Uneven skin tone treatment

Why is my skin tone uneven?

Melanin is the pigment that gives skin its colour. When pigment production changes, some areas become darker or lighter than the surrounding skin. Too much melanin causes hyperpigmentation, meaning darker spots or patches. Sun exposure, hormonal changes during pregnancy, acne, cuts and burns can all contribute. Medicines, including some birth control pills and medicines that increase sensitivity to light, can also play a part. Uneven skin tone is a description, not a diagnosis, which is inconvenient for a serum aisle organised around promises.13

Dark marks after acne or another skin injury are called postinflammatory hyperpigmentation. Melasma is another cause of dark patches. Too little melanin produces lighter areas instead: infections, blisters and burns can leave pale patches, while vitiligo causes patches of light skin. Pigment changes can affect a small area or much of the body. Do not assume every colour difference needs a lightening treatment.23

Start with daily sun protection

1. 1Choose a broad spectrum sunscreen, which protects against UVA and UVB rays. SPF 30 or higher is the minimum; SPF 50 or higher is a practical choice for exposed areas with pigmentation.
2. 2Apply sunscreen every day to exposed skin. Choose a water resistant formula for outdoor use.
3. 3For dark spots, especially on darker skin, consider a tinted sunscreen containing iron oxides. These improve protection against visible light, which can darken darker skin tones. Look under inactive ingredients.
4. 4Reapply sunscreen every two hours outdoors, and add shade, protective clothing and a wide brimmed hat.

Match tinted sunscreen to both your skin tone and undertone, the hue beneath the surface. A matching tint can avoid a visible white film, so the sunscreen does not have to announce its arrival.4

What should I use for uneven skin tone?

If breakouts keep leaving new marks, treat the acne as well as the pigmentation. Azelaic acid is an option that addresses both. A topical retinoid can also clear pores and lighten dark spots after acne. Adapalene is available without a prescription in the US; tretinoin and several other acne retinoids require one. Prescription combination treatments contain specific medicines and doses, so do not assemble an equivalent routine by adding products yourself.56

How should I use a retinoid?

Follow the prescribed directions; topical retinoids are often applied in the evening. Protect your skin from the sun during treatment. If a retinoid has irritated your skin before, tell your dermatologist. They can adjust the amount or frequency, or recommend applying moisturizer first. Make those changes with their help rather than pushing through irritation. Using more acne medication than prescribed will not clear acne faster.5

When is hydroquinone an option?

Hydroquinone reduces production of new melanin. Creams and lotions contain concentrations of 1% to 5%, and access depends on the country; many countries require a prescription. It is particularly useful for marks after inflammation when the underlying condition is controlled. Melasma often needs several treatments rather than hydroquinone alone. Use it under medical guidance, with a defined treatment period rather than indefinite daily use.6

When hydroquinone is part of your treatment plan:

1. 1Test an area about 1 cm across and wait 24 hours for redness or irritation.
2. 2Apply a thin film only to darkened skin, initially once daily. If there is no irritation after one week, the usual schedule increases to twice daily.
3. 3Keep it away from the eyes and mouth. Do not add other topical medicines, particularly benzoyl peroxide, unless your prescriber has arranged the combination.
4. 4Wait 10 minutes before applying sunscreen or cosmetics.
5. 5Review the result at three months. Stop if there has been no benefit; some people maintain improvement with twice weekly use.

Stop hydroquinone for excessive redness, scaling, itching or weeping. Do not use it if you are allergic to hydroquinone or an ingredient in the formula. High concentrations used repeatedly for years can cause ochronosis, a form of skin darkening. Hydroquinone safety during pregnancy and breastfeeding is not established; discuss treatment with your clinician before using it.6

How long does treatment take?

Pigmentation treatments can take a few months or a year to work. Some spots clear, others become less noticeable, and new spots can appear, especially with further sun exposure. The six to eight weeks needed to start seeing fewer acne breakouts is not a deadline for dark marks to disappear. Cosmetic camouflage is a valid option for uneven pigmentation, even if it lacks the drama of a resurfacing appointment.125

Are peels or lasers better?

Chemical peels, lasers, intense pulsed light and dermabrasion can help some pigmentation, but they can also damage the outer skin layer and produce more pigment. Freezing small areas carries a risk of permanent pale patches. Discuss the type and depth of your pigmentation with a dermatologist before choosing a procedure. A more intensive treatment is not automatically the better choice.2

What if the uneven areas are pale?

Pale patches caused by inflammation or infection usually resolve over weeks to months once the underlying problem clears. Pigment loss caused by scarring has no effective treatment, and vitiligo responds variably to therapy. These are different problems from excess melanin, so get unexplained pale or white patches assessed rather than treating them with a dark spot product.2

When should I see a doctor?

Seek medical care if discoloured skin is red, hot, itchy, painful or leaking blood, pus or other fluid. Hyperpigmentation itself does not cause those symptoms. If the cause is unclear, a clinician can review when the change began, your medicines and your skin, with tests when needed. If a medicine is contributing, discuss changes with the prescriber rather than stopping it yourself.1