Skin pigmentation affects almost every single person at some point in their lives, especially in Sunny Singapore, where our UV exposure is high all year round. Although some accept pigmentation as a natural part of aging, others can be extremely disturbed by their appearance. Here, we outline a few common types of pigmentation which differ in their etiology, appearance, as well as response to treatment.
Melasma – Arguably the most challenging form of pigmentation to treat, melasma occurs due to genetic predisposition, and is invariably worsened by hormone changes and light exposure. It is prone to recurrence, sometimes from the slightest trigger. There are many variations in terms of appearance and location of pigments. It is important that your doctor is able to identify the different presentations of melasma as response to treatment can vary greatly.
Hori’s Naevus – Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori’s Naevus, occurs commonly in Asian women. Although unsightly, this form of pigmentation has one of the best outcomes in terms of resolution. It is one of the few forms of pigmentation where recurrence is rare, and clearance may be complete. Many sessions of lasers are needed to get to that stage, however.
Post inflammatory hyperpigmentation – Post inflammatory hyperpigmentation or PIH occurs as a result of melanin overproduction in response to any form of skin injury. This may be from direct physical injury, UV burns, infections, or inflammatory skin conditions. People with darker skin tones or higher sun exposure are more prone to this condition. PIH is generally transient and resolves completely, especially when treatment is initiated early.
Freckles – Some children may be genetically predisposed to getting freckles, although these often fade as they grow older. In adults, freckles sometimes occur because of hormone changes e.g., pregnancy. In general, they become increasingly prevalent as we age due to cumulative UV damage. As melanin deposition occurs in the top (epidermal) layer of the skin, freckles usually respond to skin-lightening products. For complete clearance, however, pigment laser treatments are suggested. Although easy to remove, freckles tend to recur easily with sun exposure.
Age spots – Solar lentigines or age spots occur frequently in adults over 40 years old, but may appear earlier due to genetic predisposition and hormonal stimulus. They represent a larger area of skin ‘damage’ from cumulative sun exposure as compared to freckles. Response to treatment is also poorer and the recurrence rate higher when compared to freckles.
Birthmarks – Naevus of Ota, Naevus Spilus, Café au lait spots, and Port Wines stains are some birthmarks commonly seen in our practice. Excellent treatment outcomes can be achieved in Naevus of Ota and Port wine stains as they can be removed completely with sufficient laser sessions without recurrence. Other forms of birthmarks, however, respond variably to treatment.
Regardless of the form of pigmentation, a key factor in determining treatment success is the expertise of your doctor. There is no fixed treatment algorithm available. Most people suffer from a mixture of pigmentations; some may have concurrent problems like acne or eczema. With modern technological advancements, there are now many more tools available in combating pigmentation. Knowing how to combine those tools effectively while keeping the fine balance between expediting results and avoiding adverse effects, however, is a skill very few clinicians have mastered.
Having dealt with thousands of cases over more than a decade, you can be assured that we are more than equipped to handle any pigmentation concerns you may have. After a detailed consultation process, you will be advised on a customized treatment plan based on your expectations, skin type, lifestyle, and budget. Treatment methods are best combined so as to target the different pathways of pigment production simultaneously. As most pigmentations cannot be cured, be prepared that any treatment program you start on may need to be continued in the long run.
A proprietary blend of active ingredients help to keep melanin production at bay while speeding up skin renewal and melanin clearance. A good sunscreen is essential in not only reducing UV damage, but also in blocking off harmful infrared and blue light.
Oral Medication & Supplements
Oral medication and Glutathione supplements inhibit pigment formation in both superficial and deep layers of the skin. They are especially helpful in preventing the recurrence of melasma and PIH. Oral Sunblock supplements reduce UV damage and therefore pigment production.
With the aid of photothermal and photoacoustic actions, Spectra XT and PicoPlus selectively target and break up melanin into smaller particles while sparing other skin structures. The Clarity II effectively clears up stubborn pigmentation which does not respond to other lasers. The Dual Yellow complements the effects of other lasers when used in treating and stabilizing melasma.
Sylfirm is the latest treatment available for combating melasma. Pulsed radiofrequency waves emitted via microneedles selectively destroy abnormal blood vessels that contribute to pigment formation. It also repairs the basement membrane, which stops melanin from migrating deeper into the skin. This slows down disease progression, stabilizing melasma.
Pigments in tattoos can be effectively removed with the help of the PicoPlus. The ultra-high speeds at which laser beams are fired generates a shockwave effect, known as photoacoustic action. This shatters tattoo pigments into tiny fragments, which can be readily removed by the body’s immune system and exfoliative process. The rate of clearance depends on various factors such as the size, intensity, colour, depth and location of the tattoo.
Before initiating any treatment, our doctor will have an extensive discussion with you regarding your expectations, treatment limitations, and potential side effects. Detailed after care instructions will be provided to aid recovery and minimize adverse effects. Be prepared that multiple laser sessions may be required before your desired outcome is achieved.