Why do we get dark spots on our skin?

These are the spots most people think of as "age spots", although they are really sun spots: round or oval lesions, uniformly brown and with well-defined edges, in the areas that have received radiation over the years.

Solar lentigo starts to show from your thirties or forties, more often in fair skin types. Senile lentigo appears later and tends to be more numerous. Neither goes away on its own, and they are the spots that respond best to treatments that act on localized pigment.

Their presence indicates cumulative sun damage, and that has an implication that goes beyond appearance: anyone with many lentigines has had a lot of sun and needs regular dermatological check-ups.

Melasma (and chloasma in pregnancy)

Melasma appears as grayish-brown patches with irregular edges and a characteristically symmetrical distribution: forehead, upper lip, cheeks and chin. When it appears during pregnancy it is called chloasma.

It mainly affects women of reproductive age and is more common in medium and darker skin types; roughly one in ten cases occurs in men. The hormonal component is decisive, but sun exposure is the essential trigger: without sun, melasma does not show.

It is a chronic, recurring condition, and it is worth saying so clearly: it can be controlled and faded until it is barely noticeable, but the tendency to pigment remains for years. Any approach that promises to remove it for good is promising something it cannot deliver.

Three factors make existing melasma worse: sun exposure, heat (waxing, heat-based devices, saunas) and skin irritation. That is why, in skin with melasma, gentle and sustained care works better than intense procedures.

Melasma on the hands, arms and décolletage

Although melasma affects the face in most cases, there is an extrafacial form that appears on the backs of the hands, the forearms, the upper trunk and the décolletage. It is seen more often in perimenopausal women and in areas that get sun every day without us realizing it: hands on the steering wheel, forearms in short sleeves.

How to tell it apart from a lentigo in the same area. Extrafacial melasma forms diffuse patches that are more or less symmetrical on both sides of the body; a lentigo is an isolated, rounded lesion with a sharp edge. They can coexist on the same hand, and the approach is not the same: lentigo responds well to treatments that act on localized pigment, whereas melasma can get worse with any procedure that generates heat.

That is why the initial consultation matters as much as the treatment.

Ephelides or freckles

Freckles are small, light-colored spots with poorly defined edges on the nose, cheeks, shoulders and arms. They are genetic in origin and typical of fair skin types. Unlike the rest, they darken with the sun and fade in winter without any need for treatment.

They do not require any intervention, but they do point to skin with little natural protection against ultraviolet radiation and, therefore, a greater need for daily sun protection.

Post-inflammatory hyperpigmentation: acne marks

These are brown or purplish marks left exactly where there was a previous lesion, and they reproduce its shape. They can appear anywhere on the body, not only in sun-exposed areas.

It is the most common type of mark after acne and especially affects darker skin types. The good news is that it tends to disappear on its own, although the process can take anywhere from several months to a couple of years. The bad news is that anyone who has had it once is more prone to getting it again.

The approach here is different: the priority is to control the inflammation that causes it (treating the acne, not picking at the lesions) and to protect the area from the sun, because radiation fixes the pigment and prolongs the process. Aggressive procedures are contraindicated: they can generate more inflammation and, with it, more marks.

Periocular darkening

The darker coloring under the lower eyelid is often not a melanin spot. It is attributed mainly to a vascular component: an increase in the number and caliber of the blood vessels beneath the thinnest skin on the body. Genetics, skin type and the loss of fat volume in the area also play a part.

This explains why depigmenting products give only partial results here: if the problem is not pigment, acting on pigment does not solve it. You can read about the specific approach on our dark circles treatment page.

White spots and red spots: when it is not melanin

• White spots involve a loss or absence of pigment. The most common causes are vitiligo, pityriasis versicolor (fungal in origin), pityriasis alba and guttate hypomelanosis, those small dot-like spots associated with cumulative sun damage. None of them are treated with depigmenting products, and several require a medical diagnosis.
• Red spots are due to an excess of hemoglobin or a vascular alteration: rosacea, couperose, angiomas, temporary inflammatory reactions. Here the aim is not to reduce pigment.

Mistaking one for the other is one of the most common errors, and in the case of white spots it can delay a diagnosis that matters

The vast majority of spots are benign and only affect the appearance of the skin. But melanoma, one of the most aggressive skin cancers, usually starts as a dark spot that grows progressively, and detecting it early completely changes the prognosis.

Dermatological societies recommend checking spots using the ABCDE rule:

• A Asymmetry. If you divide the spot in half, the two parts do not match.
• B Borders. Irregular, jagged or poorly defined.
• C Color. Several shades in the same lesion: brown, black, red, white or bluish.
• D Diameter. Larger than 6 millimeters, or one that has grown in size.
• E Evolution. It changes in shape, color, elevation or texture over time.

Other signs that warrant a consultation:

• The spot bleeds, oozes or ulcerates.
• It itches or hurts persistently.
• It is visibly different from all the other spots on your skin, which is known as the ugly duckling sign.
• A rough lesion appears that does not heal within weeks.
• It changes in appearance during pregnancy or when you start a hormonal treatment.
• A new spot appears under a nail, or on a palm or sole.

Where our role ends

Instituto de Benito is not a dermatology center and we do not diagnose skin lesions. Our work in the Wellness area is professional skincare: improving the skin's quality, its radiance and the evenness of its tone.

That means two things. First, that if your spot meets any of the criteria above, your first visit is to a dermatologist, not to an aesthetic center; and that if you come to us, that is what we will recommend. Second, that we do not start any treatment on a spot that needs to be medically assessed first.

When the spot is the predictable result of the sun, age or a hormonal change and raises no doubts, that is where we can help your skin look more even and radiant.

When the problem is an uneven tone, skin dulled by cumulative sun or diffuse spots that raise no doubts, the work is not about attacking the spot but about improving the overall quality of the skin. It is a slower, more sustainable approach, and in skin that tends to pigment it usually gives better results than intense procedures, which can have the opposite effect.

It rests on three pillars: in-clinic treatment, your routine at home and seasonal consistency.

Mesoestetic Age Element Brightening

This is the facial treatment we use in these cases. It works on skin quality by combining specific active ingredients with professional in-clinic application, and it is indicated when the goal is radiance, an even tone and improving the appearance of skin with signs of photoaging.

What it offers:

• It restores the face's natural glow in dull skin.
• It improves the evenness of skin tone.
• It acts on texture and hydration, not just on color.
• It improves the appearance of sun-damaged skin.
• It is an option for anyone who wants to improve their skin without resorting to aggressive techniques.

What you should be clear about. It is not a medical depigmenting treatment, and it does not remove a defined lentigo or resolve established melasma. Its territory is improving the quality and evenness of the skin, and maintaining the result over time. If what you have is a localized, pronounced spot, the honest thing is to tell you that the right approach is a different one, and that is what we will tell you at the consultation.

Results are gradual and are planned as a protocol, not a single session. You can see the details on the brightening anti-dark-spot facial treatment page.

Your routine at home: where the result is won or lost

No in-clinic treatment can sustain a result if your daily routine does not support it. In skin that tends to pigment, the routine carries more weight than the treatment:

• Daily sun protection, all year round. It is the most effective measure and the one most often neglected. We come back to it in the next section.
• An active ingredient that acts on pigmentation. Vitamin C, niacinamide and azelaic acid are the ones most commonly used in cosmetics, and they are well tolerated over the long term.
• Gentle, consistent renewal, rather than occasional aggressive exfoliation.

At the consultation we define which routine fits your skin and your real level of consistency, a factor worth taking into account from the start.

Facial hygiene and maintenance in fall and winter

Spots become visible at the end of summer, but the season for working on them is fall and winter, when radiation is lower and the skin tolerates renewal better.

That is the time to schedule a series of sessions and establish the routine that will sustain the result in spring. A deep facial hygiene treatment beforehand improves the penetration of active ingredients, and for skin that is also looking for a plumper, more radiant finish, the protocol can be combined with The Glossy.

Working on spots in July, on the other hand, makes little sense: the sun undoes in two weeks what is achieved in a month.

When wellness is not enough

There are three situations in which professional skincare is not the answer, and we say so at the consultation:

• Defined, pronounced lentigines. The pigment is concentrated and responds better to medical treatments that act on it directly.
• Established melasma. It requires an ongoing medical plan, and the usual approach involves a depigmenting peel under medical supervision.
• Any lesion with warning signs. Dermatology, and before anything else.

How to prevent dark spots from appearing

Sun protection

It is the most effective measure, by far. For it to really work:

• Use a sunscreen that covers UVB, UVA and visible light, the last of which is especially relevant if you have melasma.
• Apply it daily, all year round. Cumulative damage happens on everyday journeys, not just at the beach.
• Reapply every two hours when outdoors, and apply enough: using too little is the most common mistake.
• Add a hat and sunglasses.
• Do not forget the backs of your hands, your décolletage and your ears, three areas that get far less protection than the face.

What to avoid

• Heat on areas with melasma: waxing, heat-based devices, prolonged saunas.
• Picking at pimples and lesions. It is the direct cause of a good share of acne marks.
• Perfumes and essential oils before sun exposure.
• Aggressive treatments without a prior consultation, including high-concentration at-home peels and home-use light devices.
• Skin-whitening formulas. They do not treat hyperpigmentation: they alter the pigment of the whole skin, and some contain substances banned because of their toxicity.