Pigmentation and Dark Patches: Why Over-the-Counter Creams Can Backfire

You notice a darker patch on your cheeks. A wedding is a few weeks away. A friend swears by a cream that worked for her, an online ad promises clear skin in days, and the pharmacy shelf has three options. It is a very common moment, and what you do next matters more than most people expect.

Dr Vaishali Makwana, an MD in Skin & VD who practises in Surendranagar, sees the results of these choices in her clinic. Here is her plain-language explanation of pigmentation and what she advises.

What is pigmentation, and why does it happen?

Dr Makwana describes pigmentation as an increase of melanin, the pigment in the layers of the skin. When it builds up, it shows as dark patches, most often on the face.

She stresses that it has many causes, not one. Some people develop it during pregnancy. Some get tanning after time in the sun. In some, a medicine is responsible. Others are left with dark marks after acne or chickenpox.

Because the causes differ, she says, the level of pigmentation, the skin type and each person's physiology differ too. This is why a treatment has to be matched to the person.

Why can creams from the counter or online make it worse?

Dr Makwana is firm on this point. Many products sold in the market contain a steroid or hydroquinone. When people apply them, she says, the skin may look clear at first.

The trouble comes when the cream is stopped. The pigmentation returns. The steroid can also cause side effects, which she lists as thinning of the skin, hair growth on the face and acne.

Her advice to patients is direct:

• Do not use over-the-counter de-pigmenting agents.
• Do not order such products online.
• Use only what a doctor has prescribed specifically for you.
• Use it for as long as advised, and follow the maintenance therapy.

Why should a prescribed cream be given about three months?

Skin conditions ask for patience, and pigmentation is no exception. Dr Makwana explains that when a doctor prescribes a cream, the choice is based on your skin, your level of pigmentation and its cause.

Her guidance is to wait a minimum of three months to see how the medicine is working. If it does not work, a higher-level cream can be given. That decision belongs to the doctor.

What does not help is changing the cream, or the doctor, every 15 days or every month. In her words, this brings no real effect and can sometimes cause side effects.

Is it safe to share a cream with a friend?

Dr Makwana advises against it. She points out that a cream you apply is not just a cream. It is a medicine, with a specific concentration and specific instructions.

She gives an example from acne. A cream may need to be applied at night, for a set number of hours. If another person does not know this and applies it during the day, she may return with irritation or burns. A cream that works for one patient does not necessarily work for another.

What can you do every day?

Alongside treatment, Dr Makwana lists simple habits that support it:

• Sunscreen: use it without fail, and during the day.
• Hydration: keep up your water and fluid intake.
• Vitamin C-rich food: she suggests oranges, mosambi, other citrus fruits and lemon water in good quantity.

When a doctor decides it is needed, the treatment can also include vitamin C supplements, anti-pigmentation creams and medicines. For procedures, she mentions special peels and laser sessions, with results coming over a series of sessions rather than at once.

She also notes that some face washes now contain ingredients such as kojic acid, glutathione and vitamin C, which can help lighten dark spots. Her broader point is that care has to be steady, not occasional.

What about the viral peel-off strip that removes melasma?

Dr Makwana mentions a recent video in which a strip is applied over pigmentation and peeled off, and the patch seems to come away with it. She says dermatologists were stunned to see it.

Her reasoning is simple. Melanin is not dirt sitting on top of the skin, waiting to be pulled off. She calls it impossible, and suggests such a video may be AI-generated. She tells her patients not to experiment on their skin in this way.

She adds that tempting advertisements still pull many people towards such products, and some end up with damaged skin.

Key takeaways

• Pigmentation is excess melanin in the skin, with causes such as pregnancy, sun tanning, medicines and marks left by acne or chickenpox.
• Over-the-counter and online products with steroids or hydroquinone may clear skin at first, but the patches return once they are stopped, and the steroid can thin the skin.
• A prescribed cream should be given at least three months before judging it.
• Changing creams or doctors every few weeks does not help and may cause side effects.
• A cream is a medicine. What suits one person may not suit another.
• Daily sunscreen, good hydration and vitamin C-rich foods support treatment.
• A peel-off strip cannot lift melanin out of the skin.

If dark patches are bothering you, it is worth seeing a qualified dermatologist who can look at your skin and work out the cause before starting anything.

Common questions

What is pigmentation?

Dr Makwana describes it as an increase of melanin in the layers of the skin, which shows as dark patches, commonly on the face. It has many causes, including pregnancy, sun tanning, certain medicines, and marks left by acne or chickenpox.

Are over-the-counter pigmentation creams safe?

Dr Makwana advises against them. Products containing steroid or hydroquinone may make skin look clear at first, but the pigmentation returns once they are stopped. The steroid can also thin the skin, cause facial hair growth and bring acne.

How long should I use a pigmentation cream before judging it?

She advises waiting a minimum of three months after a doctor prescribes it. If it does not work in that time, a higher-level cream can be given by the doctor.

Can I use a cream that worked for my friend?

Dr Makwana says no. A cream is a medicine with a specific concentration and way of use, and every person's skin type and level of pigmentation is different. Using it wrongly, for example in the daytime when it is meant for night, can cause irritation or burns.

What helps pigmentation besides creams?

She recommends daily sunscreen, staying well hydrated and eating vitamin C-rich foods such as oranges, mosambi, citrus fruits and lemon water. Where needed, a doctor may also use special peels or laser sessions.

Can a peel-off strip remove melasma?

Dr Makwana calls this impossible. She explains that melanin is not something stuck on top of the skin that can be pulled away, and says such a video may be AI-generated.