Dark spots on the face come in three distinct patterns, and treating them without knowing which you have is a lot of wasted product.
1. Solar lentigines ("age spots"). Discrete, small, brown-to-dark-brown spots that appear on chronically sun-exposed areas — cheekbones, forehead, backs of hands. Driven by cumulative UV exposure activating melanocytes. Not hormonal; not inflammation-driven. Treatments with evidence: broad-band light or Q-switched lasers, prescription hydroquinone, tranexamic acid, and above all daily broad-spectrum sunscreen to prevent new ones.
2. Melasma. Larger, symmetric, patchy hyperpigmentation typically on the forehead, cheeks, upper lip, and jawline. Strongly hormonal — often appears during pregnancy or on hormonal contraception — and sun is a major trigger. Common in women 25-50 with darker skin tones. Notoriously difficult, requires long-term management. Sun protection is the foundation; other treatments (tranexamic acid, azelaic acid, hydroquinone under medical supervision) work slowly.
3. Post-inflammatory hyperpigmentation (PIH). Discoloration that lingers after acne, cuts, or bug bites. Melanin overproduces at the site of inflammation. Fades slowly with time — much faster with retinoids, vitamin C, azelaic acid, and consistent sunscreen.
The through-line: sun protection is the foundation of every treatment plan. And for melasma and PIH, addressing underlying inflammation and hormonal drivers helps meaningfully. Blood work that measures hs-CRP and estradiol gives you the biological picture.