In this article:
What causes skin discolourations?
Different types of skin discolourations
Uneven skin tone
Dark spots
White spots
Freckles
Post-inflammatory hyperpigmentation (PIH)
Does hyperpigmentation look different on darker skin tones than lighter skin?
What causes skin discolourations?
Skin discolourations are something everyone will experience at some point, particularly if you have a medium to dark skin tone (1). Almost all discolourations occur from two sources: unprotected exposure to daylight or injuries to skin that trigger excess melanin (skin pigment) production (2, 3). The following is our research-supported guide explaining the different types of discolourations, complete with tips on how you can get rid of dark spots—or at least minimize their appearance.
Different types of skin discolourations
There are two primary types of discolouration: hyperpigmentation and hypopigmentation. Hyperpigmentation involves the overproduction and uneven distribution of melanin, the pigment that gives skin its colour. Excess melanin leads to spots and patches that are darker than the surrounding skin. Hyperpigmentation can occur anywhere but is most common in areas routinely exposed to UV light (4).
Hypopigmentation refers to a partial or total loss of pigment. It’s primarily due to cumulative sun damage, skin injury, and the skin disorder vitiligo (5). The latter requires dermatologic attention— no skin care product can stop its progression; however, some find that use of self-tanner helps make their skin colour look more even. And it’s worth mentioning that daily use of sunscreen is essential to protect this extra-vulnerable skin.
Some people wonder if skin discolourations go away on their own. Except for post-inflammatory hyperpigmentation, discolourations don’t fade or disappear completely without the help of key skin care products and, in some cases, the in-office treatments a dermatologist provides.
Skin discolouration treatments cover a wide range of topical ingredients, including some that are available by prescription. Following a daily skin care routine, including use of a broad-spectrum sunscreen and a leave-on exfoliant, can make a big difference for many types of discolouration. The trick is patience and consistency. Easier said than done, but most people will find the results worth the wait.
Uneven skin tone
What does uneven skin tone look like: Facial and neck skin have areas of slightly different colour, sometimes sallow or gray, with or without clusters of dark spots. Skin may look dull in areas, normal in others, and its texture may also be uneven.
What causes uneven skin tone: Photoageing, also known as sun damage (6). It’s a cumulative process, which is why uneven skin tone often first shows up in early adulthood and progresses as we age.
How can I visibly improve uneven skin tone: A leave-on AHA exfoliant or BHA exfoliant will shed the buildup of dead surface cells that contribute to dullness, and a niacinamide or vitamin C treatment used once or twice daily can make a significant improvement in a few months (7, 8). Choose niacinamide if you also have enlarged pores and rough texture. Choose vitamin C if you also have wrinkles and loss of firmness. Ascorbic acid (pure vitamin C) is the most researched form, but there are other forms too, often combined in one formula (23). If you have uneven tone on your body, a body treatment with a 5% concentration of niacinamide can help fight dullness and discolourations stemming from sun damage, ageing, or shaving.
Dark spots
What do dark spots look like: Also known as age spots, sunspots, brown spots, and liver spots, these are smaller, concentrated discolourations that show up most often on the high points of the face, hands, and arms—all areas routinely exposed to UV light. Dark spots tend to be flat and smooth. They can have an uneven border and tend to darken further with ongoing unprotected UV exposure.
Important note: Any dark spots that have an irregular border, are wider than the tip of a pencil eraser, show two or more colours, or that scab and bleed should be examined by a dermatologist. All of these can be signs of skin cancer requiring prompt medical attention.
What causes dark spots: Sun exposure is the primary culprit, but they can also be triggered by indoor tanning (9). Dark spots can also be triggered by injury to skin, which we discuss below in the section on post-inflammatory hyperpigmentation.
How can I visibly improve dark spots: Research has firmly established that most people struggling with stubborn dark spots will need to use multiple products (or ingredients) to see a significant difference (10). Fading dark spots takes time, often up to 12 weeks of twice-daily usage of topical products. Daily sun protection is a must. If you’re not willing to commit to applying a broad-spectrum sunscreen, don’t bother treating dark spots (it’s akin to putting on a raincoat when you’re already soaked).
Why are multiple ingredients necessary? It’s because the process of dark spot formation has many pathways within skin. Different topical ingredients target specific pathways in this process, each making a difference in how skin looks over time. Sunscreen is an instant way to dramatically reduce the melanin-stimulating effect exposure to UV light has, which is why it’s non-negotiable if you truly want to fade existing (and help reduce the chance you’ll see new) discolourations.
