Uneven Skin Tone of the face can represent different skin conditions. We will describe this common occurrence in 3 categories. Firstly, patches of skin that is darker than your natural skin colour (hyper-pigmentation). Secondly, patches of skin that is lighter than your natural skin colour (hypo-pigmentation) or white patches (de-pigmentation). Thirdly, facial redness.
HYPER-PIGMENTATION (Dark colored patches)
There are many reasons of having darker patches on facial skin. See also brown spot/age spot.
Post Inflammatory Hyper-pigmentation
Darker skin patches can be a result of injury or inflammation to the skin. This is called post inflammatory pigmentation. It could be due to a skin disorder such as eczema, psoriasis or lichen planus pigmentosus. In addition, it could be due to trauma, treatments such as cryotherapy and surgery. Darker skin types can more susceptible to this type of pigmentation. If the pigmentation is superficial layer of the skin, then it could response to lightening agents such as Obagi and chemical peels. Avoidance of sun is a good idea to prevent worsening of pigmentation. If the pigmentation is deeper in the skin, then it would be difficult to remove or reduce.
Melasma
This is a common pigmentory disorder seen as irregular patches of cheeks in females. It can affect other areas of the face and rarely seen in sun exposed areas of the body. There is hormonal influence and melasma is most commonly starts during pregnancy or due to contraceptive use. Sun and heat (infrared) exposure is a major aggravating factors and should be strictly avoided where possible. This condition is very difficult to treat, options are topical lightening agents, chemical peels and lasers.
Solar Lentigo
This is a flat round or oval shaped uniform-coloured brown spot often seen in sun exposed area of the skin. They are often multiple, some larger and some smaller. They are caused by chronic sun exposure, and therefore, the cheeks and back of the hands are the most common areas to have these. They do not usually cause any itchy or pain or bleeding. If these symptoms occur, it is best to consult a doctor. Many treatments are available including topical lightening agents, cryotherapy, chemical peels and lasers.
Hori’s Nevus
This is sometimes mistaken to be solar lentigo of the cheeks. They are most commonly seen in young to middle aged East Asian females. There are multiple small brown to grey to greyish brown round or oval flat spots of cheeks. The pigmentation is deep in the skin and therefore do not response to topical treatment creams. This condition is best treated with a laser.
HYPO-PIGMENTATION or DE-PIGMENTATION (Light coloured patches or white patches)
Post -Inflammatory Hypo-pigmentation
Lighter skin patches can be a result of injury or inflammation to the skin. This is called post inflammatory hypo-pigmentation. It could be due to a skin disorder such as eczema or psoriasis.. In addition, it could be due to trauma, and treatments such as cryotherapy or surgery.
Pityriasis Alba or Hypo-pigmented Eczema
Low grade eczema can sometimes cause the skin to become lighter. In children, we call it pityriasis alba (scaly white patches). In older patients, the same process is called hypo-pigmented eczema. This is more common in darker skin types. The treatment would be sun avoidance, mosturizing and steroid or non-steroidal cream for the underlying eczema.
Vitilgo
This is a common disorder that causes white patches of skin. It affects 1% of the population in varying severity. It is more obvious in a person of colour. Treatment is not necessary if the discolouration does not bother the person or if the discoloration is in covered areas. This condition is usually treated with topical medications including steroid creams, tacrolimus cream (calcineurin inhibitor non-steroidal treatment), Ultraviolet B phototherapy and excimer laser. Sun avoidance is usually advised because of accentuation of the white patches when skin is tanned. Surgical option is not available in Ontario. Laser treatment in Ontario but it is not covered by the Ontario Health Plan. The areas that are usually resistant to treatments are lips, fingertips or toes, and genitalia. There is a potential new treatment which is under research development.
FACIAL REDNESS
Redness of the facial skin can be due to irritation, eczema, contact allergy, acne, rosacea and skin lupus (an autoimmune condition). It is important to establish a diagnosis with a dermatologist.
A gentle cleanser and emollient are recommended for patient with these conditions. Underlying conditions such as eczema should be treated with appropriate creams. If there is a suspected contact allergen (a product that causes allergy when applied to the skin), patient should withdraw the product and an allergy test called patch testing can be arranged if appropriate.
MW Skin Concept 