Is uneven skin tone always hyperpigmentation?

What kind of uneven color are you seeing?

Sun damage can combine dark spots, white spots and visible blood vessels, so one face can contain several problems under one marketing heading. Uneven texture can accompany those color changes. Lightening pigment and treating visible vessels are different jobs: lightening agents target uneven pigmentation, while pulsed dye lasers can treat broken blood vessels and redness.2

Dark patches do not all have the same cause

Postinflammatory hyperpigmentation appears at the site of earlier inflammation or injury after it has healed. It can affect anyone, but tends to be more intense and last longer in darker skin tones. Sunlight can darken the marks. More severe injury can instead leave lighter areas, called hypopigmentation, so a mark left after inflammation is not automatically a dark pigment problem.3

Melasma involves more active pigment producing cells, although the exact cause is not fully understood. Possible triggers include sunlight, pregnancy and some medicines, including birth control pills. It is more common in medium and dark skin tones. Melasma sometimes clears after childbirth or removal of a trigger, but can persist for years.4

Medicines can cause darker, lighter or mixed pigmentation, sometimes with blue gray or orange yellow coloring. The mechanism can involve altered melanin production or deposits of a drug in the skin. Note which medicines you take and when the change appeared; those details help a clinician identify the cause.5

Some pigmentation patterns are inherited. One rare example, Dowling Degos disease, causes a netlike pattern of dark coloring, usually beginning in skin folds. Not every dark patch starts with sun exposure or a skincare product.6

What should you do first?

1. 1Identify the cause before choosing a fading treatment. Active rashes or infections need treatment aimed at that condition, not just its color.
2. 2If dark marks follow acne or eczema, address the ongoing condition first. Stop using a skincare product that burns or stings, and choose gentler products.
3. 3For dark spots, apply tinted sunscreen containing iron oxide, with SPF 30 or higher, broad spectrum protection and water resistance, before going outside. Reapply every two hours and after swimming or sweating.
4. 4Once the trigger is controlled, consider a dark spot product containing azelaic acid or vitamin C. Do not stop a prescribed medicine because of discoloration; ask the prescriber about alternatives.

How long does fading take?

After the cause stops, marks a few shades darker than your usual skin color generally fade within 6 to 12 months. Deeper pigment can take years. Peels and lasers can aggravate postinflammatory pigmentation by injuring the skin, and do not effectively treat pigment deep in the dermis, the deeper skin layer.37

When should you get the color change checked?

Contact a healthcare provider about new or changing discoloration, moles, markings or rashes. Mention itching, scaling, bleeding or other symptoms rather than treating the change as purely cosmetic. A clinician can examine the pattern and, when needed, use tests or a biopsy to identify the cause. See a dermatologist if dark spot treatment is not giving you the results you want.17