What does it mean when a small black spot grows under the skin, and what should be done about it?

Small black spots on the skin may be caused by factors such as hyperpigmentation, follicular keratosis, pigmented nevi, seborrheic keratosis, or post-inflammatory pigmentation. These can be improved through sun protection, skin cleansing, medication, or physical treatments. If the spots grow rapidly, have irregular shapes, or are accompanied by itching or pain, prompt medical attention is recommended.

1. Hyperpigmentation: Ultraviolet radiation or friction may stimulate melanocytes, leading to increased melanin deposition and the formation of small, uniformly colored black spots without significant discomfort. It is advisable to practice proper sun protection, avoid repeated local friction, and use gentle whitening skincare products to help fade the pigmentation.

2. Follicular Keratosis: Abnormal accumulation of keratin at the hair follicle opening, mixed with small amounts of melanin, forms small black spots commonly found in areas with dense pores, with a slightly rough texture. It is recommended to clean the skin with a gentle facial cleanser, exfoliate regularly, avoid squeezing with fingers, and maintain clear pores.

3. Pigmented Nevus: A benign clustering of melanocytes in the skin forms small black spots with clear borders and uniform color, typically without pain or itching. Under medical guidance, topical medications such as hydroquinone cream, tretinoin cream, or azelaic acid cream may be used to improve appearance, or the spot may be removed via physical treatments like laser therapy or cryotherapy.

4. Seborrheic Keratosis: Caused by skin aging and UV exposure leading to abnormal keratinocyte proliferation, this condition results in brown or black spots that may have a rough surface, commonly seen in middle-aged and older adults. Under medical supervision, topical treatments such as tretinoin cream, tazarotene gel, or salicylic acid ointment may be used to relieve symptoms, or laser therapy may be considered.

5. Post-inflammatory Hyperpigmentation: After resolution of skin inflammation, localized melanocytes may overproduce melanin, forming small black spots often appearing after acne or wound healing. Patients may follow medical advice to use hydroquinone cream, vitamin C injection solution, or niacinamide gel to improve symptoms, along with sun protection to support recovery.

Maintain daily skin hygiene by using mild, non-irritating skincare products. Practice strict sun protection when outdoors, avoid frequent rubbing or squeezing of the spots. Eat a diet rich in fruits and vegetables containing vitamins, maintain regular sleep patterns, and reduce the risk of pigment deposition.