Types of hyperpigmentation
Sun spots
Flat brown spots on the face, hands or forearms after years of sun. Unlike freckles, they do not fade in winter. A doctor checks each spot before treatment.
Marks after acne or eczema
Dark marks left after inflammation or injury. More common and longer-lasting on brown and black skin; treating the cause helps prevent new marks.
Melasma
Blotchy brown or grey-brown patches on both sides of the face, linked to sunlight and hormones. It can improve with treatment but often returns.
Freckles
Small brown spots that often run in families. They darken in summer and fade in winter; sunscreen helps reduce darkening.
What causes dark spots?
Sunlight stimulates extra pigment. Skin inflammation, injury and hormonal changes can also cause darker patches. Gentle skin care, daily sun protection and treatment for underlying acne or eczema help prevent new marks.
Management and treatment
Most plans combine daily sunscreen with treatment applied to the dark areas; for some people a tablet is added. Improvement is gradual: allow 8–12 weeks for most creams, and longer for tretinoin.
Daily sunscreen and gentle skin care
- Use broad-spectrum SPF 30 or more with a 4- or 5-star UVA rating every day. For melasma, tinted sunscreen with iron oxides also protects against visible light.
- Apply about a teaspoon to the face and neck and reapply every 2 hours outdoors. Make-up SPF is not enough on its own.
- Wear a hat, seek shade between 11am and 3pm, avoid sunbeds and irritating skin products.
Doctor-reviewed treatment
Treatment options
Hydroquinone 4% cream
Reduces pigment production in sun spots and dark patches. Apply only to affected areas as directed, for courses of up to 3 months. Mild redness or irritation can occur.
Hydroquinone 4% + tretinoin 0.1% + hydrocortisone 1% cream
Combines pigment reduction, skin renewal and control of irritation. Apply a thin layer once daily to dark areas for up to 3 months. Redness and peeling can occur.
Tretinoin cream
Encourages skin renewal and helps sun spots, acne and the marks acne leaves behind. Apply at night; sun spots may need 6 months or more. Dryness, peeling and sun sensitivity can occur.
Azelaic acid 20% cream
Treats acne, inflammation and dark marks. Start once daily and build up to twice daily by week 4 as advised, for up to 12 weeks. Mild stinging or itching may occur initially.
Tranexamic acid tablets
A tablet that can help stubborn melasma when creams alone are not enough. Your doctor checks your clotting history, medicines and other risk factors first, and reviews you regularly while you take it.
Your doctor chooses the treatment, strength and application plan to suit your skin. Do not increase the amount or extend a course yourself.
Other options
Vitamin C, niacinamide, kojic acid and cysteamine products may help, but evidence is more limited. Cryotherapy, laser, intense pulsed light and chemical peels can fade some spots, but may leave lighter or darker patches, especially on brown and black skin; an experienced practitioner should assess suitability.
Using treatment safely
- Patch test hydroquinone on a small area for 24 hours. Keep it away from eyes and mouth, do not combine it with benzoyl peroxide, and limit courses to 3 months.
- If azelaic acid irritation has not settled by week 4, contact your doctor. Irritation can worsen dark marks, particularly on brown and black skin.
- Avoid tretinoin during pregnancy or while planning pregnancy. Tell your doctor about all medicines, allergies and skin products before treatment.
- Tell your doctor if you have ever had a blood clot in a leg, lung or eye, if you or a close relative has a clotting disorder, or if you use oestrogen-containing contraception, as tranexamic acid tablets may not be suitable. Report leg swelling or pain, chest pain, breathlessness or sudden vision changes straight away.
Your online skin pigmentation assessment
- 1
Tell us about your skin
Share when the spots appeared, triggers, previous treatments, medicines, allergies and pregnancy plans.
- 2
Upload clear photos
Photos are required: a close-up of each spot or patch and one of the whole area in good light.
- 3
Doctor reviews your case
Technology helps organise your answers; a doctor checks your photos and makes every assessment and prescription decision.
- 4
Get your personalised plan
Discuss treatment in live doctor chat, with a prescription if clinically appropriate.
Complete care. One simple price.
£24.99
Includes clinician review, live doctor chat & prescription
One payment. No subscription. Any prescription depends on clinical suitability.
Start skin pigmentation assessmentYour plan and follow-up
- Keep using sunscreen during and after treatment to help maintain results.
- Share updated photos at your doctor’s advised review. Contact them sooner if irritation is troublesome.
- Repeat treatment is doctor-reviewed, never automatic. Hydroquinone courses last no longer than 3 months.
Frequently asked questions
Can I get hyperpigmentation treatment online in the UK and EU?
Yes. A doctor reviews your skin and health information and photos, then recommends a personalised plan with a prescription if appropriate. Online treatment is not available during pregnancy or breastfeeding.
What’s the difference between melasma, sun spots and acne marks?
Melasma causes blotchy facial patches linked to sunlight and hormones. Sun spots are separate brown spots after years of sun. Marks after acne or eczema appear where the skin was inflamed.
Can I get hydroquinone cream on prescription?
A doctor can prescribe hydroquinone 4% cream, alone or combined with tretinoin and hydrocortisone, if suitable. Apply it only to dark patches for courses of up to 3 months.
Do tranexamic acid tablets treat melasma?
Tranexamic acid tablets can help stubborn melasma when creams alone are not enough. A doctor checks your clotting history, medicines and other risk factors before prescribing them, and reviews you regularly while you take them.
How are sun spots treated?
Daily sunscreen helps prevent new sun spots. Tretinoin or hydroquinone may help existing spots fade. Procedures are other options, but a doctor should check each spot before treatment because some skin cancers look similar.
What sunscreen should I use for dark spots?
Use broad-spectrum SPF 30 or more with a 4- or 5-star UVA rating daily, and reapply every 2 hours outdoors. For melasma, tinted sunscreen with iron oxides also protects against visible light.
How long do dark spots take to fade?
Allow 8–12 weeks to judge hydroquinone or azelaic acid, and 6 months or more for tretinoin. Marks after acne may take months or years; treating acne helps prevent new marks.
When should I worry about a dark spot?
Call NHS 111 about a new or changing spot, especially one with an uneven shape or border, several colours, a size over 6 mm, or bleeding, itching or crusting. A spot that has not healed after 4 weeks also needs urgent advice.
Can I use treatment while planning a pregnancy?
Tell your doctor before starting treatment if you are planning a pregnancy. Some creams, including tretinoin, should not be used. Our online hyperpigmentation treatment is not suitable during pregnancy or breastfeeding.
Related conditions
Get urgent help if…
New or changing spot — call NHS 111
Check ABCDE: Asymmetry (different halves), Border (uneven edge), Colour (several colours or a change), Diameter or different (over 6 mm or unlike other spots), Evolving (changing size, shape, colour or height). Smaller spots can still need checking.
Bleeding, crusting or a non-healing spot
Call NHS 111 if a spot bleeds, itches, crusts, is sore or has not healed after 4 weeks.
New widespread darkening with other symptoms
Call NHS 111 about new darkening in several places, including creases, scars or gums, with tiredness, unexplained weight loss or dizziness.
Do not wait for an online reply. ChatDoc is not an emergency service.
General medical information, not a substitute for individual medical advice.