Pigmentation & Brown Spots

Skin pigmentation is the colour of the skin. Changes in pigmentation can cause areas of skin to look darker, lighter, or patchy compared with the surrounding skin.

Pigmentation may develop due to a variety of causes, including:

• Sun exposure, such as solar lentigines (“sun spots”)

• Post-inflammatory pigmentation following skin conditions like acne or eczema

• Medication-related pigmentation

• Hormonal influences

• Less commonly, underlying medical or skin conditions

Different causes can look similar clinically, which is why careful assessment is important.

Pigmentation may appear as:

• Flat brown, grey, or dark patches

• Freckle-like spots

• Diffuse or patchy discolouration

• Pigmentation confined to sun-exposed areas or areas of prior inflammation

The pattern and distribution often provide clues to the underlying cause.

Medical review may be helpful to:

• Determine the cause of pigmentation

• Exclude concerning or uncommon causes

• Guide appropriate management and prevention strategies

• Clarify expectations regarding improvement

Assessment involves a detailed history and skin examination, considering:

• Onset and progression

• Distribution and pattern

• Sun exposure history

• Medical history and medication use

Where appropriate, tools such as dermoscopy or further investigation may be used to clarify the diagnosis.

Management is guided by the underlying cause of pigmentation. In many cases, treatment focuses on:

• Preventing progression

• Sun protection

• Addressing contributing factors such as inflammation or medication

For selected pigmentation concerns where cosmetic improvement is the primary goal, referral to a cosmetic dermatologist for further management may be appropriate. This helps ensure treatment is targeted, safe, and aligned with individual expectations.

Dermatologists are trained to assess pigmentation accurately and distinguish benign changes from conditions requiring further investigation. Specialist review supports appropriate diagnosis, avoids unnecessary treatments, and guides safe, evidence-based management.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist supports patients by assessing pigmentation concerns, identifying underlying causes, and providing guidance on prevention and appropriate management.