Hyperpigmentation (Dark Spots and Melasma)
Hyperpigmentation means patches of skin darker than the skin around them. On dark skin the commonest causes are marks left by acne, eczema, insect bites or injury (post-inflammatory hyperpigmentation); melasma, symmetrical patches on the cheeks, forehead and upper lip triggered by sun and hormones, including pregnancy and the pill; and darkening caused by bleaching creams themselves. Most hyperpigmentation can be improved, slowly and safely, with sun protection and the right prescribed treatment.
Find a Dermatology SpecialistSee a dermatologist by video on ClearSkinMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Symptoms
- Dark brown or grey-brown patches on the face, often the cheeks, forehead and upper lip (melasma)
- Dark marks where spots, rashes or injuries have healed
- Uneven skin tone
- Darkening of the knuckles, neck or skin folds
- Blue-black darkening after long use of bleaching creams (exogenous ochronosis)
When to See a Doctor
See a dermatologist if dark patches are spreading, not improving with sunscreen, or affecting your confidence, and before using any lightening product. See a doctor promptly for a dark spot that is new, growing, changing shape or colour, bleeding or itching, or for dark velvety skin on the neck and armpits, which can be a sign of insulin resistance.
Treatment options
- Daily broad-spectrum sunscreen, including on cloudy days and indoors near windows
- Treating the underlying cause, such as acne or eczema
- Prescription creams: azelaic acid, retinoids, and short supervised courses of hydroquinone
- Combination creams for melasma, prescribed and monitored
- Chemical peels by a specialist experienced with dark skin
- Careful laser treatment in selected cases
Common Questions
Are bleaching creams safe for dark spots?
No. Many creams sold in Nigerian markets contain mercury, strong steroids or high-strength hydroquinone. They can thin the skin, cause stretch marks, acne and infections, damage the kidneys, and cause permanent blue-black darkening. A dermatologist can treat dark spots safely.
How long do dark spots take to fade?
Usually two to six months with consistent treatment and sun protection, and sometimes longer for melasma. Stopping sunscreen can bring them back quickly.
Can melasma be cured?
Melasma can be controlled and often greatly lightened, but it tends to return with sun exposure or hormonal changes. Long-term sun protection and maintenance treatment keep it under control.
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