Dark spots, discolouration, and scarring – pigmentation is a common skin complaint but one that can be difficult to treat. I see a lot of patients in my clinic troubled by uneven skin tone. And many have spent a small fortune on various treatments and products with little impact because they either haven’t used them correctly or aren’t tackling it in the right way. The good news is that there are effective treatments for pigmentation, but they do require a little commitment. Here, I reveal my tried-and-tested strategies for reducing the appearance of stubborn pigmentation.

What is pigmentation, and why does it occur?

There are three main types of pigmentation. Sunspots – damage that occurs after years of sun exposure – are the most common type. The second is melasma, which is the recurrent appearance of patches of pigmentation caused by hormonal changes – such as pregnancy, use of the contraceptive pill or breastfeeding. And finally, there’s post-inflammatory hyperpigmentation (PIH), which occurs when the skin overproduces melanin in response to injury or trauma, such as acne or chemical peels.

Taking a preventative approach

Unfortunately, once you have pigmentation, you’ll always be prone to it, so you’ll need to commit to a maintenance skincare regime and be cautious in the sun to keep it at bay. Use a broad-spectrum sunscreen with an SPF of 50 daily to help ward off UV rays and high-energy visible light. An excellent antioxidant serum will help to protect your complexion further whilst brightening it and helping to fade any existing unevenness.

The doctor-led approach 

One of the most effective treatments for excess pigmentation is a prescription cream called Hydroquinone. It has a controversial history because it’s been used, abused, and counterfeited over the years by people trying to bleach their skin. But when used at the appropriate doses, under medical supervision and in the short term, it can be very effective in the right candidate. It works by inhibiting the enzyme tyrosinase, which inhibits melanin and is generally used at a 4% treatment dose. It’s often combined with exfoliants like glycolic and salicylic acid and tretinoin to help it perform better. The Obagi Nu-Derm range contains Hydroquinone and is available on prescription following a consultation at an Obagi stockist clinic.

I’m also a big fan of Cyspera, which many people now favour over Hydroquinone as it has been proven to be more effective and doesn’t require any downtime. Cyspera contains an ingredient called cysteamine which is found naturally in human cells and reduces melanin in the skin’s epidermis.

Cyspera is the first and only topical cream containing cysteamine hydrochloride (HCl) to diminish the appearance of stubborn skin discolouration. It effectively improves the appearance of persistent brown patches and dark spots while minimising the recurrence of skin discolouration with continued use.

There are also many over-the-counter serums and creams for dark spots and pigmentation, but few are fully corrective because they tend to be better suited to maintenance once the pigmentation has been clinically treated. That being said, when it comes to treating some forms of pigmentation, the right medical-grade skincare can have a really beneficial effect. Ingredients that can help include L-ascorbic acid (vitamin c), arbutin, kojic acid, and glycolic acid. They all suppress or inhibit (to varying degrees) overactive pigmentation cells in the skin.

Clinical treatments

Some chemical peels are excellent for tackling surface discolouration, brightening the skin and speeding up skin cell turnover. The most common clinical treatments for pigmentation include light and laser therapy, but generally, they’re not recommend for melasma or PIH as they may make them worse. In my experience, the Cyspera and Obagi Nu-Derm are two of the best ways to tackle pigmentation effectively with minimal downtime.