Uneven Skin Tone and Texture: Melasma, Rosacea, Age Spots, and More

Uneven pigmentation and skin texture issues are common and can occur for a number of reasons. Hyperpigmentation is the most common cause of uneven skin tone and texture, which is due to excess melanin production in the skin. Other causes range from hereditary skin conditions to lifestyle choices, acne and scarring, and hormonal changes. Dark spots, rough, bumpy, or reddish areas can be unflattering, distressing, and in some rare cases, dangerous. Finding the cause of your uneven skin tone or texture is the first step towards getting the treatment you need to resolve it.

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Most people have uneven skin tone to some degree, whether it’s a slight darkening around the mouth or cheeks from sun exposure or highly pigmented splashes of color from a medical condition or disease. Similarly, unbalanced skin texture that is dry, scaly, or rough in spots is another frequently discussed symptom of patients, which can come from a wide variety of sources.

Although there are other causes of uneven skin tone and texture, the most common causes for both symptoms are hyperpigmentation--a skin condition where dark spots or patches appear due to excess melanin, and for unbalanced skin texture, lack of hydration in the skin. In uneven skin tone, too much melanin in an area of the skin can happen after skin damage due to sun exposure or smoking, illness or disease, or an injury to the skin, while lack of hydration can lead to rough, dry skin in patches from the lack of moisture retention in the skin as we age, to insufficient water intake in the diet.

Sometimes, hyperpigmentation and uneven skin tone or texture can be symptoms of underlying congenital diseases or other illnesses. In most cases, however, hyperpigmentation and skin texture symptoms are painless and physically harmless, but can dramatically affect the appearance and self-esteem of the patient.

Additionally, hyperpigmentation and skin texture issues are usually very treatable, whether the condition is acquired from sun exposure, diet, acne scarring, or congenital disease or condition.

This article will go over some of the most common causes of uneven skin tone and texture, what you can do to prevent hyperpigmentation and other skin tone issues, and what you can do to resolve the issues once spots or other pigmentation problems have appeared.

The Signs, Symptoms, and Causes of Uneven Skin Tone and Texture

Determining the cause for uneven skin tone can be complicated, and requires a thorough examination from a licensed and qualified dermatologist for an accurate diagnosis. In many cases, the cause of discoloration or less-than-uniform skin textures are unknown but can usually be treated successfully with the help of a medical professional.

The signs and symptoms of uneven skin tone and texture issues can range from slightly noticeable and harmless, to obvious and even dangerous. Minor uneven skin tone and texture issues that are not categorized as medical conditions can be bothersome to those that have it, with light age or sun spots, rough patches, and other common problems as some of the most frequently discussed complaints heard in dermatologists’ offices across the country.

When a skin condition is more severe, however, signs and symptoms can be much more apparent and noticeable. In general, patients with uneven skin tone and texture should look out for the following symptoms of these common skin conditions and diseases and consult with a doctor for a complete evaluation and diagnosis.

Here are some of the most common types of hyperpigmentation and skin texture issues seen in patients across the country, along with the signs, symptoms, and causes of each condition.

Post-Inflammatory Hyperpigmentation: Acne scars are one of the most common causes of hyperpigmentation in patients. Post-inflammatory hyperpigmentation describes dark spots that are sometimes left behind after an inflammatory wound on the skin has healed, often caused by acne breakouts or from picking at acne lesions (causing scars).

Dark spots caused by post-inflammatory hyperpigmentation are often flat, dark brown, red, gray, black, pink, or purple. When the skin heals from the inflammation, excess melanin is produced to aid the body in its recovery. As a result, the affected area is discolored—which is usually permanent, though skin discolorations can fade over time.

This type of discoloration can also appear after cosmetic treatments such as chemical peels, dermabrasion, or laser treatments—usually as a result of poor, unprofessional practices or on candidates with darker skin tones unsuitable for these types of procedures.

Age Spots: Solar lentigines, also known as age spots, have many names—including liver spots, dark spots, and sun spots. These dark patches are caused by sun damage as we age, which tend to darken over time and are most noticeable and pronounced in older patients. Age spots are most commonly seen in people with lighter skin colors, though they can affect all types of skin colors. Symptoms usually appear as increased pigmentation in small spots or patches that are flat, oval-shaped, and beige, black, or brown-colored. You’ll usually find age spots in areas that have been most exposed to the sun over many years, on the face, shoulders, hands, arms, and chest.

