How to get rid of this dark spot under my lip on the chin area that appeared randomly? (Photos)

Question

I had a rash similar to cold sore appearing and within day 2-3, the rash turned into a deep brown hyperpigmentated spot. I did two rounds of pico at a derm office and have seen no improvement. I am Fitzpatrick type IV and have been using tretinoin 0.5% for a while and added HQ 4% about a month ago. What do you recommend? I see no change in pigmentation at all.

Anna Chacon, MD, FAAD · Answer

Based on your description and the photo, the dark spot under your lip is most consistent with post-inflammatory hyperpigmentation (PIH), which can occur after an inflammatory lesion, rash, or blistering episode — especially in Fitzpatrick type IV skin. PIH in this area can be particularly persistent due to repeated movement, saliva exposure, and friction.

Given that you have already tried pico laser twice without improvement and are using tretinoin 0.05% and hydroquinone 4%, here are important considerations:

Treatment Duration & Patience

PIH can take several months to fade, especially in deeper pigmentation or in higher Fitzpatrick types.

Hydroquinone is usually prescribed in cycles (e.g., 3–4 months on, followed by a break) to avoid resistance or ochronosis.

Adjunctive Topical Therapies

Consider adding azelaic acid 15–20%, kojic acid, or cysteamine cream as alternate or combination therapies.

Niacinamide can also help by reducing melanin transfer to skin cells.

Procedural Caution

Aggressive lasers (including pico) can sometimes worsen PIH in darker skin types. Gentle, low-fluence settings or other modalities such as microneedling or chemical peels with glycolic/lactic acid may be safer.

Sun Protection

Strict daily sunscreen use (SPF 50+, broad-spectrum) is critical, even indoors, as visible light can contribute to pigmentation.

Underlying Trigger

Since this followed a cold sore-like rash, consider evaluation for recurrent herpes simplex virus, as recurrence could lead to repeated pigmentation changes. Preventing new episodes is as important as treating the spot.

In summary, the persistence is not unusual for PIH in this location and skin type. Gradual improvement can occur with consistent topical therapy, strict photoprotection, and careful selection of in-office procedures.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, I highly recommend treating the area of concern with a PICO laser. PICO laser is an advanced technology designed to effectively treat brown hyperpigmentation and other skin discolorations. Utilizing ultra-short pulses of laser energy, the PICO laser targets pigment particles in the skin with precision, breaking them down into smaller fragments that are then naturally eliminated by the body. This process not only reduces existing pigmentation but also stimulates collagen production, improving skin texture and tone. PICO  is known for its minimal downtime and reduced risk of side effects compared to traditional lasers, making it a safe and efficient option for achieving a clearer, more even complexion. I use this laser all the time and highly recommend it! I hope this helps and best of luck!

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