Pigmented Spots on the Face: Types, Causes, and When to See a Doctor

A brown spot on the cheek rarely appears out of nowhere: it is usually down to sun, hormones, or inflammation that the skin has remembered. I break down the types of facial pigmentation, the causes, and the point at which it is time to see a dermatologist.

What pigmented spots and facial pigmentation are

Pigmentation is the coloration of the skin. The color comes from melanin, which is produced by special skin cells; when they are damaged or do not function properly, pigment production changes — with an excess the skin darkens, with a deficiency it lightens. Hyperpigmentation is increased formation and deposition of melanin in the tissues: normally it is present in the skin, retina, and meninges, while an excess looks like freckles, pigmented birthmarks, and limited dark patches. Pigmentation disorders can be local or widespread, affecting the whole body.

Why brown spots appear: the main causes

The mechanism is common: melanocytes produce too much melanin, which accumulates in the epidermis or is deposited in the dermis. The triggers differ.

• Heredity: among people with melasma, 60% report relatives with the same condition.
• Sun: ultraviolet and visible light increase melanin production.
• Hormones: pregnancy, contraceptives containing estrogen and progesterone, intrauterine devices, implants, and hormone therapy are involved in a quarter of melasma cases in women; thyroid pathology is also linked to it.
• Medications and fragrances: targeted cancer drugs, scented soap, hygiene products, and cosmetics cause a phototoxic reaction.
• Endocrine shifts and external influences: the adrenal glands, pituitary, gonads, hydrocarbon intoxication, light, heat, chemical irritants.

Age spots on the face: how they differ

“Age spot” is a colloquial term, not a diagnosis. Lentigo and freckles are on the list of conditions resembling melasma; the type of spot is determined by a dermatologist.

Other types of pigmentation: melasma, freckles, post-inflammatory spots

Melasma is an acquired condition: symmetrical mottled patches ranging from light to dark brown, without symptoms. The pattern can be centrofacial (forehead, cheeks, nose, upper lip with preservation of the philtrum) — 50–80% of cases — malar, along the jawline and chin; off the face — forearms and shoulders. By melanin level, epidermal, dermal, and mixed types are distinguished. Post-inflammatory hyperpigmentation is the aftermath of past skin inflammation. The same list of similar conditions includes freckles, lentigo, drug-induced hyperpigmentation, nevus of Ota, and nevus of Hori: the resemblance is external, the diagnoses are different.

How a dermatologist determines the type of spot

Usually the diagnosis is made by appearance, examining the skin under a Wood's lamp and a dermatoscope; sometimes a biopsy is taken. In the epidermal type the borders are clear, the color is dark brown, the spot is more noticeable under a Wood's lamp, and dermatoscopy shows islands of brown reticular network with small dark granules. In the dermal type the borders are blurred, the color ranges from light brown to blue-gray, there is no accent under a Wood's lamp, and a reticuloglobular pattern, dilated vessels, and arciform structures are seen. The mixed type is the most common. Dynamics are tracked with serial photos and area and severity indices.

When a spot on the face requires a doctor's examination

Melasma usually runs without symptoms; any unusual sensations in the area of the spot should be discussed with a doctor. A spot that differs from the usual bilateral picture is assessed by a dermatologist.

A pigmented spot by itself is not a reason to call an ambulance. 103 or 112 — if the face suddenly becomes distorted, weakness appears in an arm or leg, speech is impaired, or severe chest pain occurs.

This material is for reference: it helps you come to an appointment prepared, but does not replace a doctor's consultation and skin examination.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer