Why do I have dark patches on my face?
Most facial pigmentation falls into one of three categories: melasma, post-inflammatory hyperpigmentation, or sun damage. They can look almost identical in the mirror. They respond to completely different approaches, and they heal on timelines that differ by years.
This matters more than it sounds. Treating melasma as though it were acne marks wastes months. Treating acne marks as though they were melasma leads people to spend heavily on products they did not need. And treating any of them without addressing sun exposure guarantees they come back.
Pigmentation is the single most common skin concern we see in Pakistani clients, driven by a genuinely difficult combination: intense year-round UV, high rates of acne worsened by heat and pollution, and skin tones that are more prone to pigmenting after any inflammation.
What does melasma look like?
Melasma appears as symmetrical brown or grey-brown patches, usually across the cheeks, forehead, upper lip and bridge of the nose. The defining feature is symmetry — it tends to appear in a mirrored pattern on both sides of the face.
The edges are typically diffuse rather than sharply defined. It looks more like a wash or a map than a spot.
It is strongly associated with hormonal changes — pregnancy, hormonal contraception, thyroid conditions — and it is heavily driven by both UV and visible light, including heat. It disproportionately affects women, and disproportionately affects people with medium to deep skin tones, which is why it is so prevalent among Pakistani women specifically.
Melasma is a chronic condition. That word matters. It is managed rather than cured, it fluctuates with sun exposure and hormones, and it commonly returns after periods of improvement. Anyone promising permanent removal is either misinformed or selling something.
What do post-acne marks look like?
Post-inflammatory hyperpigmentation — PIH — appears as flat spots exactly where a spot, cyst or injury previously sat. The giveaway is location: each mark maps to something that happened there.
On lighter skin tones these can look pink or red. On medium and deeper skin tones they tend to be brown, grey-brown or almost purple. The colour is not the diagnostic feature; the history is.
PIH is flat. If you run a finger over it, you should feel nothing. This is the most useful way to separate a post-acne mark from a scar — a scar has texture, either a depression or a raised area. A mark is only colour.
The good news, and it is genuinely good news: PIH fades on its own. It usually takes three to twelve months depending on depth and skin tone, and it fades considerably faster with consistent sun protection. It is the one type of pigmentation on this page that resolves without intervention.
The bad news is that most people do not let it. They pick at the original spot, which deepens the mark. They stack aggressive treatments, which causes fresh inflammation and therefore fresh PIH. The cycle sustains itself.
What does sun damage look like?
Sun-induced pigmentation — sometimes called solar lentigines or, less accurately, "age spots" — appears as small, distinct, well-defined spots with clear borders. Unlike melasma, they are not symmetrical. Unlike PIH, they do not correspond to a previous spot.
They cluster where sun exposure is highest: the tops of cheeks, the forehead, the nose, and — the one most people forget — the backs of the hands and the forearms, particularly on the side that faces the car window.
They accumulate over years and they do not fade on their own. They are essentially a record of cumulative exposure.
How can I tell which one I have?
Four questions get you most of the way there:
- Is it symmetrical? Mirrored patches on both cheeks point strongly to melasma. Random distribution does not.
- Does each mark sit where a spot used to be? If yes, it is post-inflammatory pigmentation.
- Are the edges sharp or diffuse? Sharp, well-defined borders suggest sun spots. Blurry, map-like edges suggest melasma.
- Can you feel it? If there is texture — a dip or a raised area — it is a scar, not pigmentation, and it needs an entirely different conversation.
A useful fifth: does it get noticeably worse in summer, or after a beach day, or during pregnancy? Melasma responds dramatically to heat, light and hormones. Sun spots accumulate slowly and do not flare. PIH does not flare either, though unprotected sun exposure slows its fading considerably.
Be aware that many people have more than one type at once. Melasma on the cheeks and PIH along the jawline is a common combination, and it is one of the main reasons self-diagnosis from photographs is unreliable.
What actually helps?
Sun protection is the whole foundation. Not one of several options — the foundation. Every type of pigmentation on this page is worsened by UV, and melasma is worsened by visible light and heat as well. Without daily sun protection, nothing else you do will hold. This is the least exciting advice in skincare and the most consistently ignored.
In Pakistani conditions that means daily use regardless of season or weather, reapplication if you are outdoors for extended periods, and — for melasma specifically — physical shade and hats, because sunscreen alone does not block visible light or heat.
For post-acne marks: stop the acne first. There is no point fading marks while new ones form. Then protect from the sun and be patient. Most PIH fades without any active treatment at all. Gentle, consistent care beats aggressive intervention here, because aggression causes inflammation and inflammation causes more PIH.
For melasma: this needs professional input rather than a routine assembled from articles. It is chronic, it is stubborn, and several commonly recommended approaches can worsen it — including some heat-based treatments and some aggressive exfoliation. Getting this wrong is not neutral; it can set you back a year.
For sun damage: prevention works, reversal is limited. Existing spots generally need clinical treatment to shift meaningfully. Consistent protection stops new ones forming, which over a decade matters more than treating the ones you have.
How long does pigmentation take to fade?
Honest timelines, because unrealistic expectations are why most people quit:
- Post-acne marks: three to twelve months, faster with sun protection, faster on lighter skin tones, slower for deeper marks.
- Melasma: managed rather than resolved. Expect improvement over months, expect fluctuation, expect recurrence with sun and hormonal change.
- Sun spots: do not fade on their own in any meaningful way.
Nothing on this list works in two weeks. Any product or treatment promising visible pigmentation results in days is describing surface exfoliation, not pigment change — you are seeing dead cells removed, which is temporary.
What makes pigmentation worse?
- Picking. The most damaging habit for post-acne marks, without competition. A spot you leave alone leaves a lighter mark that fades faster.
- Over-exfoliation. Inflammation causes pigmentation in skin that is prone to it. Aggressive acids and scrubs frequently cause the exact problem they are being used to fix.
- Unprotected sun exposure. Undoes months of progress in a single afternoon.
- Heat. Under-appreciated for melasma specifically. Cooking over a stove, hot cars, and hot showers can all aggravate it independently of UV.
- Unregulated skin-lightening creams. This one deserves a warning of its own. Products sold informally in Pakistan promising rapid fairness have been repeatedly found to contain undisclosed mercury or high-strength steroids. These cause real harm — steroid-induced rosacea, thinned skin, and rebound pigmentation that is significantly worse than the original problem, sometimes permanently. If a cream produces dramatic lightening within days, stop using it and see a doctor.
When to see a doctor
See a doctor rather than treating it as a cosmetic concern if:
- A pigmented spot is changing in size, shape or colour, has irregular borders, or bleeds — this needs proper assessment to rule out something serious
- A single dark patch appears suddenly with no clear cause
- Pigmentation appears alongside other symptoms — fatigue, weight change, menstrual irregularity — which may point to a hormonal or thyroid cause
- You have used a skin-lightening product and are seeing redness, burning, thinning skin or worsening pigmentation
- Melasma is significantly affecting how you feel day to day, in which case a dermatologist can offer options that are not available over the counter
Getting a straight answer for your own skin
The four questions above will usually narrow it down. What they cannot do is tell you which combination you have, how deep the pigment sits, or what your skin will tolerate — and those three things determine what actually works.
Deep pigment and surface pigment can look identical in a mirror and respond completely differently. That is a judgement that needs someone looking at your skin properly, in good light, with the context of your history.
If you are dealing with dark patches and are not sure what you are looking at, our skin assessment is built for exactly this: you send photos and answer questions about your history, and a certified practitioner tells you which type you are dealing with, what will realistically help, and how long it should take — written down, so you can hold us to it.