From lasers to IPL to peels, There are many, many products and treatments to fight pigmentation, or hyperpigmentation, to give the patchy-skin issue its proper name. If you’ve noticed a sudden increase in dark spots and uneven skin tone, you won’t be alone: that’s a long, hot summer of basking in the sun’s rays coming home to roost. And you’re in luck because now is the time that some of the best skincare for pigmentation is around and innovative pigmentation treatments are being launched.
Finding your way through the maze of available products isn’t easy, so we’ve created the ultimate guide to the best skincare for pigmentation for you, while deep-dives into pigment-busting power ingredients tranexamic acid and best high strength vitamin C serums are also worth a read if you want to fade those pesky blotches.
However, dark spots and other forms of pigmentation such as the hormonal skin condition melasma are deep-seated issues that skincare can only do so much about. Of your blotches are advanced and they bother you, you may want to look into professional treatments for pigmentation. These won’t magically wipe your discolouration away either, but with a careful and consistent treatment plan, they can successfully suppress it long-term.
There is a serious caveat, though: the wrong treatment can actually make your hyperpigmentation worse. Laser and light treatments for example, while very successful in fading individual pigment patches, should “never, ever be used to treat melasma,” says consultant dermatologist Dr Alexis Granite. “If you do, it’ll just come back worse.”
So below, we will look at the most common forms of pigmentation and with the help the country’s foremost experts, select a professional treatment for each that offers the greatest chance of success while posing the smallest risk.
But first, let’s answer a few of the most often-asked questions about pigmentation and the treatments that fight it.
Why do you get pigmentation?
There are three main types of pigmentation, says Dr David Jack, “Solar lentigines (sun damage), melasma (hormone-related pigmentation) and post-inflammatory hyperpigmentation or PIH (pigmentation caused by inflammation or injury)”.
- Sun/ UV rays: they are the main cause of hyperpigmentation and present every minute of every day, but the brighter the sun shines and the more you sunbathe the more uneven pigmentation your store up just below the skin surface. Trust us, even if you can’t see it now, you will in years to come. So we’ll say it again (and again): the best way to stave off uneven pigmentation is to use an everyday SPF, preferable SPF50.
- Hormonal imbalances (pregnancy, Pill, menopause)
- Any injuries (particularly acne marks)
- Illness and certain medications, such as Prozac
- Aggressive skincare or treatments that ‘injure’ the skin too much
The cause of the pigmentation determines how stubborn and deep-seated it is, and this in turn determines the right course of treatment. Not only is the treatment different for each type, but the outcome that can be expected is also.
Can pigmentation be cured permanently with a professional treatment?
Generally, no. “Some very superficial patches of sun damage might disappear permanently. But in most cases, the best you can expect is significant reduction of the hyperpigmentation, which then has to be managed permanently with top-up treatments and a daily high SPF,” says Dr Jack.
Once you have pigmentation it will “always lie in wait” says oculoplastic surgeon Dr Maryam Zamani: “With consistent treatment, hyperpigmentation can be suppressed and therefore kept out of sight long-term. But once you have it, most types of pigmentation will always lie in wait. If you re-activate the trigger that brought it on in the first place (such as sun exposure), it can come back in a flash, even after months or years of skin tone-evening treatments.”
Will laser or IPL treatment get rid of pigmentation?
Zapping pigmented blotches caused by sun damage (those solar lentigines) with laser energy or Intense Pulsed Light can be very effective in significantly fading these marks and in some cases entirely removing them over a course of treatments. But you’ll need regular top-up treatments every six to 12 months to keep further pigmentation at bay. The two work in a similar way but are suited to different types of pigmentation.
Will treatments to fight pigmentation make it worse before it gets better?
Any treatment designed specifically to increase cell turnover, transferring cells from the deeper skin layer (the dermis) up to the surface, will ‘push out’ pigmented cells and make your dark spots look worse before your system eventually sheds them, says aesthetic physician Dr Paris Acharya. “You’ll see this specifically with professional skincare such as hydroquinone and retinoic acid creams, and with deep professional peels.”
