DR FLO: What can I do about my uneven skin tone?

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Darkening in some areas is caused by overproduction of melanin.

Monday July 23 2018

Dr Flo,

I have uneven skin tone especially around my eyes. I also have black patches which I didn’t have before. My legs (down from my knees) are darker than the rest of the body.

What’s the cause of this and is there any treatment? Liz

Dear Liz,
We get our skin, hair and eye colour from a pigment called melanin, which is produced by cells called melanocytes.

Skin colour depends on the number of melanocytes one has and their production of melanin. Darkening of the skin in some areas is called hyper-pigmentation and is caused by overproduction of melanin.

This can happen due to too much sun exposure, pollution, inflammation, skin disorders like acne and fungal infections. In women, hormonal changes can cause hyper-pigmentation, which is called melasma.

This can occur during pregnancy or when using hormonal contraceptives. Hyper-pigmentation can also be caused by cosmetics and creams, especially those that contain mercury.

There are some diseases that can lead to darkening of the skin e.g. diseases of the adrenal glands like Addison’s and Cushing’s disease; thyroid disease, diabetes, porphyria, haemochromatosis (iron overload), celiac disease, etc. These diseases have other serious symptoms and are diagnosed after appropriate examination and tests.

To manage the darkening of the skin, always use sun screen, use a scrub to exfoliate the skin regularly and see a skin specialist to get the right products for your skin.

It takes time for skin colour to even out, so be patient. It may be a month before you start to notice a difference and up to four months for the skin colour to become even.


Dr Flo, I had a large hernia surgery in November. I got diagnosed with GERD, gastritis, duodenitis and diabetes type 2. I have to take out my gall bladder too and I have a lot of gas.

I am in perimenopause and I have hot flashes, a tight head, anxiety and depression. I can’t get up early. The doctor gave me venlafaxine, but I can’t take it because it gives me gas and makes me burp.

When I lie down, I can’t sleep because of insomnia. I feel so horrible every day. I’m scared. What is happening to me? Help me, please. Anon

Dear Anon,
You have several issues that are causes for concern, but thankfully, they can all be managed.

GERD means gastroesophageal reflux disease, which means that acid and digestive enzymes from the stomach go back to the food pipe and cause irritation and inflammation.

Gastritis means that acid and some digestive enzymes are causing inflammation of the stomach lining.

Duodenitis means that acid and digestive enzymes are causing inflammation of the lining of the duodenum (part of the small intestines). Essentially, these three have a similar disease process and are managed similarly.

They can cause abdominal pain and/or discomfort, nausea, vomiting, a feeling of fullness, lack of appetite and a lot of gas.

Problems with the gall bladder can also lead to abdominal pain and a lot of gas.

The peri-menopausal state is responsible for the hot flashes. It may also cause mood changes, depression, anxiety, headaches, memory problems, joint pains and problems with sleep.

The lack of sleep makes you feel tired, irritable and worsens your mood. All these make you feel horrible. You can get hormone replacement therapy to help with some of the symptoms.

For depression, anxiety and insomnia, you would benefit from proper screening for anxiety and major depressive disorder.

You will be given medication that will help you sleep, improve your mood and reduce anxiety. If the medication has unpleasant side effects, let the doctor know so that you can get an alternative.

It would be advisable to see a mental health professional to get psychological support as you tackle the different health challenges.

It will also beneficial to get a daily activity schedule and stick to it, plan and eat healthy balanced meals; take enough water during the day but not in the evening, to avoid going to the washroom a lot at night; exercise (preferably in the morning) and practise sleep hygiene.

Sleep hygiene refers to practices that improve quality of night time sleep and contribute to alertness during the day.

How to sleep better
Make your bedroom a relaxing place with a good bed, and block out noise and light e.g. by using heavy curtains.

Sleep and wake up at the same time every day, whether it is a work day, weekend, leave day or holiday.

Try to sleep when you are tired or sleepy.

If you are unable to fall asleep after two or more minutes, wake up and do something boring or calming, with the lights dimmed, until you feel sleepy.

Avoid bright light and gadgets (like TV, computer, phone) or anything very interesting before bed.

A bath (one or two hours before bedtime) may help you sleep better.

Develop and follow a sleep time ritual e.g. shower at 9pm then read a book for 30 minutes, then pray for 10 minutes in the dark in your bedroom before you enter bed.

Keep your day time routine the same, whether you had enough sleep or not. Hopefully, by evening, you will be tired enough to have a good night’s sleep. Avoiding your day time activities or sleeping during the day may worsen insomnia.

Expose yourself to natural light during the day and keep the bedroom dark at night. The light and darkness will help your internal clock with the sleep-wake cycle.

Avoid using the bed or bedroom for work or watching TV.

Avoid caffeine or tea before sleep. Milk has tryptophan which is a natural sleep inducer, so taking a cup of milk may be helpful.

Avoid alcohol about four to six hours before sleep as it interferes with the quality of sleep.

Do not take a heavy meal just before bedtime.

Avoid sleeping during the day. If you have to, take one 20 to 30 minute nap before 3pm.

Do not watch the clock when you are unable to sleep. It adds to your stress and makes it more difficult to sleep.