Can I Get Rid Of Pigmentation?

Posted on by Anouschka in Anti-Aging, Ask The Experts

I recently received the following questions regarding pigmentation, and Dr Alek Nikolic very kindly agreed to answer them for us. 


“How can I tell if my pigmentation is caused by sun damage, is hormonal, or due to ageing? “


This is a difficult question to answer over the net as ideally one would like to take an adequate history, examine the skin and the pigmented lesions, and even do a VISIA skin analysis (computerised analysis that allows us to see below the skin surface) to determine the exact cause of the pigmentation and determine the best treatment approach.


Generally speaking the following are good guidelines for determining what caused our pigmentation to occur:



Melasma is identified as patchy and connected brown, tan, or blue-gray facial skin discolorations, usually seen in women in the reproductive years. It typically appears on the upper cheeks, upper lip, forehead, and chin of women 20-50 years of age. Although possible, it is uncommon in males. Most of those with melasma are women. It is thought to be primarily related to external sun exposure, external hormones like birth control pills, and internal hormonal changes as seen in pregnancy. That is why Melasma is often referred to as the mask of pregnancy and when it appears on the upper lip it can often look like a coffee stain. Typically, this form of pigmentation is confluent and creates large patches as opposed to separate smaller pigmented lesions.


Sun Damage:

UV exposure tends to cause our melanocytes to produce more melanin (the pigment that gives our skins and hair our colour) as a protective mechanism for the skin. With over exposure or worse with sun burn the melanocytes are over activated to make more melanin as a response to enhance the skins defense. This excess pigment eventually appears on the skin surface as hyper-pigmentation. What separates this from Melasma is very simply the size and distribution: the dark brown marks are smaller, less confluent, and can be seen anywhere on the face, neck or chest. They are often referred to as age spots but pigmentation (or hyper-pigmentation) from sun exposure can appear at all ages. Hyper-pigmentation is not a prerequisite to ageing; if one stays out of the sun from our childhood then no pigmentation changes will appear as we age. So as we age and if pigment marks appear then they were very simply caused due to sun exposure when we were younger.


Post Inflammatory Pigmentation:

Another form of pigmentation is post inflammatory hyper-pigmentation (PIH) which is caused where the skin’s melanin production is increased as a reaction to an inflammatory response within the skin. This can be due to trauma to the skin, acne, infection, chemical peels, or excessive laser treatments.


Other causes:

Certain medication can predispose us to hyper-pigmentation such as some antibiotics, oral vitamin A (Roaccutane) and chemotherapy medication.


“Which treatments and products would be best to get rid of my pigmentation and stop it from coming back?”

It is important to note that once hyper-pigmentation has taken place it is extremely difficult to remove as it has been shown that the over stimulated melanocytes have memory cells that will produce pigment with every sun exposure. Once we have pigmented lesions on our skin the best we can do is to reduce its appearance on the skin surface but unfortunately the memory cells in the deeper layers will stay unless we have ablative lasers that completely remove all pigment and the melanocytes but this will leave our skins with no natural protection against UV exposure and in my opinion is not advisable. The end result will be a white waxy looking skin that is completely blemish free but looks a little unnatural.


Your first and most important ‘pigmentation treatment’ is a good SPF. I am a firm believer in using a SPF 30 or higher that contains zinc oxide and/or titanium dioxide. These minerals act as UV reflectors and have been shown to give the best UV protection. Furthermore, studies have shown that using a daily SPF will reduce the appearance of dark pigmented marks.


The second most important thing to remember is unfortunately there is no cure for hyper-pigmentation. We cannot get rid of it. The only way to ‘treat and get rid of it’ is to prevent it from happening so using SPF from a young age and practicing sun avoidance is the best approach. I am a realist and we do live in sunny SA so I know this is not possible but by applying a good SPF, wearing a hat and not actively sun tanning will go a long way in preventing hyper-pigmentation.


I like to divide hyper-pigmentation treatments into topical or technology based or a combination of both.



When it comes to choosing the best skincare products for treating hyper-pigmentation my recommendation is to look at products that are doctor dispensed and contain high concentrations of active ingredients.


The best approach with a topical treatment regime is to combine chemical peels with skincare products. At my practice we tend to mostly use superficial chemical peels that contain glycolic acid to further enhance the effect of the skin care ingredients. One can use medium and deep peels as well for added benefits but these tend to leave one with downtime.


After the SPF the two most important ingredients one can use on your skin for hyper-pigmentation is Vitamin C and Vitamin A or retinol.



Vitamin C in the mornings

Both of these ingredients have been shown with numerous clinical studies to have a direct effect in reducing the appearance of pigmentation and inhibiting melanin production. Furthermore, it has been shown that Vitamin C enhances the UV protection of one’s SPF.


My recommendation is to use a Vitamin C serum in the mornings after cleansing and before applying a moisturiser and your SPF and to use the retinol at night after cleansing. For added benefit one can spot treat the pigmented lesions at night after cleansing followed by the retinol.


Vitamin A at night

Retinol at night

Added skin benefits to using Vitamin C and Retinol is increased collagen and elastin production, improved hydration, smoother skin texture, a reduction in pores, and an improvement in fine lines and wrinkles.


Another topical ingredient for hyper-pigmentation is hydroquinone and is still the gold standard as a treatment for Melasma. This usually requires a prescription (for concentrations of 4% and higher) and needs to be mixed by a pharmacist. Typically, one adds a mild cortisone steroid to the mix to help reduce inflammatory reactions on the skin.


Technology Based Treatments:

There are a number of lasers that can be used for pigmentation removal including IPL (although IPL is not beneficial for Melasma) and both fractional ablative and non-ablative lasers. Results are dependent on the machine used and the operator and the setting chosen. Lasers need to be used with caution as inflammatory responses can produce further pigmentation and certain lasers may not be indicated for all skin types.



For stubborn pigmented marks or for an enhanced clearance one may have to combine a topical regime with the above mentioned lasers.


Dr Alek Nikolic


MBBCh (WITS) 1992, ATLS (ACS) 1998, MBA (UCT) 2000, BLS (ACS) 2016

Dr Alek Nikolic is a well-known aesthetic medical practitioner with practices in Chelsea London and in Chelsea Village Cape Town. He has been appointed as an Allergan Local Country Mentor for Facial Aesthetics and has extensively lectured and presented live demo techniques both locally and internationally. Dr Alek has performed over 20 000 cosmetic dermatology procedures and as such has been responsible for training numerous doctors in the art of cosmetic treatments.


He currently holds advisory positions with numerous aesthetic supplier companies and is an Associate of the American Society for Laser Medicine and Surgery and a member of the prestigious International Allergan Medical Institute.



Aesthetic Facial Enhancements :

SkinMiles: :

Tel: +27 21 797 0960


If you have any questions, please email them to and I’ll get an expert to answer them.


About Anouschka

Anouschka is a full time mom and part time Spa addict and pamper fanatic. After taking a 'mommy break' from working in the advertising industry, she started managing facebook fanpages for businesses and fell in love with social media. She divides her time writing for PamperMeNow!, managing the ‘ILoveBeingPampered’ fanpage, and running after her two young boys, with a little bit of Spa action in between.

Let Us Know What You Think! Leave Your Comments Below: