Treating stubborn dark spots: What actually helps

Common causes of facial hyperpigmentation include melasma, post-inflammatory hyperpigmentation (PIH), tinea pigmentosa, pityriasis versicolor, and seborrheic pigmentation. Management begins with recognizing biological differences in skin color that influence treatment response, with photoprotection as the foundation—sunscreens of SPF 30 or higher are essential. First-line topicals include retinoids and 4% hydroquinone, sometimes combined with mild steroids, though hydroquinone can cause irritation and rarely ochronosis. Retinoids such as tretinoin, adapalene, and tazarotene remain important but may lead to dryness or retinoid dermatitis. Newer options include azelaic acid, tranexamic acid, kojic acid, and cysteamine. Chemical peels like glycolic or salicylic acid are reserved for persistent pigmentation but may cause PIH. For device-based treatments, low-fluence Q-switched lasers or picosecond lasers are preferred due to better safety profiles.