"Pigmentation" covers several different things, and they don't all respond to the same treatment. Before we suggest anything for dark patches, we work out which kind you have, because treating the wrong cause can make some of them worse.
Brown spots and uneven tone from years of sun exposure are part of photoageing. Daily sun protection is what stops new ones forming and helps any improvement last.
Post-inflammatory hyperpigmentation is the darkening left behind after acne, a rash, a burn or an overly aggressive treatment. It can affect any skin tone, and your skin tone is one of the things we take into account when deciding how cautious to be. The priority is calming whatever caused the inflammation, and not creating more.
Melasma usually appears as matching patches on both cheeks, the forehead or the upper lip. It is linked with hormones and with light, including visible light as well as UV. It tends to be long-term, and it often comes back after treatment stops. Some professional treatments can make it worse in the wrong case, so we assess carefully first. Some of the most effective options are prescription-only, and where that's the right route, we'll point you to a doctor.
Whatever the cause, daily broad-spectrum sun protection is the foundation. Without it, any improvement from treatment is hard to hold on to.
If you'd like to read more, Skinipedia's pigmentation entries set out what the evidence actually says. They're written by our sister academy, MSTA, and each is reviewed by a named clinician. You can also see how we approach pigmentation at the clinic on our pigmentation page.