Identify the cause (acne marks, sun spots, melasma, post-inflammatory hyperpigmentation, fungal spots, or warts) before treating
Use broad-spectrum sunscreen SPF 30–50 daily; reapply if outdoors
Start a gentle routine: mild cleanser, non-comedogenic moisturizer, avoid harsh scrubs
Apply a dark-spot treatment (choose one and use consistently for 8–12 weeks)
Options for dark spots:
Azelaic acid 10–20% once daily or twice daily
Niacinamide 4–5% once or twice daily
Vitamin C (ascorbic acid or derivatives) in the morning
Retinoid at night (adapalene 0.1% or tretinoin as prescribed)
For stubborn pigmentation: consider hydroquinone 2–4% for limited time under clinician guidance
For acne-related marks: use retinoid and/or azelaic acid; avoid picking or squeezing
If spots are likely melasma: prioritize sunscreen; consider azelaic acid and clinician options (e.g., prescription creams)
Consider chemical exfoliation 1–3 nights per week if tolerated (lactic acid, glycolic acid, or salicylic acid)
Avoid mixing multiple strong actives at once; introduce one product at a time
Patch test new products; stop if irritation, burning, or worsening occurs
If you suspect fungal folliculitis (“tiny uniform bumps” that itch): use ketoconazole or selenium sulfide wash and see a clinician if no improvement
If spots are raised, rough, growing, bleeding, or changing: get a dermatology evaluation
If spots are persistent, widespread, or not improving after 8–12 weeks: ask a dermatologist about options (chemical peels, laser/light therapy, microneedling, cryotherapy for certain lesions)
Seek urgent care if a spot is rapidly changing, painful, ulcerated, or bleeding without cause