What pigmentation actually responds to, and what it does not

Pigmentation is the single most common thing people bring to a skin consultation, and the single most common thing they have already spent money on without success. Usually they have tried a brightening serum, then a stronger one, then a course of something at a salon, and the patches are still there.

The reason is almost always the same. Not all pigmentation is the same condition, and the treatment that clears one kind can make another kind worse. Before anything else, you need to know what you are actually looking at.

The three kinds you are most likely to have

Sun damage. Flat brown spots with fairly defined edges, on the face, chest, neck, shoulders and the backs of the hands. They accumulate over decades and they appear where the light lands. This is the most treatable kind by a wide margin.

Melasma. Larger, softer edged patches, usually symmetrical, across the cheeks, upper lip, forehead and jaw. It is driven by hormones as well as by light, which is why it so often starts in pregnancy or after starting or stopping hormonal contraception. It is the most difficult kind, and the most easily made worse.

Post-inflammatory pigmentation. The brown mark left behind after a spot, a cut, a burn or a rash. It follows the shape of whatever caused it. It fades on its own, but slowly, and it can take a year or more.

There are others. Freckles are genetic and come back with every summer. Some pigmented marks are not pigmentation at all and need to be looked at properly rather than treated, which is one good reason to have an assessment before anyone points a device at your face.

What sun damage responds to

This is the good news part. Sun damage responds well to light.

Intense pulsed light targets the brown pigment directly. The spot absorbs the energy, rises to the surface, darkens noticeably for a few days and then flakes away over one to two weeks. People are often alarmed by the darkening. It is the treatment working.

Most people need three to six sessions spaced three to four weeks apart. Hands and chest often need more than the face. At our East Finchley clinic we use the Lumenis Stellar M22, and you can read what that involves on the IPL and laser page.

Chemical peels work too, and work well alongside. A course of chemical peels removes the pigmented surface layers and encourages faster turnover, which suits people who want a gradual change rather than a week of flaking.

What melasma responds to, and what makes it worse

Melasma needs its own section because the usual advice is actively unhelpful for it.

Aggressive light treatment can make melasma worse. Not always immediately. Sometimes it looks better for a month and then comes back darker than it started. Heat alone is enough to trigger it, which is why some people find it flares after a hot holiday, a sauna, or a treatment that had nothing to do with light.

What tends to help is slower and less exciting. Daily high factor sunscreen, reapplied, worn in winter too. A proper medical skincare routine, which is where a structured programme such as Obagi earns its place. Careful, low strength peels. And where light is used at all, low settings from someone who knows why they are being cautious.

Melasma is managed, not cured. Anyone promising to clear it in three sessions is either inexperienced or hoping you will not come back and say so.

What post-inflammatory marks respond to

Time, mostly. The mark is the skin's record of an injury, and it fades as the skin turns over.

You can speed that up. Peels help. So does a retinoid in an evening routine, introduced slowly. Microneedling helps where there is texture involved as well as colour.

What you must not do is pick at the thing that caused it in the first place, and what you must do is wear sunscreen, because ultraviolet light darkens these marks and keeps them there for months longer than they need to be.

The one thing every kind has in common

Sunscreen.

We are aware that this is dull. It is also the whole ballgame. Every form of pigmentation is driven or worsened by ultraviolet light. You can spend hundreds on a course of treatment, get an excellent result, and undo it in a single sunny fortnight.

SPF 50, every day, all year. It is not a London summer problem, it is a London daylight problem.

How we approach it at the clinic

The consultation comes first and it is free. We look at the marks, ask how long they have been there, what changed when they appeared, what medicines and hormones you take, and what you have already tried. That conversation usually tells us more than the device does.

Then we tell you which of the three you have, what result is realistic, roughly how many sessions it will take, and what you will have to do at home for it to hold. If the honest answer is that light is the wrong tool for your skin, we say that.

There is a patch test before any light treatment, at least a week beforehand, and we do not skip it.

Full details on approach and pricing are on the pigmentation treatment page.

Where we are

Nova Beauty Clinic is at 260 East End Road, East Finchley, London N2 8AU. It is clinician-led, so the person who assesses your skin is the one who treats it, and we see patients from East Finchley, Muswell Hill, Finchley Central and across London.

If you have been working on the same patch for two years with no change, a proper assessment is a better use of your money than another serum.

Book a free skin assessment

See what we offer on our pigmentation treatment page, including IPL and clinic skincare at our East Finchley clinic.

Call 020 3925 1232 or book online. Nova Beauty Clinic, East Finchley, London N2 8AU.