Sun Damage: Excessive exposure to the sun can result in skin damage, which can also result in discoloration and a change in skin texture when the body begins producing excess melanin to protect it from harmful UV rays. Aside from age spots, sun damage can present itself in a variety of harmful ways, including sunburn and peeling, skin dryness, and the darkening of freckles.

A particularly dangerous symptom of sun damage is actinic keratosis, a condition where rough, scaly, red patches of skin appear after excessive sun exposure. Patients that develop this skin texture change are often at a higher risk for developing skin cancers and tend to be lighter complected, blonde or red-haired individuals.

Melasma: Melasma, or chloasma, is a dark patch of skin that appears over the cheeks, nose, upper lip, and the chin, and less commonly, on other areas of the body like the legs and the arms that are frequently exposed to the sun. Only 10% of those that are affected by melasma are men, as women are much more likely to develop this condition, often during pregnancy. For this reason, it is often referred to as “the mask of pregnancy” and is thought to be caused by a change in hormones, among other factors.

Melasma is one of the most difficult pigmentary issues dealt with by as many as five million Americans, mostly women. Melasma symptoms are purely aesthetic and otherwise harmless. Some signs of melasma are gray, brown, or light-beige patches appearing on the chin, cheeks, upper lip area, the nose, and the forehead, usually during pregnancy or other hormone-related changes in the body.

When uneven skin tone and texture symptoms occur for other reasons than hyperpigmentation, the condition that causes it is sometimes (but not always) a more serious complication. In all cases where pigmentation symptoms are present, it’s important to seek medical advice from a licensed, professional dermatologist for evaluation. Here are some of the most common non-hyperpigmentation disorders that cause uneven skin tone and texture:

Broken Capillaries: When capillaries or blood vessels on the face erupt or become enlarged, the result is can be highly visible and unattractive reddish lines that appear under the surface of the skin. Broken capillaries are best described as “spider veins”, or red, spider web-shaped patterns visible underneath the skin surface, and can be found anywhere on the body. Usually, broken capillaries are found on the face or the legs, and do not cause symptoms other than the change in the appearance of the skin.

Broken capillaries are the result of an eruption of blood vessels on the face, which can happen for a variety of reasons. These include genetics, pregnancy, excessive sun exposure, extreme weather changes, injuries, allergic reactions to chemicals or environmental irritants, alcohol consumption, vomiting, and sneezing. Broken capillaries can also appear as a secondary symptom of rosacea. Patients with lighter skin tones are more likely to notice broken capillaries, though they can appear on anyone.

Vitiligo: In contrast to hyperpigmentation caused by an overproduction of melanin, Vitiligo is a skin condition that results in the loss of pigmentation of the skin. This happens when the cells that normally make melanin stop producing it, causing lighter skin to appear in blotches anywhere on the body.

Rosacea: Rosacea is a chronic skin condition, where patients have flare-ups of flushed, reddish-toned skin on the face, with enlarged blood vessels and sometimes red, pus-filled bumps around the nose, cheeks, and chin. The symptoms of rosacea can come and go, appearing for weeks to months, and returning sometime later. Signs and symptoms of rosacea usually include swollen blood vessels on the nose and cheeks, sensitive skin, and a general redness in the center of the facial areas that may feel hot or swollen. This may or may not include small bumps with or without pus with a skin look similar to acne. About 50% of all rosacea patients report eye irritation, dryness, swelling, and redness of the eyes and eyelids.

While anyone can develop rosacea symptoms, it’s most commonly found in middle-aged women with lighter skin tones. In more severe conditions (that affect mostly men), rosacea can cause a rare symptom where an excess build-up of tissue forms over the nose and cheeks, and the nose begins to deform into a more bulbous shape. This is called rhinophyma and is caused by the enlargement of the oil glands in those areas.

While the actual cause of rosacea has yet to be determined, most medical professionals believe that the symptoms are caused by a variety of factors including genetics, lifestyle habits, and others. Some of these triggers that are most closely connected with flare-ups include alcohol consumption, too-hot or too-cold weather conditions, over-exposure to the elements, physical exercise or exertion, allergic reactions to skincare products like cosmetics, lotions, or creams, spicy foods, and medications. Another factor thought to trigger outbreaks of rosacea are emotional outbursts of anger, sadness, embarrassment, or joy.

It is worth mentioning that rosacea is not known to be caused by poor hygiene and is most often found in those over the age of 30 years old. Anyone can develop rosacea, though it’s most commonly found in middle-aged women with lighter skin complexions, smokers, and those with a family history of the skin condition.

Fungal or Bacterial Infections: Discoloration of the skin can happen when there is a fungal or bacterial infection affecting the area. Cuts, scrapes, and other openings on the skin can become infected with bacteria that changes its color and texture, or with a fungal infection like tinea versacolor, ringworm, or candida infections.

Skin Cancer: Another cause of discoloration of the skin happens when lesions on the skin are cancerous. This may become apparent when a lesion changes in shape, size, or color, as in melanoma, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, and other cancerous lesions.

Pathophysiology of Uneven Skin Tones

In the human body, there are more than 150 genes that have been proven to regulate pigment in the skin—which is why there can be so many different reasons that attribute to the development of uneven skin tones. The most important and influential of those genes in regards to skin pigmentation are melanocytes, which produce melanin, and the keratinocytes that receive the melanin and deliver it to the skin’s surface. Another essential factor in skin pigment regulation of the body are fibroblasts, the cells that are responsible for collagen production and connective tissue in response to skin injuries. Endocrine can also influence pigmentation, while other neural and inflammation-related causes can also produce changes in the color of the skin.

When the body is processing normal levels of melanin in the skin, the result is an even, uniform color throughout the skin. If there is an overproduction of melanin, however, the skin’s tone will be uneven in the affected areas which are generally considered to be undesirable and unflattering.

Excess melanin production happens for several reasons, most commonly as a response to solar damage from UV rays. When unprotected skin is exposed to the sun, melanin production kicks into overdrive in that area in an attempt to shield the skin from damage. Hormonal changes in the body can also affect normal production levels of melanin, as can skin injuries and certain medications. In most cases, excess melanin and hyperpigmentation are directly caused as a result of the body’s natural attempt to heal itself or to protect itself from harm.

How to Treat Uneven Skin Tone and Texture: Procedures, Products, and Home Remedies

Most skin tone and texture conditions are cosmetic, and unless they’re symptoms of a more serious condition like skin cancer, they are relatively harmless. But even if they don’t cause pain or physical discomfort, having irregular pigmentation problems can be quite distressing—especially when affecting areas of the body that are most visible to others, like the face.

Luckily, many different treatments and procedures can effectively treat uneven skin tone and texture, even for dramatic cases of melasma or rosacea. From home care and DIY facial treatments for minor corrections to in-office and clinical procedures with a licensed dermatologist, most people have several options for treating their skin pigmentation irregularities and do not have to live with an unattractive skin tone or less-than-smooth skin texture.

Here are some of the many treatment options available for reducing or eliminating minor to major cases of uneven skin tone and texture:

Laser Skin Resurfacing: Laser skin resurfacing is a cosmetic procedure designed to rejuvenate the skin. The technique uses either an ablative or non-ablative, fractional or non-fractional laser tool to eliminate to remove damaged layers of skin. Laser resurfacing treatments can address all uneven skin/tone texture concerns, however, the type of laser, whether ablative or non-ablative and fractional or non-fractional, are each suited to address different symptoms. In other words, the type of laser used will vary depending on the severity of skin concern or if the treatment is preventative or reactionary.

The four types of lasers used in laser resurfacing to reduce or eliminate the appearance of various skin pigmentation conditions (from the most invasive to the least invasive) are: non-fractional ablative, fractional ablative, non-fractional non-ablative, and fractional non-ablative.

Non-ablative lasers are generally less invasive than ablative lasers, which use dermal heat to remove the deeper layers of the epidermis. Non-ablative laser treatments pose less of a risk for epidermal burning or other complications, though results will be less dramatic in cases where hyperpigmentation, discoloration, or skin texture issues are more severe. Similarly, non-fractional lasers are more invasive as they treat entire areas of skin at once, as opposed to fractional lasers, which very small target points of skin in a contained fashion.

In general, non-fractional ablative and fractional ablative, the most invasive types of lasers, are used in cases where dyspigmentation, hyperpigmentation, and other skin tone and texture conditions are the most severe. Meanwhile, non-fractional non-ablative, and fractional non-ablative lasers, which are gentler and less invasive, are used to correct minimal pigmentation and texture issues.