If you’re having laser, IPL or energy-based treatments such as radiofrequency microneedling, to treat superficial (epidermal) pigmentation, patches in most cases will get quite dark before peeling off: the treatment has killed off the pigment on the skin surface and the dead cells are being sloughed off. But this is a matter of only a few days, rather than weeks or months as will be the case with treatments for deeper pigmentation.
How do I know if my pigmentation is superficial or deep?
Dr Paris says that you can lightly stretch the skin to see if it pales, indicating surface pigmentation, but really this is not an assessment you should try to make yourself. Superficial epidermal pigmentation may be caused by short-term inflammation or short-term sun exposure. Deep dermal pigmentation is often due to damage from prolonged sun exposure, while melasma, set off by hormones and heat, is a particularly deep-lying type of discolouration. “It’s extremely difficult to assess these differences yourself,” says Dr Acharya. “Leave it to a pro, who can then advise the right treatments to fight pigmentation for you.”
When should I worry about skin pigmentation?
Most pigmented patches (known as lesions) are harmless, but that doesn’t mean you should be gung-ho in having them zapped by someone who isn’t a skin expert. Heat-based treatments can actually activate pre-cancerous cells, while cancerous lesions may not be recognised by an untrained therapist and partly removed, causing them to quietly develop without you noticing. So it is extremely important to have your brown spots assessed by a doctor – preferably a dermatologist or skin cancer specialist – before subjecting yourself to any treatments to fight pigmentation.
Are there clinic treatments to fight pigmentation on the body?
Most pigmentation treatments for the face can also be used on the body, but because of the large treatment areas such as the legs or chest, they are often a tad more expensive than facial pigmentation treatments.
“Every area of the body will respond differently to treatments,” says skin and laser specialist Debbie Thomas. “The chest, where the skin is thin, is far more sensitive and reactive than the face, so it needs a lighter touch to avoid damaging the area.”
We’ve seen some bad damage on colleagues whose décolletage was treated too aggressively by a not-so-reliable therapist, so Thomas is not lying. “The further away from the heart, the slower the healing,” she continues. “So hands and feet heal the slowest; treatment should be slow and steady.”
The best clinic treatments to fight pigmentation on the face
Best treatment to fight pigmentation caused by sun damage: Lumecca IPL, from £450 per treatment at Dr David Jack Clinic
Why? “For treating photodamage (ie sun damage)-related hyperpigmentation - also called solar lentigines, or age spots - Intense Pulsed Light is my treatment of choice. The Lumecca machine offers the most advanced and most powerful technology in this field,” says Dr Jack. “It also has a large treatment head, so you can treat areas of diffused, mottled pigmentation fast.”
The light energy is attracted to and absorbed by the pigment in the skin, which then gets destroyed. The ‘debris’ gets removed from the skin by the body’s systems over the course of a few days. Because of the intensity of the energy, IPL (there are many different IPL machines, all roughly doing the same thing) is not suitable for pigment patches caused by inflammation, as these would only get aggravated. IPL is not right for dark skin tones (types V and VI on the pigment scale) as it may cause burns in the area around the pigment patch.
How many treatments? Usually between two and four (full results after each treatment are seen at ten days), with top-ups every 6-12 months
Does it hurt? You’ll feel snaps, as from a hot elastic band, but it’s bearable, and there is a slight ‘sunburn’ feeling afterwards
Downtime? There can be some swelling and occasional bruising. Treated patches will get darker before the dead skin naturally flakes off or is absorbed by the body
Alternative treatments for sun spots: Any other IPL device including BBL (Broad Band Light, see below) and certain lasers. Lasers are more focused and targeted than IPL, making them great for individual moles and age spots.
