Facial blemishes: what types exist, why do they appear, and how are they treated?

A brief guide to recognizing the most frequent patterns, understanding why they appear, and knowing when it is appropriate to consult a doctor.

Summary in 60 seconds

• “Stain” describes a visible change, but it is not a diagnosis.
• Brown spots can be related to melasma, sun exposure, acne, or inflammation.
• Red areas often reflect inflammation or changes in blood vessels.
• White spots can appear due to eczema, infections, or loss of pigment.
• The shape, texture, distribution, and evolution help to differentiate its causes.
• Sun protection is important, and not all spots are treated with depigmenting agents.
• Peels and lasers are not suitable for all cases either.
• A lesion that changes, bleeds, ulcerates, or develops a textured surface should be evaluated by a medical specialist.
• The safest treatment begins with a correct diagnosis.

What are facial blemishes?

A facial blemish is an area of the face whose color differs from the surrounding skin. It can be brown, gray, white, red, pink, purple, or black.

Some spots are completely flat. Others are scaly, rough, crusty, or raised. This difference is important because a lesion with texture or growth requires a different evaluation than one that is purely pigmentary.

The term “stain” can include several phenomena:

• Hyperpigmentation: the area appears darker.
• Hypopigmentation: the area is lighter, but retains some color.
• Depigmentation: there is a more complete loss of pigment.
• Vascular changes: the skin appears red, pink, or purplish.
• Pigmented lesions with texture: in addition to color, they present roughness, scaling or elevation.

A stain describes what we see, but it doesn’t explain why it appeared.

Why do they appear?

Sun exposure

Ultraviolet radiation promotes the appearance of freckles and sunspots. It can also darken melasma and marks left after acne or other inflammations.

Skin inflammation

Acne, eczema, dermatitis, burns, hair removal, and scratching can leave darker or lighter areas.

The darkening that appears after inflammation is called post-inflammatory hyperpigmentation . It can be more intense and persistent in medium and dark skin tones. Davis and Callender 2010

Hormones and predisposition

Melasma is linked to light exposure, genetic predisposition, and certain hormonal factors. It can appear during pregnancy or with hormonal treatments, although many people do not identify a specific trigger. Ogbechie-Godec and Elbuluk 2017

Loss of pigment

Some light spots appear because the skin produces less melanin. Others, like those of vitiligo, are related to the loss of the cells responsible for producing it.

Dermatitis, infections and medications

Rosacea, some types of dermatitis, certain superficial infections, and certain medications can also change the color of the face.

Perfumes, dyes, cosmetics, or hair products can cause irritation or allergies and leave residual pigmentation.

What do they look like?

Brown or gray spots

Melasma usually forms relatively symmetrical patches on the cheeks, forehead, upper lip, or jaw.

Acne scars appear where pimples or inflammation once existed. Solar lentigines, on the other hand, are usually individual, flat, and well-defined spots.

Red or purplish spots

They may be related to rosacea, dermatitis, or vascular scarring after acne. In darker skin tones, the inflammation may appear more purplish, grayish, or brown than red.

White or pale spots

Pityriasis alba produces clear, poorly defined and sometimes slightly scaly areas, especially in children with dry skin or eczema.

Vitiligo usually forms milky white patches, more defined and without scaling.

Rough, crusty, or raised spots

A rough lesion that persists in an area highly exposed to the sun may correspond to actinic keratosis.

Lesions that are raised, have multiple colors, grow, or bleed should not be considered merely a cosmetic problem.

In what diseases or conditions do they usually occur?

The frequency depends on age, skin tone, sun exposure, and personal history. This classification is for guidance only.

1. Very frequent

• Hyperpigmentation after acne, eczema, or irritation.
• Melasma.
• Freckles and sunspots.
• Red or purplish marks after acne.
• Rosacea.

2. Frequent

• Irritant, allergic or seborrheic dermatitis.
• Pityriasis alba.
• Benign moles.
• Seborrheic keratosis.
• Vitiligo.
• Pityriasis versicolor.

3. Infrequent, but important

• Pigmentation related to medications or cosmetics.
• Pigmented lichen planus.
• Cutaneous lupus.
• Exogenous ochronosis due to improper use of bleaching agents.
• Actinic keratosis.
• Melanoma and other skin cancers.

Most facial spots are benign, but a lesion that is different from the others or that evolves needs evaluation.

How are they treated?

The treatment depends on the cause. Not all dark spots improve with a lightening cream.

Sun protection and gentle care

Broad-spectrum sunscreen with SPF 30 or higher is usually an essential part of sun protection. It’s also advisable to reduce direct sun exposure, wear a hat, and avoid products that cause burning or peeling.

In melasma and some hyperpigments, colored sunscreens and iron oxides can provide additional protection against visible light.

Melasma and spots after inflammation

The dermatologist may use azelaic acid, retinoids, hydroquinone, or other combinations, depending on the diagnosis and skin tolerance.

Melasma often requires long-term treatment and can recur. Peels, lasers, and other procedures are reserved for selected cases because they can also cause irritation or new pigmentation. Neagu et al. 2022

Sunspots

Benign solar lentigines can be treated with cryotherapy, peels, pulsed light or certain lasers when there is an aesthetic interest.

Before destroying a pigmented lesion, it must be confirmed that it is benign.

