[Department of Dermatology and Venereology] How can a man remove facial pigmentation spots?

Facial hyperpigmentation in men—commonly referred to as “age spots,” “sun spots,” or “melasma”—can arise from multiple causes, including chronic ultraviolet (UV) radiation exposure, hormonal fluctuations, post-inflammatory changes (e.g., after acne or folliculitis), genetic predisposition, and certain medications. Effective management requires accurate diagnosis first: a board-certified dermatologist should evaluate the lesion’s morphology, distribution, dermoscopic features, and history to distinguish between benign lentigines, melasma, post-inflammatory hyperpigmentation (PIH), or rarer entities such as solar lentigo versus early lentigo maligna.

First-line interventions emphasize strict photoprotection: daily use of broad-spectrum sunscreen with SPF 30 or higher (preferably mineral-based for sensitive or acne-prone skin), reapplication every two hours during sun exposure, and adjunctive physical measures like wide-brimmed hats and UV-blocking sunglasses. Topical therapies may include prescription-strength hydroquinone (4% cream, used cyclically under supervision), triple-combination creams (hydroquinone, tretinoin, and fluocinolone acetonide), azelaic acid (15–20%), kojic acid, tranexamic acid (topical or oral formulations in select cases), and niacinamide. These agents work via inhibition of tyrosinase, modulation of melanocyte activity, or anti-inflammatory mechanisms.

For recalcitrant or deeper pigment, procedural options include chemical peels (e.g., glycolic, salicylic, or trichloroacetic acid at appropriate depths), Q-switched or picosecond lasers (targeting melanin with minimal epidermal injury), and intense pulsed light (IPL). However, laser and light-based treatments require careful patient selection—especially in Fitzpatrick skin types IV–VI—to minimize risks of paradoxical hyperpigmentation or hypopigmentation. All procedures must be performed by experienced providers and followed by rigorous sun avoidance and maintenance therapy.

Importantly, self-treatment with unregulated “bleaching” creams containing high-dose hydroquinone, corticosteroids, or mercury is unsafe and can cause ochronosis, cutaneous atrophy, or systemic toxicity. A comprehensive, individualized approach—combining diagnosis, sun protection, evidence-based topicals, and, when indicated, supervised procedures—is essential for safe, sustainable improvement.