Best treatment to fight pigmentation due to melasma: Dermamelan professional peels, about £1250 for the package. Look on Mesoestetic for your nearest provider
Why: Melasma is a chronic condition where discolouration is caused by a combination of pigmentation and dilated veins caused by inflammation. This means treating it is very tricky because anything too powerful will break up the melanin faster but exacerbate the redness and make matter worse. High-energy devices are therefore mostly avoided, and a combination of professional peels and prescription pigment-fighting skincare is the gold standard. The medium-depth Dermamelan Peel mask is widely considered to be one of the best treatments for melasma. It’s a blend of tyrosinase inhibitors (they suppress melanin) and exfoliating acids that, in the words of Dr Granite, “will make your face fall off, but it works.” You’ll need to follow the peel up with Dermamelan home care products for several months. A second peel is often advised, and follow-up appointments to check progress are also important, so Dermamelan is often offered as a treatment package
How many treatments? One, but a second one may be advised
Does it hurt: No
Downtime? A week of tightness and intense redness, peeling and flaking will have to be endured
Alternative options: Dr Jack will combine a course of prescriptive pigment-suppressing skincare with “a series of microneedling treatments. These can be surprisingly effective for any skin type and colour, and the risk of side effects is very low,” he says.
Debbie Thomas relies on a careful ‘chip-away’ approach with relatively mild peels (no-downtime Dermaceutic Mela Peels, of which 4-8 are required) combined with AvaTX yellow laser. “It creates minimal heat and primarily targets the vascular element that triggers pigment production, which is why it, uniquely, works on melasma,” she says. “It suppresses pigmentation, rather than attacking it.”
Why: “As with melasma, powerful treatments are not necessarily better when it comes to PIH, as there is an inflammatory aspect here,” says Dr Jack. “So the first line of treatment would certainly not be IPL or lasers.” The consensus among skin professionals is to play it safe with peels and prescription skincare. Dr Sophie’s approach involves an in-clinic retinol and AHA peel, followed by a healing hydrating mask and calming LED light. You are sent home with the Cyspera Intensive System, a three-step regime that is clinically proven to reduce pigmentation by an average of 42%. An in-clinic review will follow after a month, with a prescribed at-home regime at an additional cost.
How many treatments? One
Does it hurt? No
Downtime? Potential redness, dryness and mild irritation which should disappear quite fast
Alternative options: Dr Jack says “I would always start with a 6-8 week programme of tyrosinase-inhibiting professional skincare (it stops the formation of melanin) with ingredients like hydroquinone, tranexamic and azelaic acid. I’ll prescribe these in a bespoke skincare preparation.” After this kind of intensive prep, he says, IPL may be used on PIH patches, “but please choose a very experienced doctor who knows what they’re doing.”
“Calming” yellow lasers can also be used, says Thomas, as can, says Dr Jack, low-energy lasers such as the Nd:YAG set to a high wavelength (1064nm). “This means they don’t interact strongly with melanin in the skin, but focus more on vascular (red) lesions. In most cases, however, these won’t shift very stubborn pigment.”
Why: IPL and laser treatments are, in principle, a definite NO if you have skin that is darker than pigmentation level IV: laser light is drawn to the pigment in the skin, so there needs to be a marked colour contrast between the pigmented lesion (spot) and the ‘healthy’ skin for the light to zap only the lesion and not the surrounding skin. When skin is very dark, this is not the case, so laser and IPL isn’t safe. Except, says Dr Zamani, with BBL: “This IPL device has a 590nm wavelength that regular IPL does not have which allows pigment to be targeted in darker skin tones.” But, she cautions, it’s not for all types of pigmentation in dark skin: “I like to use it for sun damage, or age spots,” she says. You also want to make sure your doctor is extremely experienced if you’re going to have this treatment. For melasma or PIH in dark skin tones, consider the alternative options below.
How many treatments? 2-4 treatments, four weeks apart, with biannual top-ups
Does it hurt? The zaps can smart, so topical numbing cream might be applied
Downtime? You’ll have red patches on your face which will turn to scabs; Dr Zamani says there’s “24 hours of social downtime.”
Alternative options: Dr Jack’s treatment of darker skins “would depend on the type of pigmentation, but would always start with a 6-8 week course of tyrosinase-inhibiting skincare to fully prep the skin – this is very important,” he says. “I then follow that up with chemical peels, such as TCA peels for sun damage, microneedling for melasma, and anti-inflammatory brightening topicals such as azelaic acid for post-inflammatory pigmentation.” Thomas is also a fan of peels or microneedling to treat pigmentation in darker skin, followed by scrupulous prescriptive home care