What are dark spots on your skin? Types, causes and when to worry

What are dark spots on the skin and why do they form?

A dark spot is a lay term for a patch of skin with extra melanin, the pigment that colors skin. It is not one diagnosis, and that is why the topic feels like a pile of look-alikes.

Where they come from depends on the type. Sun exposure is the main driver of sun spots and age spots. Sun, hormones and visible light drive melasma. Inflammation drives the marks that linger after acne.

The American Academy of Dermatology (AAD) says people with medium to dark skin tones tend to get spots when something triggers extra melanin: a pimple or psoriasis patch clearing, a healed wound, certain medications, an irritating skin or hair product, or hormonal change such as pregnancy.

For more on the whole category, see our dark spots hub.

What do dark spots look like on the face?

It depends on which one you have, and shade alone won't settle it. This table is a starting sort, not a way to diagnose yourself.

Are dark spots and age spots the same?

Not exactly, but one common type goes by many names. Cleveland Clinic lists liver spots, age spots, sun spots and solar lentigines as labels for the same lesion. It has nothing to do with your liver.

These are tan to dark brown patches that show up where UV hits most. Harvard Health says they are most common in people over 55. They are harmless, and treating them is cosmetic.

Options include hydroquinone, corticosteroid or retinoid creams, peels, cryotherapy and lasers. We found no trial-grade evidence in our research that over-the-counter creams fade age spots, so the guidance here is expert opinion, not proof.

Are dark spots and melasma the same thing?

No. Melasma is its own condition: flat, symmetrical patches, usually on both sides of the face, that are not painful or itchy. AAD says it is not a sign of skin cancer.

It is most common in women and in medium to dark skin tones, and it often starts in pregnancy or with birth control pills. It tends to worsen in summer and fade in winter. It can clear after pregnancy or after a trigger stops, or it can last for years. It is not curable and often comes back.

Sun protection is the baseline. AAD recommends broad-spectrum SPF 30 or higher, a hat and shade, and suggests sunscreen with zinc oxide, titanium dioxide or iron oxide. One small randomized trial of 68 people, all also using 4% hydroquinone, found iron oxide sunscreen improved scores more than sunscreen without it. Treat that as moderate-to-low evidence.

AAD also says to limit non-prescription melasma treatments to 3 to 6 months, then see a dermatologist. Some treatments can irritate darker skin and worsen the pigment.

Are dark spots acne scars?

Usually not in the strict sense. Flat brown marks after a pimple are post-inflammatory hyperpigmentation (PIH), which is pigment only. True scars change skin texture, like pits.

That distinction is our synthesis, but a review of acne scarring supports it by treating redness, pigment and scarring as separate outcomes of acne inflammation. Red or pink marks tend to persist in fair skin, while brown PIH is more typical in dark skin.

Timing helps. AAD says a spot a few shades darker than your skin usually fades in 6 to 12 months, while pigment deep in the skin can take years.

A systematic review of 48 studies in 1,356 people with skin of color found 89% of cases followed an inflammatory condition and 83% were on the face. It calls PIH chronic and hard to treat. Partial improvement occurred in 85% of those using topical retinoids and 66% of those having laser, though the studies varied a lot, so treat those numbers as rough.

One catch: retinoids used for acne can cause irritant dermatitis, which can itself cause PIH.

Are dark spots on the skin a problem?

Medically, usually not. Age spots are not harmful, melasma does not typically harm your health, and PIH is harmless but can be chronic and distressing.

The practical risks sit elsewhere: mistaking a cancer for a benign spot, and irritating darker skin with aggressive treatment that leaves more pigment behind.

When should you worry about dark spots on your face, and which need a dermatologist?

Worry less about darkness and more about change, irregularity and not knowing what it is. Flat facial lesions are hard to judge by eye, even for clinicians. A review of lentigo maligna calls diagnosis challenging and names biopsy as the gold standard.

In a dermoscopy study, specialists compared 42 lentigo maligna, 107 pigmented actinic keratosis and 16 solar lentigo lesions and found they shared many features. In a series of 240 flat pigmented facial lesions, 24 (10%) were lentigo maligna. That came from a specialist clinic, so it is not a general-population rate. We found no figure for how often an everyday dark spot is skin cancer.

DermNet describes the ABCDE checklist for early melanoma: asymmetry, border irregularity, color variability or change, diameter, and evolving. A spot unlike your others, the so-called ugly duckling, is suspicious even if it passes the checklist.

On dark skin, melanoma can look like only a somewhat darker spot and may not stand out, so the change-and-contrast rules matter more than color.

• A spot that changes, or has irregular color or borders.
• A spot that looks different from your others.
• Any flat brown or gray patch you can't confidently name.
• A new patch on one side only, since melasma is typically bilateral (our inference).
• A 'melasma' that doesn't respond to treatment (our inference).

Get the answer before you buy a fade cream. AAD notes that dermatologists can tell a true age spot from seborrheic keratoses, actinic keratoses or skin cancer, and that fading a skin cancer with a cream can give it time to grow and possibly spread.