulative UV exposure; melasma, driven largely by hormonal factors; and post-inflammatory hyperpigmentation, which follows acne, eczema or skin injury.
Ultimately, this is a basic guide which does not replace specialist diagnosis by a dermatologist. This is especially important if your spots are not clearing as brown spots can represent melanoma, pigmented skin cancer, pigmented pre-cancerous conditions and benign age spots.
Each responds differently to treatment, and treating pigment without addressing the underlying trigger is the most common reason spots return.
The Three Main Types of Dark Spots
Solar Lentigines (Liver Spots)
Flat, well-defined tan or brown patches, usually on the face, backs of the hands, chest and shoulders. They appear where sun exposure has been heaviest over years, which is why they tend to emerge from the mid-thirties onwards and why they are so common in Australia.
They are stable rather than fluctuating, and they generally respond well to treatment because the pigment sits relatively superficially.
Melasma
Larger, symmetrical patches with less defined edges, typically across the cheeks, forehead, upper lip and jawline. Melasma is far more common in women, and it fluctuates: darker in summer, often darker in pregnancy, and prone to returning.
It is the most difficult of the three to manage, because the pigment frequently sits deeper and because the underlying hormonal and vascular drivers do not switch off. Melasma is managed rather than cured, and anyone promising permanent clearance is overstating what is achievable.
Post Inflammatory Hyperpigmentation
Marks left behind after the skin has been inflamed or injured. Common after acne, eczema, cuts, burns, or aggressive cosmetic treatment.
Post inflammatory hyperpigmentation (PIH) follows the shape of whatever caused it, which is often the clue. It is more common and more persistent in deeper skin tones, and it usually fades on its own over months, though treatment can shorten that considerably.
One important distinction: PIH is a pigment mark, not a scar. Scars involve changes to the skin’s texture and structure. A flat brown mark left by a healed pimple will fade; an indentation will not. They need different treatment, and they are frequently confused.
What Causes Dark Spots?
UV Exposure
The dominant factor. Ultraviolet radiation stimulates melanocytes to produce more melanin as a protective response, and repeated stimulation over years leads to permanently overactive cells clustered in specific areas.
This is why dark spots appear on sun-exposed sites and why they worsen each summer. It is also why sun protection is not optional aftercare but part of the treatment itself, a point Dr Ritu has made in her commentary on sunscreen and Australian conditions.
Hormonal Fluctuations
Oestrogen and progesterone influence melanocyte activity, which is why melasma commonly appears during pregnancy, after starting oral contraception, and around perimenopause and menopause.
Hormonal pigmentation is also heat-sensitive and visible-light sensitive, not just UV-sensitive, which is why it can worsen in summer even with diligent sunscreen use and why mineral or tinted formulations are often recommended.
Inflammation and Trauma
Any inflammatory process in the skin can trigger excess pigment production during healing. Acne is the most common cause, but eczema, psoriasis, insect bites, waxing, and overly aggressive peels or lasers all produce the same result.
This is the reason picking at acne is worth avoiding, and the reason treatment intensity has to be matched to skin type rather than pushed for speed.
Ageing and Genetics
Cell turnover slows with age, so pigment that would once have been shed within weeks lingers. The distribution of melanocytes also becomes less even over time. This is part of the same broader process of cellular ageing affecting the skin.
Why the Cause Matters More Than the Spot
Treating visible pigment while the trigger remains active produces short-lived results. Melasma treated without sun and heat management returns. PIH treated while the acne continues is replaced by new marks. Sun spots cleared without ongoing photoprotection reappear.
This is the single most common reason people conclude that pigmentation treatment does not work.
Professional Treatments for Dark Spots
Treatment selection depends on diagnosis, pigment type, depth, and your skin tone. Dr Ritu has discussed the clinical approach to pigmentation on ABC 702 Radio.
Topical Treatment
Several ingredients interrupt melanin production at different points. Vitamin C, niacinamide, kojic acid and azelaic acid are available over the counter, and Dr Ritu has covered common mistakes people make with azelaic acid, which is one of the more useful agents for pigmentation alongside inflammatory acne.
Prescription depigmenting agents are also available and are commonly the backbone of melasma management. These are prescription decisions made after examination rather than products to select from a list.
A caution worth stating plainly: unregulated skin lightening products bought online or overseas frequently contain undisclosed mercury or high-strength steroids, and can cause permanent damage including a paradoxical darkening that is extremely difficult to reverse. Dr Ritu has spoken about the dangers of skin whitening products on ABC News.
Laser and Energy-Based Treatment
The absolute best, fastest and most targeted treatment for brown marks is by laser and energy-based devices.
Laser involves targeted light energy absorbed by melanin, breaking pigment into fragments small enough for the body to clear. Picosecond lasers deliver energy in extremely short pulses, which fragments pigment with less heat transferred to surrounding tissue, and our guide to treating pigmentation with picosecond precision explains the mechanism.
Here, at Dr Refresh, we utilise 3 different picosecond wavelengths to treat even the darkest of skin tones. We also have other energy-based devices including broadband light (BBL) to treat pigmentation and redness.
For melasma specifically, settings and expectations differ, since the aim is controlled clearance without provoking rebound pigmentation.
Risks and considerations. Redness, swelling and temporary darkening of treated pigment are expected. Less commonly, treatment can cause blistering, crusting, or paradoxical worsening of pigmentation, and that risk rises in deeper skin tones and where settings are too aggressive. Matching device and settings to skin type is what separates a good outcome from a worse starting point. Multiple sessions are standard, and results build progressively.
Medical-Grade Chemical Peels
These have largely been replaced by lasers, as these are more targeted.
Peels involve controlled application of acids that accelerate turnover of the outer layers, shedding pigmented cells and allowing newer cells to surface. Depth is matched to pigment depth and skin type.
Peels carry their own risks, including irritation, prolonged redness and, in deeper skin tones, post-inflammatory hyperpigmentation, which is the outcome the treatment is meant to address. Aftercare and sun avoidance are not optional.
Frequently Asked Questions
Can dark spots be completely removed?
Many fade substantially, and sun spots and post-inflammatory pigmentation often clear well. Melasma is different: it is managed rather than cured, and it commonly recurs with sun exposure, heat or hormonal change. Individual results vary considerably.
How long does it take to fade dark spots?
Skin turnover takes around 28 days, and pigment sitting deeper takes longer to clear. Visible change from clinical treatment typically develops over three to six sessions spaced weeks apart, with topical treatment measured in months rather than weeks.
Are laser treatments safe for darker skin tones?
Yes, with appropriate device selection and settings. Deeper skin tones carry a higher risk of post-inflammatory hyperpigmentation, so conservative settings and suitable wavelengths matter more, not less. Our guide to picosecond lasers in darker skin tones covers this.
Will my dark spots come back?
Treated pigment does not spontaneously return, but new pigment can form where the trigger remains. Ongoing sun protection is what determines whether results hold.
Find Out Which Type You Have
You deserve to know what is actually causing your pigmentation before spending money on treating it, because the three main types respond to entirely different approaches.
Understanding the difference between sun-driven, hormonal and inflammatory pigmentation is a worthwhile starting point. If you would like that established properly, with examination rather than guesswork. Please make an enquiry online, WhatsApp us at 0493 766 096, or call (02) 8014 6505.
