Are Lasers Really The Best To Treat Pigmentation?

Almost everyone has some form of pigmentation — Singaporeans, in particular, are more prone to this skin condition due to our constant exposure to UV rays all year round. Women and darker skin individuals are at a higher risk of developing pigmentation issues as well. 

With pigmentation appearing to be an ongoing issue in Singapore, it’s important that we educate ourselves on the best pigmentation treatments out there. Many patients think that lasers are the be-all, end-all for pigmentation removal. While lasers have been proven to work, the truth is they might not produce the same results for everyone as we all have different conditions and skin types. 

In this article, I will discuss how to tailor treatment plans based on the different types of pigmentation.

Getting a diagnosis

Before jumping to a treatment plan, you’ll first need to get a diagnosis from a doctor on what type of pigmentation you have. Do you have freckles, melasma, or a combination from both? Often, it can be hard for a non-professional to tell these skin conditions apart as they look almost the same. As such, always make sure your doctor gives you a diagnosis on your pigmentation before going with a treatment plan.

Types of pigmentation in Singapore

Melasma

• Characterised by blotchy patches of discolouration 
• Prevalent in dark skinned and middle aged women of Asian descent 
• Influenced by hormones, genetics and sun exposure 
• Usually appears on the cheeks and forehead 
• Tends to recur, thus making it a skin condition that’s difficult to treat

Freckles

• Characterised by tiny brown spots on the nose and cheekbones 
• Prevalent in younger individuals 
• Forms in a scattered pattern

Solar Lentigo

• Characterised by round dark spots that are well defined and uniform in colour 
• Often resembles coins 
• Prevalent in the elderly and those with prolonged sun exposure

Hori’s naevus

• Characterised by marks with shades of dark blue and grey, usually clustered together 
• Forms on the nose, forehead and cheekbones 
• Influenced by genetics 
• Prevalent in middle-aged women of Asian descent

Post-inflammatory hyperpigmentation

• Characterised by ill-defined, discoloured patches 
• Usually occurs from acne outbreaks, inflammation or infection to the skin, squeezing of pimples, using unsuitable makeup products or undergoing skincare procedures

Seborrheic keratosis

• Characterised by tiny black or light brown spots that are rough in texture and slightly elevated 
• Often mistaken as moles 
• Influenced by genetics, prevalent in the elderly

Current pigmentation removal treatments in Singapore

Medical Grade Creams

Not to be confused with over-the-counter creams, medical-grade creams are specially formulated for lightening pigmentation and can only be prescribed by a doctor. These creams, such as hydroquinone, contain tyrosinase inhibitors that prevent melanin from forming. 

Cyspera is the latest pigmentation lightening cream prescribed by doctors in Singapore. Cyspera contains cysteamine, an antioxidant that works to lighten pigmentation through several pathways. Typically, doctors would prescribe a mix of different creams for 5-7 weeks for optimum effect, but potential side effects like redness and itching must be monitored. 

Medical-grade creams are best suited for less severe melasma and freckles.

Chemical Peels

Chemical peels involve using acids to remodel skin and increase cell turnover. In Singapore, the most commonly used acids for chemical peels are alpha-hydroxy acid beta-hydroxy acid. Most chemical peels performed here target only the epidermis to keep discomfort and downtime to a minimum. However, they are generally safe and effective for most types of pigmentation, including melasma and post-inflammatory hyperpigmentation. 

Furthermore, chemical peels also bring in other benefits, such as an improvement in acne and overall smoother and brighter skin.

Lasers

Lasers work by breaking down melanin or hyperpigmentation spots into smaller pieces. These particles are then removed from the skin via lymphatic channels. Melanin absorbs energy at wavelength spectrums from 250nm to 1200nm; I’ve found the Discovery Pico Plus and Fractional Thulium Laser to be highly effective for treating most types of pigmentation, including severe cases. 

In particular, I like to bring in the Discovery Pico Plus laser for almost all my laser treatments. This is because it can go up to 1064nm for darker skin types or sensitive skin. 

While lasers have proven to be very effective, I like to combine them with treatments like creams and oral supplements, especially for recurring pigmentation like freckles and melasma. Sometimes I also add in Fractional Microneedle Radiofrequency to complement the effects of lasers as this reduces complications by stabilising the activity of melasma. 

For conditions like Hori’s naevus, lasers are a must as they are rooted deep in the skin and tend to be more stubborn. In my experience, treatment for this condition will take longer (up to 10 months), but the final result is often very gratifying and the pigmentation doesn’t tend to recur by the end of the treatment sessions.

To sum it all up

As you can see, there are several ways to treat pigmentation in Singapore. Depending on the severity of your condition, some patients can treat their pigmentation just fine without lasers. An experienced doctor will be able to advise accordingly.

References

1. https://pubmed.ncbi.nlm.nih.gov/27918005/
   Li, J. Y., Geddes, E. R., Robinson, D. M., & Friedman, P. M. (2016). A review of melasma treatment focusing on laser and light devices. Seminars in cutaneous medicine and surgery, 35(4), 223–232. https://pubmed.ncbi.nlm.nih.gov/27918005/
2. https://pubmed.ncbi.nlm.nih.gov/28985086/
   Pavlic, V., Brkic, Z., Marin, S., Cicmil, S., Gojkov-Vukelic, M., & Aoki, A. (2018). Gingival melanin depigmentation by Er:YAG laser: A literature review. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 20(2), 85–90. https://doi.org/10.1080/14764172.2017.1376092