How to treat an uneven skin tone and dark spots

Published: Oct 2015 Updated: Jun 2021
Dr. Jason rivers

Research shows that pigmentation is the most obvious miscreant in the appearance of aging. In this article we explore the triggers of hyperpigmentation and what to look for in a topical treatment.

While a dusting of freckles on a sun-kissed child’s face might be charming, as you grow older, extra facial pigmentation (brown patches and the associated changes in skin tone and texture) sends a different and unappealing message; they are the familiar and telltale signs of aging. Dark spots and uneven skin tone are beauty banes that affect millions.

Research shows that hyperpigmentation plays a significant role in the appearance of aging. For this reason, it's important to learn about the triggers behind hyper pigmented skin and which ingredients work to even skin tone, and correct dark spots.

Causes of Hyperpigmentation and Dark Spots

#1 Culprit: Sun Exposure.

It may come as a surprise, but uneven skin tone and hyperpigmentation are not caused by old age. Conversely, the root of nearly all unwanted pigmentation in the 21st century’s is the sun. Sunshine is like an attack on the skin, and one of the ways the skin defends itself is by making it pigment. If you are skeptical about the relationship between dark spots and the sun, consider this: the parts of your body that remain covered are rarely - if ever - as pigmented as the rest. If these changes really did come from aging, you would have them all over your body.

Aging Effects of the Sun

Without protection from the sun, even a few minutes of exposure per day can cause the skin to prematurely age. Over time, the negative effects will be cumulative. Sun Damage usually presents itself as freckles, age spots, rough or leathery skin, enlarged capillary blood vessels on the face, blotchy skin, and skin cancer.

Photoaging is a common term used by dermatologists. Simply put, it refers to aging caused by sun exposure rather than skin aging from genetic causes. The degree to which any individual experiences photoaging depends on their skin tone, their sun exposure history, and their lifestyle.

Those with fair skin typically show signs of photoaging earlier, than those with dark skin. This is not to say dark skinned individuals are immune to the negative effects of the sun, but it takes more sun exposure to achieve the same degree of sun damage.

Scientific research shows that with repeated sun exposure, the skin loses its ability to repair itself efficiently. Ultraviolet (UV) exposure is known to break down collagen and impact elastin, reducing the skin's ability to spring back, resulting in fine lines and wrinkles. In addition to affecting the skin's elasticity and structure, the sun can cause hyperpigmentation.

Age spots, liver spots, lentigo and sun spots: All different names for the same thing

A sun-kissed glow on your skin is a common goal for many, but this exposure to UV light stimulates pigmentation and with time, can result in an uneven skin tone in specific areas such as the backs of the hands, the face, and neck. These flat tan, brown or black spots have been given many names including sun spots, age spots, solar lentigo, and liver spots. It's important to note that "liver spots" is a misnomer as they are not related to liver disease.   

Because of the popularity of tanning salons and the increasing accessibility to sun-filled vacations, sun damage is occurring at younger ages. Sun-related pigmentation is caused by the skin’s continued exposure to the sun over many years. Unlike freckles, they do not fade in the winter.

Varieties of uneven skin tone

Here is a quick guide to help determine the difference between various forms of skin pigmentation:

Freckles:  small light brown spots, usually less than half a centimeter. They can come and go, becoming more pronounced with exposure to the sun.

Lentigo: Also known as liver spots, age spots and sun spots: These lesions are flat, and light to medium brown in color. They increase in number as you get older, most commonly on the face, hands, and chest — all places with the most exposure to sun. Unlike freckles, they do not fade with decreased sun exposure.

Post-inflammatory hyperpigmentation: This is hyperpigmentation that develops after pimples, bug bites and inflammation of the skin.  These dark spots will stick around long after the initial inflammation has healed.

Melasma: Brown patches that are often associated with hormonal changes. They appear on the cheeks, forehead, and around the lips when a woman is pregnant, taking hormone replacement or birth control pills.

Melanoma: Like other forms of hyperpigmentation, melanoma often appears as dark spots on the skin. How do you tell the difference between melanoma and other forms of pigmentation? Consider the ABCDEs of melanoma

  1. Asymmetry: Melanoma spots tend to be asymmetric. That is, each side of the lesion is not similar when bisected by an imaginary line through the middle.
  2. Border: Check out the border of your spot; if it’s irregular, not well-defined and round, there’s reason to be suspicious.
  3. Colour: Melanoma often has multiple colours or shades of colours – brown, black, blue, white.
  4. Diameter: As a general rule of thumb, melanomas tend to be larger than 6 mm in diameter, that’s the size of a pencil eraser. However, melanomas may be detected when they are smaller, so it’s always best to keep an eye on a spot regardless of size.
  5. Evolution: A spot that changes in any of the ABCD’s, when all other pigmented spots are stable should be assessed by your doctor.
Keep in mind that this is only a general guide to spotting early stages of melanoma. Early detection – it’s the best way to minimize risk to your health

What to do about it?

