Dark Spots Won't Fade? Why Your Skin Is Darkening & Medical Next Steps

If you've noticed dark patches or spots on your skin that don't seem to fade, you're not alone. Hyperpigmentation is one of the most common skin concerns in both men and women. In many cases, it's harmless. But sometimes, ongoing or worsening skin darkening can signal an underlying medical issue that needs attention.

Here's what causes hyperpigmentation, when to be concerned, and what medical next steps may help.

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What Is Hyperpigmentation?

Hyperpigmentation happens when your skin produces too much melanin — the pigment that gives skin its color. This extra pigment can collect in certain areas, leading to:

• Dark spots
• Patches of uneven skin tone
• Areas that appear brown, black, gray, or even bluish
• Skin that gradually darkens over time

Hyperpigmentation can affect any skin tone, though it may appear differently depending on your natural complexion.

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Common Causes of Hyperpigmentation

Not all dark spots are the same. Understanding the cause helps determine the right treatment.

1. Sun Exposure (Solar Lentigines or "Sun Spots")

Long-term sun exposure is one of the most common reasons for hyperpigmentation. UV radiation stimulates melanin production. Over time, this can cause:

• Flat brown spots on the face, hands, shoulders, or chest
• Freckles that darken
• Uneven tone in sun-exposed areas

These spots often become more noticeable with age.

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2. Post-Inflammatory Hyperpigmentation (PIH)

This type occurs after the skin has been injured or inflamed. Common triggers include:

• Acne
• Eczema
• Psoriasis
• Burns
• Cuts or insect bites
• Cosmetic procedures

When inflammation heals, it can leave behind darker patches. This is especially common in medium to darker skin tones.

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3. Melasma

Melasma causes symmetrical brown or gray-brown patches, often on:

• Cheeks
• Forehead
• Upper lip
• Chin

It's strongly linked to:

• Hormonal changes (pregnancy, birth control pills)
• Sun exposure
• Genetics

Melasma is sometimes called the "mask of pregnancy," but it can affect anyone.

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4. Hormonal Disorders

Certain medical conditions can cause widespread skin darkening. One example is Addison's disease, a disorder of the adrenal glands. Signs may include:

• Darkening of skin creases
• Pigment changes in scars
• Dark patches inside the mouth
• Fatigue, weight loss, low blood pressure

If hyperpigmentation appears alongside whole-body symptoms, it's important to seek medical evaluation.

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5. Medication-Related Hyperpigmentation

Some medications can trigger skin darkening, including:

• Certain antibiotics
• Chemotherapy drugs
• Antimalarials
• Hormonal therapies
• Some psychiatric medications

If you've started a new medication and notice pigment changes, speak with your prescribing doctor.

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6. Insulin Resistance (Acanthosis Nigricans)

This condition causes:

• Dark, thickened, velvety skin
• Usually around the neck, armpits, or groin

It's often linked to:

• Prediabetes or type 2 diabetes
• Obesity
• Hormonal disorders

Acanthosis nigricans can be an early warning sign of metabolic problems and shouldn't be ignored.

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When Dark Spots May Be More Serious

Most hyperpigmentation is harmless. However, certain features require prompt medical attention.

Watch for:

• A mole that changes in size, shape, or color
• Irregular borders
• Multiple colors within one spot
• Bleeding or crusting
• Rapid growth
• Itching or pain

These could be signs of skin cancer, including melanoma. While not all dark spots are dangerous, changing lesions should always be examined by a doctor.

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Why Your Hyperpigmentation Isn't Fading

If your dark spots aren't improving, several factors may be at play:

Ongoing Sun Exposure

Even small amounts of daily UV exposure can worsen hyperpigmentation. Without consistent sun protection, treatment results may stall.

Incomplete Treatment

Many over-the-counter products are too mild for moderate or severe hyperpigmentation. Stronger prescription treatments may be needed.

Hormonal Triggers

If hormones are driving melasma, topical creams alone may not fully resolve the issue.

Chronic Inflammation

Untreated acne, eczema, or skin irritation continues to stimulate pigment production.

Underlying Medical Condition

Persistent or spreading darkening may point to metabolic or endocrine issues that require medical testing.

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Medical Next Steps

If hyperpigmentation is persistent, worsening, or accompanied by other symptoms, here's what to consider:

1. Schedule a Medical Evaluation

A primary care doctor or dermatologist may:

• Examine your skin with magnification
• Review medications
• Ask about hormonal changes
• Order blood tests if needed
• Perform a biopsy for suspicious lesions

Early evaluation prevents delays in diagnosing more serious conditions.

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2. Address Underlying Causes

Treatment depends on what's driving the pigmentation:

• Hormonal therapy adjustments
• Blood sugar management
• Treating inflammatory skin conditions
• Adjusting medications

Correcting the root cause is often essential for improvement.

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3. Evidence-Based Treatment Options for Hyperpigmentation

Medical treatments may include:

• Topical retinoids – Increase cell turnover
• Hydroquinone – Reduces melanin production (short-term supervised use)
• Azelaic acid – Helpful for acne-related pigmentation
• Chemical peels – Superficial peels can improve tone
• Laser therapy – Targets pigment directly
• Tranexamic acid – Sometimes used for melasma

These treatments should be guided by a professional, especially for darker skin tones where improper therapy can worsen pigmentation.

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4. Daily Sun Protection Is Non-Negotiable

Without consistent sun protection, hyperpigmentation will likely return.

Use:

• Broad-spectrum SPF 30 or higher
• Reapply every 2 hours outdoors
• Protective clothing and hats
• Shade during peak sun hours

Sun protection isn't just cosmetic — it reduces skin cancer risk.

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Should You Check Your Symptoms?

If you're experiencing persistent dark spots on skin and want to better understand what might be causing them before your doctor's visit, Ubie's free AI-powered symptom checker can help you identify possible causes and determine whether you should seek medical care right away.

Online tools are not a diagnosis, but they can help you decide your next step.

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When to Speak to a Doctor Urgently

Seek medical care promptly if you notice:

• Rapidly changing moles
• Unexplained full-body darkening
• Dark patches with fatigue or weight loss
• Thickened dark skin with signs of diabetes
• Bleeding or painful skin lesions

Some causes of hyperpigmentation can be life-threatening if ignored. Early evaluation makes a difference.

If something feels unusual or concerning, speak to a doctor rather than waiting.

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Can Hyperpigmentation Be Reversed?

In many cases, yes — but it takes time.

• Post-inflammatory hyperpigmentation may fade over months
• Melasma often improves but can recur
• Sun spots may lighten with treatment
• Hormonal causes require systemic management

Improvement is gradual. Realistic expectations are important.

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The Bottom Line

Hyperpigmentation is common and often harmless. Sun exposure, acne, hormones, and inflammation are frequent causes. However, persistent, spreading, or changing dark spots deserve medical attention.

Don't panic — but don't ignore changes either.

If your dark spots won't fade:

• Protect your skin from the sun
• Treat underlying inflammation
• Review medications
• Consider medical evaluation
• Use evidence-based treatments

And most importantly, speak to a doctor about any symptoms that could be serious or life-threatening.

Your skin often reflects what's happening inside your body. Paying attention to changes is not overreacting — it's proactive care.