Lighten Up! How to treat an uneven skin tone and dark spots


Dark spots and uneven skin tone are beauty banes that affect millions. By the time we reach 60 years of age, 90% of all people will have sun-induced age spots, most commonly appearing on the back of the hands, face and neck.

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. By the time we reach 60 years of age, 90% of all people will have sun-induced age spots, most commonly appearing on the back of the hands, face and neck.

Research shows that pigmentation is the most obvious miscreant 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.

Vancouver dermatologist Dr. Jason Rivers created Riversol to provide his patients with a simple skincare routine that visibly reduced hyperpigmentation and dark spots while minimizing the look of fine lines and wrinkles over time. While supplies last, the line is available in a 15-day sample kit completely free. Find it here.  

First things first, what causes these 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 more and more noticeable. Sun Damage usually presents itself as freckles, age spots, rough or leathery skin, broken blood vessels, blotchy skin, actinic keratosis and even skin cancer.

Photo Aging is a common term used by dermatologists. Simply put, it refers to aging caused by sun exposure. The degree to which any individual experiences photo aging depends on their skin color, their lifetime of sun exposure, and their lifestyle history.

Those with fair skin typically show signs of photo-aging sooner and with greater severity, than those with dark skin. This is not to say however, that dark skinned individuals are exempt from the negative effects of the sun.

Scientific research shows that with repeated sun exposure, the skin loses its ability to repair itself efficiently. UV exposure is known to break down collagen as well impact elastin, eventually resulting in skin with an inability to spring back, presenting with fine lines and wrinkles. In addition to affecting skin laxity & structure, the sun can discolor and create hyper-pigmentations.

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 hyperpigmentation and uneven skin tone in specific spots on the hands, face and neck. These flat tan, brown or black spots have been given many names including sun spots, lentigo and liver spots. Please note "liver spots" is a misnomer and they are not related to alcohol consumption or liver disease.   

Because of the popularity of tanning salons and the increasing accessibility of sun-filled vacations, sun damage is occurring at younger and younger ages for most. These spots, more than anything else, give away a person’s age. Age spots are caused by the skin’s continued exposure to sun over many years, and unlike freckles, they do not fade in the winter. To reduce the signs of aging, such as uneven skin tone and age spots, you can try using our Anti-Aging skin care line.

What are the other causes of uneven skin tone?

We have now established that most spots are a result of too much time in the sun.  Alongside sun damage, skin pigmentation can also be effected by hormonal changes in the body as a result of prescription drugs, stress, topically-applied products etc. It is important to see a doctor or dermatologist as changes in the skin present themselves, to rule out more sinister spots (like a melanoma).

Here is a quick guide to help determine what you are dealing with:

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

Lentigines, liver spots, age spots and sun spots: Small-to-medium brown. These spots multiply 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.

Uneven skin tone: Instead of a few specific spots, this involves larger areas of pigmentation that make your skin look darker in some areas, lighter in others.

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 related to hormonal changes. They most often appear on the cheeks, forehead, and around the lips when a woman is pregnant, taking hormone replacement or birth control pills.

Finally, 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 – 4 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.
  • Avoid skin care products that exacerbate free radical damage and move towards those that are free of suspect ingredients. 

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. Please remember that many of the treatments on the market have not been adequately evaluated. Below is a brief guide to some of the topical skin lightening agents on the market:

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 can often be very irritating and has a number of side effects. This agent is not recommended for individuals with sensitive skin. 

Beta-T (Beta-Thujaplicin): an organic compound found in the essential oil of the Pacific red cedar tree. It has proven natural antioxidant properties. Beta-T reduces the appearance of hyperpigmentation, acting as a biological whitening agent. While the most common chemical whitening agent, hydroquinone, also uses this mechanism, Beta-T can do it safely. This agent is suitable for people with sensitive skin. 

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 is not suitable for individuals with sensitive skin

Kojic acid: blocks the production of pigment by binding to copper. In one study, a gel containing 2% hydroquinone, 10% glycolic acid, and 2% kojic acid was compared to a cream containing 2% hydroquinone and 10% glycolic acid only. Both treatments were applied twice daily for 12 weeks about 50 percent of individuals in the study did not report any difference between the two sides. In addition to local irritation, kojic acid may cause allergic contact dermatitis.  This agent is not suitable for people with sensitive skin.

Tranexamic Acid: is the latest development in skin brightening, dark spot and acne scar reducing research. It has been clinically proven to lighten dark spots and even skin tone across a variety of skin types. In clinical trials, this ingredient has shown to visibly reduce acne scars in a matter of weeks. In recent years, this powerful compound has been used in the treatment of melasma and UV induced pigmentation (sun damage and age spots). Showing significant improvements in patient outcome, often better than prescription alternatives, and without the side effects. Products containing >/= 4% tranexamic acid have shown the most promising results in clinical trails.

Niacinimide: also known as Vitamin B, this antioxidant has been show to be a multitasking powerhouse working to prevent moisture loss, and smooth the surface texture to brighten "dull", or "tired" looking skin. It has been shown in double-blind, randomized trials to be nearly as effective as prescription ingredients at reducing discolouration and age spots. For best results, look for products which combine Tranexamic acid and Niacinimide.

Products geared towards the reduction of age spots and sun damage can be harsh on the skin for most people. This leaves people with sensitive skin at a loss when trying to find a solution. While this article is meant to be an unbiased educational resource, we would encourage you to learn more about the ability of Riversol products to help with the look of sun damage and uneven skin tone:

The Riversol Anti-Aging Reparative Serum was developed by Dr. Rivers and geared towards the reduction of the appearance of sun damage. To make this serum, Dr. Rivers combined Beta-T with stabilized vitamin C and vitamin E complexes, maximizing anti-aging results. Try the Anti-Aging Reparative serum for free in Dr. Rivers 15-day sample kit.

 Author: Dr. James Macdonald M.D.


  1. Mayo Clinic: Patient Care and Health Info
  2. American Academy of Dermatology
  3. Uptodate: online medical resources
  1. What causes uneven skin tone and dark spots?
  2. Aging effects of the sun
  3. What are these spots called?
  4. Other causes of uneven skin tone and dark spots?
  5. What to do about it?