Rosacea and red spots

Rosacea is not treated with depigmenting agents. It may require topical or oral medications and, in some cases, vascular laser or pulsed light therapy. Schaller et al. 2020

White spots

Pityriasis alba usually improves with hydration and eczema control. Vitiligo can be treated with topical medications, phototherapy, and other options selected according to its extent and activity. Seneschal et al. 2023

Suspicious injuries

Actinic keratoses and skin cancers require specific treatments. They should not be treated as a cosmetic blemish.

When should I consult?

Seek priority consultation when a stain:

• Change size, shape, color, or relief.
• It has very irregular edges.
• It comes in several colors.
• It looks clearly different from the others.
• It grows rapidly.
• Bleeding without an obvious cause.
• It ulcerates or does not heal.
• It forms repeated scabs.
• It causes persistent pain or itching.
• It develops a rough or scaly surface.
• It appears in a person with a history of skin cancer.

The ABCDE rule can help identify suspicious pigmented lesions, but it does not replace a professional evaluation by a dermatologist. American Academy of Dermatology sf

You should also consult with a specialist before applying laser, cryotherapy, or cauterization to an undiagnosed lesion.

What NOT to do?

• Do not treat all spots as melasma.
• Do not apply lemon, baking soda, toothpaste, bleach, or irritating homemade mixtures.
• Do not combine multiple acids, exfoliants, and retinoids at the same time.
• Do not use potent corticosteroids on the face without a prescription.
• Do not prolong the use of hydroquinone without follow-up.
• Do not buy skin lighteners of unknown composition.
• Do not manipulate pimples, scabs, or inflamed lesions.
• Do not destroy a spot with laser or cryotherapy without a prior diagnosis.

Prolonged or inappropriate use of hydroquinone may be associated with exogenous ochronosis, a difficult-to-treat blue-gray pigmentation. Ishack and Lipner 2022

The correct treatment depends more on the diagnosis than on the color of the lesion.

What does a dermatologist usually do?

First, check when the spot appeared, how it has evolved, what symptoms it produces, and what products or medications the person uses.

Next, examine its color, distribution, borders, and texture. Dermatoscopy allows observation of structures that are not visible to the naked eye and is especially useful in moles and pigmented lesions.

For white patches or certain pigment abnormalities, a Wood’s lamp can be used. If an infection is suspected, a skin scraping can be performed; if an allergy is suspected, patch testing can be ordered.

Biopsy is reserved for atypical, changing, or difficult-to-diagnose lesions. It is not usually necessary in melasma with a classic presentation.

A stain that changes, bleeds, or develops texture requires medical evaluation before any procedure.

Frequently Asked Questions

Are all brown spots melasma?

• No. They can also be marks from acne, freckles, sunspots, moles, pigmented dermatitis, or raised lesions. Melasma is usually relatively symmetrical and forms large patches.

Can the stains disappear completely?

• It depends on the cause and the depth of the pigment. Some improve within months; others, like melasma, may require maintenance and may recur.

Which sunscreen should I use?

• A broad-spectrum sunscreen with SPF 30 or higher that’s comfortable for daily use. For melasma, a formula with color and iron oxides may be helpful.

Do vitamin C or azelaic acid help?

• They can help with certain types of hyperpigmentation. Their effect is usually gradual and depends on the formulation, tolerance, and the cause of the pigmentation.

Is hydroquinone safe?

• It can be helpful when properly indicated and used for a controlled period. It is not suitable for all stains and can cause irritation or adverse effects if used for an extended period.

Is laser the fastest option?

• Not necessarily. It can help with certain lentigines or visible blood vessels, but it can also worsen some pigmentations. Patient selection, device choice, and diagnosis are crucial.

Bibliography and sources

• Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20-31. Davis and Callender 2010
• Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther (Heidelb). 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1. Ogbechie-Godec and Elbuluk 2017
• Neagu N, Conforti C, Agozzino M, Marangi GF, Morariu SH, Pellacani G, et al. Melasma treatment: a systematic review. J Dermatolog Treat. 2022;33(4):1816-1837. doi:10.1080/09546634.2021.1914313. Neagu et al. 2022
• Schaller M, Almeida LMC, Bewley A, Cribier B, Del Rosso J, Dlova NC, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269-1276. doi:10.1111/bjd.18420. Schaller et al. 2020
• Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, et al. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021;85(4):e209-e233. doi:10.1016/j.jaad.2021.02.082. Eisen et al. 2021
• Seneschal J, Speeckaert R, Taïeb A, Wolkerstorfer A, Passeron T, Pandya AG, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force—Part 2. J Eur Acad Dermatol Venereol. 2023;37(11):2185-2195. doi:10.1111/jdv.19450. Seneschal et al. 2023
• Ishack S, Lipner SR. Exogenous ochronosis associated with hydroquinone: a systematic review. Int J Dermatol. 2022;61(6):675-684. doi:10.1111/ijd.15878. Ishack and Lipner 2022
• American Academy of Dermatology Association. Melasma: diagnosis and treatment [Internet] . Schaumburg (IL): American Academy of Dermatology Association; 2022 [citado 20 jul 2026] . Available at: American Academy of Dermatology 2022
• American Academy of Dermatology Association. What to look for: ABCDEs of melanoma [Internet] . Schaumburg (IL): American Academy of Dermatology Association; [fecha de publicación no indicada; citado 20 jul 2026] . Available from: American Academy of Dermatology sf