It should be noted that there is a higher risk for PIH (post-inflammatory hyperpigmentation) to occur as a complication of ablative forms of laser therapy, especially in patients with darker skin. For best results, talk to a reputable dermatologist about your best options for treatment with laser resurfacing, and the possible risks to consider for each option.

Dermabrasion: Dermabrasion is another technique that dermatologists use to scrape dead and damaged skin cells from the skin’s surface. This cosmetic procedure is meant for deep correction of facial flaws for patients with intense skin damage, including deep wrinkles, sun damage, heavy acne scarring, and uneven skin tones.

Chemical Peels: Chemical peels are a very effective technique used for removing layers of skin from the patient’s face. Patients will be given light, medium, or deep peel depending on the severity of their facial damage designed to even out skin tone and texture, eliminate wrinkles and expression lines, and generally improve the appearance of the skin.

Facials: Aside from the relaxing factor of facial treatments, skin brightening facials are a popular way to flood the skin with nutrients and hydration, which can help to temporarily even out the skin tone while improving its texture, among other benefits.

Microdermabrasion: Microdermabrasion is a quick, in-office procedure that uses a special tool to exfoliate the skin, reducing the appearance of minor skin flaws, including dark spots.

Microneedling: The goal of microneedling is to activate the body’s natural reaction to injury by puncturing the skin. The process uses tiny pinpricks with the micro-needle to stimulate the production of collagen and elastin for healthier, younger looking skin. The technique is believed to improve minor skin flaws, and to reduce the appearance of wrinkles, fine lines, and skin tone irregularities.

Skincare Products

Dermatologists can prescribe topical agents with ingredients like hydroquinone, tretinoin, hyaluronic acid, and cortisone for symptoms of hyperpigmentation. Vitamin C serums, gels, and creams are also recognized as helpful in the fight against dark spots and other pigmentation issues. All skincare products with active ingredients like hydroquinone, tretinoin, cortisone, hyaluronic acid, and vitamin C should be used under the care and guidance of a licensed dermatologist, as the improper or extended use of these treatments can sometimes cause hyperpigmentation symptoms to appear or to worsen, especially in patients with darker skin tones.

Home Remedies

When it comes to treating hyperpigmentation and other cosmetic skin conditions, patients will find much more success in treating discoloration or skin texture under the care of a professional and licensed dermatologist. While DIY home remedies do exist, little research has been done to prove that they are effective in treating skin irregularities. Some of the methods are questionable in the short-term effectiveness and/or the long-term benefits they offer, and in some cases can do more harm than good. Therefore, patients should proceed with caution when trying out home remedies as a medical or skincare treatment of any kind, and should always consult with a doctor before applying any treatments on the skin.

That said, in some cases where symptoms are very mild, minor skin tone irregularities are often treated at home with a variety of home remedies and DIY treatments. While these remedies may not be as effective in improving skin that has already seen signs of hyperpigmentation or skin texture changes, they can be somewhat effective when used as a prevention for the future development of hyperpigmentation or skin texture issues. Some popular methods for evening out skin tone and texture in facial areas include making exfoliants, face rinses, and toners using typical ingredients that can be found right at home.

Some of the most commonly used treatments for do-it-yourself skin tone correction include the following:

Baking Soda Exfoliant: Make a paste using a tablespoon of baking soda and a few drops of water. Stir the two together until the mixture forms into a thick substance. Smear the paste evenly all over the face and gently scrub the mixture to eliminate dead skin cells. Leave the paste on the face for a few minutes, then rinse off with warm water. Repeat a few times a night to even out the skin tone with a brighter complexion.

Sugar and Olive Oil Scrub: Sugar is a wonderful exfoliant, while olive oil is a magnificent moisturizer. Combining the two results in a scrub that can remove dead skin cells and even out skin tone and texture. To make the scrub, simply measure a teaspoon of olive oil with a teaspoon of sugar, and massage all over the face. Massage for at least a minute or two, and rinse off the mixture with warm water. You can also use coconut oil in place of olive oil, or add a splash of lemon juice for extra skin brightening, according to your preferences.

Apple Cider Vinegar: A splash of apple cider vinegar after cleansing the skin works as a very effective toner treatment, dark spot corrector, and as an anti-inflammatory and anti-bacterial solution. It can also help prevent acne, unclog and tighten pores, and transform dull skin into glowing skin, all while evening out your skin’s tone and texture.

How to Prevent Uneven Skin Tone and Texture

The most common cause of hyperpigmentation of the skin is excessive sun exposure, which means that your most important defense against pigment irregularities is to wear sunscreen and stay out of the sun as much as possible. Applying a high SPF sunscreen product before going outside, along with a wide-brimmed hat, or reducing the amount of time you spend in the sun will help to prevent further skin damage and can even out your skin tone over time.

Another important way to promote skin health is to drink plenty of water. Water is purifying for the body and works to flush out toxins and free radicals from the system, combat dry skin, unclog pores, and improve skin tone and texture. It’s recommended that people drink 8-10 glasses of water daily for maximum health benefits, including improved skin appearance and texture.

Getting enough sleep is another way to improve the dull appearance of the skin and to prevent the development of skin pigmentation issues like uneven skin tone. In general, adult men and women should aim to sleep between 7-8 hours every night, though this number will vary according to your individual body’s needs.

The last and final tip for preventing uneven skin tone and texture is to visit your dermatologist with your concerns. Adhering to a personalized skin care routine early and sticking to it will help you age gracefully and beautifully as you get older. For best results, consult a licensed, registered dermatologist recommended by the American Academy of Dermatology, or the American Dermatological Association.

Popular Myths and False Beliefs

There are many misconceptions about people with uneven skin tone and texture conditions, some of which have been around for ages. One of those popular beliefs is that men and women with dark skin tones do not have to wear sunscreen as the extra melanin in their skin naturally protects them from the sun. This belief is also related to the idea that men and women of color are not susceptible to developing hyperpigmentation from unprotected sun exposure in the form of age spots, liver spots, sun spots, and other forms of skin damage.

While it is true that people from different ethnic backgrounds age differently, people with all skin types and colors should wear sunscreen and avoid excessive sun exposure. While extra melanin found in darker skin tones can protect from harmful UV exposure to a greater extent than those with lighter skin tones, darker pigmentation can also mean a higher risk of dyspigmentation—or irregular pigment distribution.

Another common myth about uneven skin tones is that melasma is exclusively caused by pregnancy. While this chronic skin condition is known to appear frequently in pregnant patients, pregnancy is not the only factor for triggering melasma. In reality, melasma can occur at any time that the melanocyte cell is pushed into overdrive. This can happen for a vast number of reasons, including genetics, hypothyroidism, medications, and birth control pill usage, lack of sun protection, and hormonal changes (which often occurs during pregnancy).

Rosacea is a vascular, inflammatory condition that is frequently associated with untrue myths and false beliefs. To start, it’s commonly believed that rosacea is triggered by poor hygiene, which is untrue. Too much cleansing, exfoliating, and scrubbing of the areas where rosacea erupts can make it worse, which is another reason why it’s so important to spread awareness about this skin condition. Another rosacea myth is that the condition is contagious, and yet another says that it’s caused by heavy drinking or alcoholism. Both of these widespread beliefs are untrue.

Conclusion: Finding a Dermatologist for Uneven Skin Tone and Texture

If you’re concerned about your uneven skin tone or its irregular texture, finding a dermatologist you can trust is your first step towards achieving healthier looking skin. A professional and knowledgeable dermatologist from an established medical society like the American Board of Dermatology can help you determine the reason for your uneven skin tone, and how to best solve the underlying issues that are causing the problem.

To find the best doctor you can to help you identify and properly resolve your skin tone issues, look for a professional with the right certifications and licenses to practice dermatology in your state. If you’re particularly interested in finding a dermatological surgeon for possible laser skin resurfacing, chemical peel, dermabrasion, or other skin tone-restoring treatment, check with the American Society for Dermatologic Surgery for recommendations on experts of these procedures in your area.

Whether you are in advanced stages of rosacea or dealing with hyperpigmentation and sunspots, rest assured there are plenty of options available that can successfully treat uneven skin tone and texture problems of all kinds. Take the time necessary to research your area’s dermatologists thoroughly, to find the one that will best treat your particular case. You don’t have to live with uneven skin tone problems, and finding the right doctor for you and your skincare needs is the key to ridding yourself of the embarrassment (and potential dangers) of uneven skin tone symptoms.

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