pigmentation on skin causes

When it comes to pigmentation changes on your skin, it can indeed stem from a variety of causes. As your dermatologist hinted, hormonal changes can play a significant role, especially if they coincide with recent changes in birth control use, pregnancy, or menopause. These hormonal shifts can lead to increased melanin production, resulting in conditions like melasma. However, sun exposure is another common factor, and considering you enjoy being outdoors, it could contribute to these spots, especially if they’re more prominent on sun-exposed areas. This is often called solar lentigines, or liver spots. The itching you’re experiencing might suggest a different cause, such as post-inflammatory hyperpigmentation, which can happen if there’s been some irritation or inflammation. It’s also wise to consider if you’ve started any new medications, as some can cause photosensitivity, leading to pigmentation changes. Regardless, protective measures are key - regular use of broad-spectrum sunscreen is crucial even on cloudy days. You’ve started using fading creams, but bear in mind that these can take several weeks to show any effect. Given the persistence and escalation of your symptoms, and especially if they’re affecting your quality of life, a second opinion might be prudent. Another dermatologist could offer a fresh perspective or recommend specific treatments like creams with hydroquinone, retinoids or chemical peels, which require careful use. Though it may be a regular skin issue, keeping track of any changes or new symptoms is wise. If the spots evolve or other concerning symptoms arise, additional investigations might be necessary to rule out other underlying health issues.