The DM:
Dear derm,
What’s the best product or treatment for uneven skin tone?
Sarah C
The Derm:
Dr Aamna Adel, Consultant Dermatologist at 152 Harley Street.
The Diagnosis:
Dear Sarah,
Uneven skin tone is very common and can be due to a range of reasons. The first thing to do is to try and understand what is causing it for you (which we cover below) and work on preventing triggers. Next, there are some key ingredients and steps you can take to help improve the look of uneven skin tone.
Here's what you need to know…
What causes uneven skin tone?
UV is probably one of the biggest elements and it's around all year long – it's not something that we only see in the summer. We know that even on cloudy days, there's an element of UV and that's the biggest contributing factor to why someone may have an uneven skin tone or dark spots. Elsewhere, hormonal changes can trigger uneven skin tone. Often in pregnancy women will notice that they get melasma (or dark spots), which can occur anywhere on the face, but characteristically appear in a moustache shape or on or cheeks. Also, post-inflammatory skin tone is very common, so if you're someone that's had acne, after that initial inflammation and redness has gone down, you might be left with sort of a dark spot. Those tend to be the common reasons why people have an uneven skin tone.
Prevention is better than cure
One thing everybody can benefit from using is sunscreen. People already know that it protects your skin, but it's actually really great for improving uneven skin tone and actually preventing it from recurring. You could use all the different ingredients in the world – like retinol, vitamin C and exfoliating acids – but if you're not using a sunscreen, you're undoing all the work that you've done. That's because UV from the sun is probably one of the biggest contributing factors towards why you've got an uneven skin tone to begin with, alongside other things like post-inflammatory marks from acne or hormonal changes. So, sunscreen is the really key thing that you want to make sure that you have in your routine. I think tinted, mineral sunscreens are much better than regular sunscreens overall because they also help to block visible light. Look for a broad spectrum SPF 50.
While, as mentioned, SPF is great, even the highest level of SPF that you choose won't block one hundred percent of UV rays. So there are other things that you can be doing to provide physical protection. For instance, try wearing a hat or covering your arms or your hands if they are an area of concern. You can pick up UV protectant gloves, wear sunglasses, and also seek shade and stay out of the sun during times where UV is really high (between 11am-3pm). If you are continuously blocking UV from getting into the skin, you can actually lessen the amount of pigmentation that you have on your skin as a result.
The other thing to mention is that for some people with melasma, having an increase in body temperature can bring on or worsen the condition, so keeping cool, using fans and not sitting in front of heaters can also be really helpful in combination with seeking shade and wearing sunscreen.
For clients who come to my clinic with acne pigmentation, the most important course of action is to get the acne under control because if you're continuously getting new spots, you are forever going to be in the cycle of having recurrent hyperpigmentation. So I always say let's look at ingredients that are going to tackle both the hyperpigmentation and the acne (more on that below).
Accessing expert help is easier than you'd think
If you're really confused, speak to an expert who can help guide your skincare routine. There are now loads of platforms online, like Klira, Dermatica and Skin + Me that all do prescription treatments. You don't need to actually go and see a derm to get a prescription and they do virtual consultations. So it's much more accessible now than it was five years ago.
Ingredients to consider
In terms of skincare, I would recommend retinol or tretinoin (which needs to be prescribed by a qualified dermatologist or GP), which both increase cell turnover. They’re fantastic ingredients for pigmentation, but it's important to go low and slow – you don't want to overdo it. Start with using one or the other one to two times a week and gradually build that up.
Other actives that are really useful for an even skin tone are things like exfoliating acids. However, you don't want to start those at the same time as your retinol. I’d recommend introducing the retinol first, getting used to that for a couple of weeks, and then bringing in an exfoliating acid. It doesn't really matter so much which one you go for – there’s so many. You’ve got azelaic acid, alpha arbutin, kojic acid, tranexamic acid. It's really a case of just starting with one and seeing how you're getting on. But a good way of choosing is to base it on your skin type. If you're oily, try salicylic acid. If you've got more combo or normal skin, try glycolic acid. And if you're someone that's more dry and sensitive, go for something like mandelic acid or lactic acid. They tend to be a lot gentler for more sensitive skin. Also think about, for example, if you're someone that has also got acne, with pigmentation. I would recommend using ingredients like retinoid, azelaic acid or niacinamide because they also have the added benefit of being acne fighting.
Choose multi-hyphenate treatments
We obviously have prescription treatments that we can give to people in-clinic, that combine some of the ingredients that we've spoken about (for instance, tretinoin with salicylic acid, plus hydroquinone), but even on the market there's some really great serums that combine a few of the ingredients that tackle dark spots so that you're hitting it from different angles, which means less steps.
Anua has got a niacinamide tranexamic acid serum, which is really great at helping with dark spots. And Topicals has a fantastic dark spot serum that blends kojic acid, azelaic acid, niacinamide and tranexamic acid.
Got a skin question for our derms? Drop us a DM at @glamouruk.
