Types of Pigmentation & Treatment
What are Pigmentary Conditions?
Pigmentary conditions arise from abnormalities in pigment-producing cells called melanocytes. They present as dark spots, white spots, or general discolouration of the skin which may appear unsightly, causing stress and embarrassment. The most common pigmentary conditions are various forms of hyperpigmentation caused by sun exposure, hormonal changes, genetic predisposition, and healing from other skin disorders such as eczema or acne.
These discolourations are also more commonly seen in sunny Singapore, due to high UV exposure in our climate and with Asian skin being naturally more prone to such conditions. While pigmentary conditions may be difficult to treat, especially with some conditions such as melasma and age spots taking longer to respond compared to others like freckles, our doctors will be able to draw up the most suitable treatment plan for your unique skin condition.
Types of Pigmentation Conditions
Freckles are small brown spots usually seen in areas where there is more sun exposure, like the face and arms. Resulting from ultraviolet (UV) radiation and overproduction of melanin, freckles that present in childhood are often due to genetic predisposition. However, freckles that present in adulthood may be due to hormonal changes. Freckles in children will likely fade naturally with age or reduced sun exposure, but they may still be visible. Freckles are one of the easiest pigmentary conditions to treat. However, as they are triggered by sun exposure, there is a chance of recurrence.
Age spots, also known as liver spots or sunspots, are flat, oval spots of tan or brown discoloration, usually in areas with higher sun exposure such as the face, shoulders, and the tops of hands. They can range from freckle-sized to about 13mm in diameter, and usually cluster together, which makes them even more noticeable. They are caused by long-term exposure to UV rays, causing excess melanin production. Unlike freckles, age spots do not fade. They can be treated, though clearance tends to be less complete compared to freckles. Similar to freckles, age spots may recur due to sun exposure.
Post-inflammatory hyperpigmentation refers to discoloration caused by excess melanin production in response to injuries to the skin. This may be due to physical injuries, UV burns (sunburns), infections and inflammatory skin conditions such as eczema and acne. Those with darker skin tones or higher levels of sun exposure are also more prone to them. If treated early, post-inflammatory hyperpigmentation has a higher level of resolution, though they may also fade on their own.
Birthmarks are incredibly common and are usually grouped into two categories - vascular and pigmented birthmarks. Response to treatment varies, though some conditions respond better to treatment as compared to others.
- Vascular birthmarks are caused by extra blood vessels clumping together to form a visible discolouration under the skin. The most commonly seen vascular birthmarks in our practice are Port-wine birthmarks.
- Naevus flammeus, also known as port-wine stains, are caused by abnormal formations of blood vessels under the skin. They usually darken with age and the skin texture in the area may become dry, thickened, or pebbled. With sufficient laser sessions, these have the highest chances of clearance with reduced chances of recurrence.
- Pigmented birthmarks are caused by the overproduction of melanin in a particular area. The most commonly seen pigmented birthmarks in our practice are Café au lait spots, Naevus of Ota, and Naevus Spilus.
- Café au lait spots are pale brown and somewhat oval in shape. Though they may fade as one ages, it is also likely for the birthmark to grow larger.
- Naevus of Ota appears as a discoloration of the skin around the forehead and around the eyes, though in some cases, the eye itself may show hyperpigmentation. This condition is more common in Asian women and also has a higher chance of clearance with treatment.
- Naevus Spilus refers to a flat patch of brown with smaller, darker spots or raised bumps in it. It is caused by a defect in the melanin-producing cells in that particular area. It may be treated with pigment lasers, though responses to the treatment may vary.
Melasma, also known as the “mask of pregnancy”, refers to brown or blue-gray patches or spots that form on the skin. It is largely caused by genetic predisposition and sun exposure, but hormonal changes worsen their appearance. While it may respond to initial treatments, melasma is prone to recurrence as it may be triggered by the slightest thing- physical irritation e.g. heat and over-exfoliation, increased light exposure, hormonal fluctuations. Melasma also comes in many different forms which respond differently to treatments. It is therefore crucial that your doctor can correctly identify the type of melasma you have, so as to recommend the correct treatments for the best outcome.
Hori’s Naevus refers to clusters of small, brown, or blue-grey flat spots that form on both sides of the cheeks, and less commonly on the nose, forehead, and eyelids. While it may look like the Naevus of Ota, Hori’s Naevus usually presents later on in life. They are usually freckle-sized but cluster together like age spots or melasma, hence it takes an experienced and meticulous doctor to be able to diagnose and treat the condition correctly. Our doctors at Harmony Aesthetics have extensive experience in resolving Horis Naevus successfully with laser treatments, with little to no recurrence in the long term.
Treatment for Pigmentation
Treatment for pigmentary conditions varies greatly depending on the individual skin condition and diagnosis. What works for freckles may not work for birthmarks and vice versa. At Harmony Aesthetics, our experienced doctors are able to draw up the most suitable treatment plan to effectively target your skin concerns.