Pigmentation in Norwich: a doctor's treatment pathway

Most people who come to me about pigmentation arrive with a product, not a diagnosis. They have bought a "brightening" serum online, used it faithfully for three months, and are frustrated that the brown patches are still there, or that they have quietly spread. The effort is rarely the problem. The problem is that pigmentation is not one condition, and treating every brown mark the same way is how good skin gets undone.

Getting the cause right is the whole game. Here is how I approach pigmentation at REGEN, and why the first appointment is an assessment rather than a treatment.

First, we work out what kind of pigmentation it is

To the untrained eye, brown marks look much alike. Clinically, they are not, and they do not respond to the same treatment.

Broadly, there are three culprits. Sun-induced pigmentation, the flat brown marks and freckling that build up over years of UV exposure on the face, hands and chest. Post-inflammatory hyperpigmentation, the marks left behind by spots, injury or irritation, which are more common and more stubborn in deeper skin tones. And melasma, the larger, often symmetrical patches on the cheeks, forehead or upper lip that are driven mainly by hormones and provoked by light.

This is the Reveal stage of how we work: before anything is recommended, I want to know what I am actually treating. The right diagnosis is what separates a plan that works from one that spreads the problem.

Why melasma changes everything

If your pigmentation turns out to be melasma, the plan becomes more conservative, not more aggressive.

Melasma is usually hormonal, linked to pregnancy or the combined pill, and it is worsened by UV and by heat. It is the one form of pigmentation that heavy-handed treatment can genuinely make worse: strong lasers and heat-based devices can rebound it darker. So when someone asks me for the strongest possible peel to blast a melasma patch away, that is precisely the person I will steer gently in the other direction. With melasma, slow and steady is not caution for its own sake. It is what actually holds.

The foundation: protect first, then correct

No pigmentation plan works without daily sun protection. It is not the interesting part, but it is the part that decides whether everything else holds.

A broad-spectrum SPF, worn every day and reapplied, is non-negotiable. Yes, here in Norwich. Yes, in winter. Yes, through cloud. Ultraviolet light is what drives most pigment in the first place, so treating the skin without protecting it is treating and re-triggering the same patch at once.

On that foundation sits homecare that slows pigment production. For the right patient, that includes prescription pigment control. Hydroquinone, used in a supervised cycle rather than indefinitely, remains one of the most effective options we have, and I have written separately about how the Obagi Nu-Derm cycle works. It is prescription-only and medically supervised for good reason, it is not suitable for everyone, and that is exactly why it begins with an assessment rather than a checkout.

In-clinic treatment: resurfacing, carefully

Once the skin is protected and properly prepared, in-clinic treatment can lift pigment that homecare alone will not shift.

Chemical peels are the workhorse here. A controlled, professional exfoliation encourages the skin to shed pigmented cells and renew more evenly. For sun-induced pigmentation and post-inflammatory marks, a well-chosen peel, often as a short course rather than a one-off, does real work. For melasma, peels can still play a part, but gently and as one element of a broader plan, never as a blunt instrument.

This is the Generate stage: the skin does the regenerating, and the treatment simply gives it a good reason to. Priming the skin beforehand, and protecting it afterwards, is what makes the difference between a result that lasts and one that fades back within weeks.

What realistic looks like

I will not promise to erase pigmentation, because that is not how skin behaves, and any clinic that promises it is selling you something.

Pigmentation is managed, not cured. With the right plan, most people see their marks fade meaningfully over weeks to months, and their skin looks clearer and more even. But the underlying tendency to pigment does not vanish, which is why sun protection and light maintenance continue after the visible marks have gone. Individual results vary, and the honest version is the only one worth giving.

How the pathway starts in Norwich

That pathway begins with a proper look at your skin, not a product recommended across a counter.

A Reveal Consultation is where we identify what kind of pigmentation you have, rule out anything that needs a different route, and build a plan in the right order: protect, correct, resurface, maintain. Sometimes that plan is mostly homecare. Sometimes it is a short course of peels alongside it. It depends entirely on what your skin is actually doing, which is the whole reason to begin with an assessment rather than a guess.

If pigmentation has been bothering you, that is the sensible place to start.

Frequently asked questions

Can pigmentation be removed completely?

Honestly, it is managed rather than removed for good. Most people achieve clearer, more even skin, and individual marks can fade substantially, but the underlying tendency to pigment remains. Ongoing sun protection and occasional maintenance are what keep the results holding.

What is the difference between sun spots and melasma?

Sun spots are discrete flat brown marks from cumulative UV exposure. Melasma is larger, often symmetrical patches driven mainly by hormones and provoked by light and heat. The distinction matters because melasma needs a gentler approach, and aggressive treatment can make it worse rather than better.

Is hydroquinone safe?

Used correctly, in a medically supervised cycle rather than indefinitely, it is an effective and well-established prescription treatment for pigmentation. It is supervised for good reason and is not suitable for everyone, including during pregnancy. That is why it begins with an assessment rather than an online purchase.

Can I have a peel for pigmentation in the summer?

It depends on the type of pigmentation and how diligent you are with sun protection afterwards. For melasma in particular, we often adjust the timing and strength of treatment around light exposure. Your consultation sets the right timing rather than the calendar.

How long before I see a difference?

Usually weeks to a few months rather than days. Pigmentation responds gradually, and the steady approach tends to outlast the quick one. Results vary from person to person.

Is it safe to treat pigmentation during pregnancy?

Pregnancy is a common trigger for melasma, but it is also a time when we hold off on prescription pigment treatments such as hydroquinone and retinoids. During pregnancy the priority is diligent sun protection, and we plan active treatment for afterwards. It is worth raising anything relevant with your GP or midwife as well.

This article is general information, not individual medical advice. Suitability for any treatment depends on your medical history and an in-person assessment. Written by Dr Chris, Medical Director, REGEN Clinic.