The ingredients with the most research supporting their efficacy at various concentrations for fading the appearance of dark spots and larger areas of patchy discolourations include (10):
- Hydroquinone (available by prescription)
- Retinol and prescription retinoids
- Vitamin C (ascorbic acid) and derivatives
- Niacinamide
- Licorice root and derivatives
- Azelaic acid
- Tranexamic acid (topical and oral)
- Cysteamine
Note: All these ingredients work well together. You don’t need products that contain each of these, but it can help to use at least two or select a single product that contains several of these ingredients.
White spots
Also known as hypopigmentation and medically as idiopathic guttate hypomelanosis, these spots involve partial or total loss of melanin.
What do white spots look like: Small spots showing a noticeable loss or lightening of pigment. These will be less apparent the lighter one’s skin is and more apparent on darker skin.
What causes white spots: Sun exposure (are you seeing a pattern here?) is the most common cause. Whereas sun-induced dark spots occur from the overproduction of melanin, white spots indicate areas where skin has stopped making melanin or can no longer make the normal amount. Once the melanin-making cells deeper in the skin are destroyed, the white spot becomes permanent.
White spots on skin can have other causes that require evaluation by a dermatologist. These include exposure to harmful chemicals, yeast infections, autoimmune disorders, and nutritional deficiencies involving vitamin B12, copper, and iron (11).
How can I visibly reduce white spots: No treatments exist for this concern. Your best option is committing to daily use of sunscreen and sun-protective clothing to prevent the occurrence of more spots and to keep the spots you see now from enlarging. Some may find the use of a self-tanner creates a more even look with the surrounding skin.
Freckles
What do freckles look like: A smattering of small to medium-sized spots typically dotting the high points of the face (bridge of nose, tops of cheeks) but they can occur anywhere unprotected skin is exposed to the sun. Freckles can range in colour: people with light skin tones tend to have reddish-tan to light brown freckling, those with more melanin tend to see dark brown to black freckling.
What causes freckles: Freckles are typically triggered by unprotected exposure to UV light. They are skin’s effort to protect itself from sun damage but can also indicate an uneven or low amount of melanin. This explains why freckles are more common on those with very light to medium skin tones, although people with darker skin tones can get freckles, too. Research has shown there is a genetic component to freckles, but UV light exposure is still part of the process of causing freckles to appear.
How to visibly improve freckles: Unlike more pronounced dark spots, most people feel OK about their freckles, so they often don’t seek treatment. Many find a sprinkling of freckles an attractive trait, but some people find them distressing. Along with diligent use of sunscreen (and if you have very light, highly freckled skin, sun avoidance), the same ingredients mentioned above for treating dark spots will also help fade freckles. Most people find a leave-on vitamin C treatment coupled with an antioxidant-rich sunscreen does the trick.
Post-inflammatory hyperpigmentation (PIH)
What does PIH look like: Those with very light to light skin colour will see pink to red marks where some type of skin disruption, like a blemish, has occurred. Those with medium or darker skin tones will see a light tan to brown or black mark, so these can be confused with hyperpigmentation caused by sun exposure.
What causes PIH: blemishes, burns, picking at the skin, laser treatments, really any type of skin trauma, which explains why this type of hyperpigmentation is so common! It tends to fade on its own, but it can take over a year for this to occur (13).
How can I visibly fade PIH: Since this type of hyperpigmentation tends to reside in skin’s uppermost layers, you can speed their fading with routine use of a leave-on exfoliant containing glycolic and/or salicylic acid. Daily sunscreen use is important, especially for darker skin tones since PIH involves excess melanin. Other options to fade PIH include the same list mentioned above for dark spots, with special emphasis on tranexamic acid and azelaic acid (21, 22). Anything you do to soothe and calm skin will also help. This can be as simple as avoiding common sources of skin irritation such as fragrance and harsh scrubs (14, 15).
Melasma
What does melasma look like: Brown to brownish-gray patches on skin, often on the perimeter of the face and extending down both sides of the neck. Melasma may also be seen around the nose and mouth. There’s a clear line of demarcation where the discoloured areas meet skin’s natural colour. Freckling or diffuse clusters of dark spots may be seen within the larger area of discolouration.
What causes melasma: the causes are complex and multi-factorial, but typically related to long-term sun damage from tanning, genetics, pregnancy, birth control pills, or hormonal fluctuations. Melasma can be very difficult to fade since it’s so tenacious and has so many triggers. Frustratingly, it tends to recur due to sun exposure or any source of skin irritation, one more reason to always keep skin protected and treat it as gently as possible (16).
How can I visibly improve melasma: Pack your patience! Melasma is stubborn and demands strict adherence to sun protection measures. Sunscreen is essential, but so are hats, sunglasses, sun-protective clothing, and avoiding extended periods of time in direct sunlight. The infrared (heat) energy the sun emits is a hidden trigger of melasma as are other sources of heat, such as a hot stove (17).
Combination therapy is necessary to give you the best chance for satisfying results. That means using topical over-the-counter and, possibly, prescription treatments (often hydroquinone or a hydroquinone-retinoid blend) with the OTC options including a product with tranexamic acid, higher concentrations of ascorbic acid (Vitamin C), retinol with bakuchiol, a blend of hexylresorcinol, retinoid + niacinamide, and azelaic acid. All are intriguing ingredients to further improve signs of discolouration (16). You can begin with the over-the-counter options, used at least once daily for 12 weeks, and evaluate results before determining if prescription options are needed.
It’s a good idea to consult your dermatologist about having a series of laser treatments for melasma. Since melanin is responsive to a wide range of laser frequencies, no single laser is deemed best for this concern; instead, research has shown positive results from different types. Research has also indicated such treatments should be done alongside skin care options and daily sun protection (18).
Another point to keep in mind: blue light exposure can trigger or worsen melasma (19). The biggest culprit is the blue light emitted by digital devices. Holding that smart phone close to your face multiple times per day risks hyperpigmentation unless you set your display to night mode (the name varies depending on your phone model), a step that disables blue light in favour of harmless yellow light. You can do this on your tablets, laptops, and desktop displays, too! This is more concerning for those with darker skin tones, since they literally have more melanin for the blue light to “excite”. The melanin “senses” the blue light and reacts by speeding up processes that create excess melanin, leading to hyperpigmentation (19).
Does hyperpigmentation look different on darker skin tones than lighter skin?
Hyperpigmentation will present differently depending on a person’s skin colour. Those with a darker complexion have more melanosomes, the specialized cells that make and store melanin. The more melanin-rich the skin, the more likely it is to experience hyperpigmentation (20).
The flipside is that those with lighter skin tones (less melanin) are generally more prone to hyperpigmentation related to unprotected sun exposure. The extra melanin in people of colour offers some built-in environmental protection—melanin is an antioxidant—that explains why darker skin tends to show signs of ageing later in life than those with light skin. Although that’s a plus, it doesn’t mean people with melanin-rich skin can skip the sunscreen (20).
References for this information:
1. Indian Journal of Dermatology, September-October 2016, pages 487–4952. Journal of the European Academy of Dermatology and Venerology, September 2017, pages 17–21
3. American Journal of Clinical Dermatology, August 2018, pages 489–503
4. Annals of Dermatology, June 2016, pages 279–289
5. Journal of the American Academy of Dermatology, May 2019, pages 1,233–1,250
6. Pigment Cell Melanoma Research, November 2016, pages 607–618
7. Journal of Cutaneous and Aesthetic Surgery, January–March 2013, pages 4–11
8. Journal of Oral and Maxillofacial Pathology, May–August 2020, pages 374–382
9. The Journal of Clinical and Aesthetic Dermatology, February 2015, pages 43–47
10. Journal of Drugs in Dermatology, Volume 18, Issue 8, August 2019, ePublication
11. Madireddy S, Crane JS. Hypopigmented Macules, Updated October 2020. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2021
12. Forensic Science International, Genetics, September 2019, pages 252–259
13. Journal of Drugs in Dermatology, Volume 19, Issue 8, July 2020, ePublication
14. Indian Journal of Dermatology, January-February 2020, pages 5–10
15. Journal of Cutaneous Medicine and Surgery, January-February 2021, pages 77–86
16. Dermatology Online Journal, Volume 25, Issue 10, October 2019, pages 1–6
17. Anais Brasileiros de Dermatologia, September-October 2014, pages 771–782
18. The Journal of Dermatological Treatment, February 2020, pages 77–83
19. Journal of Investigative Dermatology, January 2018, pages 171–178
20. International Journal of Molecular Sciences, September 2018, pages 1–44
21. Journal of Drugs in Dermatology, March 2021, pages 344–345
22. Cutis, February 2006, Supplement 2, pages 22–24
23. International Journal of Cosmetic Science, October 2021, pages 495–509