First step: Prevention

Before treatment, it is imperative to take measures to prevent further damage. Always avoid unprotected sun exposure by using a high SPF (sun protective factor) sunscreen. The best line of defense against photo aging is comprehensive sun protection:

  • Avoid deliberate tanning, including tanning beds.
  • Avoid sun exposure between 10 am – 3 pm, as this is when the sun’s rays are the strongest.
  • Wear a wide-brimmed hat, and long sleeves during the day with an awareness of the parts of the body which might be exposed. Ie. Back of the neck, legs, feet, ears, scalp.
  • Apply sunscreen that is Broad-Spectrum year round with an SPF of 30+. Sunscreen should be applied 20 minutes before going outside and reapplied after sweating or swimming. 

Second step: Treatment

Treatment of uneven skin tone and dark sport is a challenge because of its long term, stubborn and reoccurring nature. After sun protection, there are a variety of topical skin lightening agents and interventions that can be useful. Below is a brief guide to some of the topical skin lightening agents on the market:

Azelaic acid: a naturally occurring acid that inhibits tyrosinase. In published clinical trials, azelaic acid 20% cream or 15% gel was found to be more effective than hydroquinone 2% and equally as effective as hydroquinone 4%. Side effects of azelaic acid include redness, burning, scaling, and irritation. This agent may not suitable for individuals with sensitive skin.

Beta-T (Beta-Thujaplicin): an organic compound derived from the Pacific red cedar tree. It has proven natural antioxidant properties. Beta-T may reduce the appearance of hyperpigmentation, acting as a biological skin lightening agent. 

Hydroquinone: a compound that inhibits the activity of tyrosinase, a key enzyme in the pigment production pathway. Concentrations of hydroquinone in topical preparation vary from 2% to 4%. The highest concentration is most effective, but may be irritating to some individuals. Very high concentrations of hydroquinone may result in paradoxical hyperpigmentation. 

Kojic acid: blocks the production of pigment by binding to copper. This agent can be effective as a substitute to hydroquinone or for individuals who do not respond to hydroquinone. 

Tranexamic Acid: is the latest development in skin brightening, and dark spot reducing research. It has been clinically proven to lighten dark spots and balance out skin tone across a variety of skin types. In recent years, this compound has been used in the treatment of melasma and UV induced hyperpigmentation (sun damage and age spots). Tranexamic acid has demonstrated significant improvements in patient outcomes, often better than traditionally used. Products containing more than 4% tranexamic acid have shown promise in the research.

Niacinamide: also known as Vitamin B3, this ingredient has shown to reduce hyperpigmentation and brighten "dull", or "tired" looking skin by inhibiting the transfer of pigment-carrying melanosomes between the cells of our body. In clinical trials, niacinamide has been shown to stabilize the skin's barrier function. This provides a hydrating effect that perfectly complements other corrective anti-aging ingredients like retinol or tranexamic acid. For best results, look for products that combine tranexamic acid and niacinamide.

Retinol: Retinol’s ability to increase your skin’s rate of cellular turnover means that the existing, darker skin cells are shed to make way for new, healthy skin cells. It also curbs the body’s production of melanin, the darker pigment that creates those dark spots and uneven skin tones. Learn more about the benefits of Retinol here

Light and Laser devices: Depending on the severity and type of hyperpigmentation, there are a number of devices that can help remove or reduce unwanted pigmentation. The most common devices use Intense Pulsed Light (IPL) or Q-switched, Picosecond, or Erbium lasers (eg Fraxel). It is best to consult with a dermatologist to determine the safest, and most effective form of treatment for your skin type. Learn more about dermatological laser treatments in our Guide to Laser Treatments here.



  1. Mayo Clinic: Patient Care and Health Info
  2. American Academy of Dermatology
  3. Uptodate: online medical resources
  4. Niacinamide hydrates to support other ingredients
  5. Hepatic Retinol metabolism. Distribution of retinoids, enzymes, and binding proteins in isolated rat liver cells
  6. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer
  1. What causes uneven skin tone and dark spots?
  2. Aging effects of the sun
  3. What are these spots called?
  4. Varieties of Hyperpigmentation
  5. What to do about it?