Pigmentation or hyperpigmentation is not foreign to many in Singapore, as our year-round tropical climate makes us susceptible to dark spots. Pigmentation refers to patches of skin that are darker than the surrounding skin, such as melasma, freckles, solar lentigo and so on. These spots form due to localized collections of melanin, a brown pigment.

Apart from prolonged sun exposure, melanin is also formed due to hereditary factors, hormones and inflammation to the skin. While we can’t control our genetics, we definitely can manage our environmental factors. Thus, it’s important to avoid picking on pimples as well as to apply sunscreen regularly — the higher the SPF, the better.

In this article, I will share some tips on choosing the correct sunscreen, as well as discuss possible ways to treat your pigmentation.

Top 3 types of pigmentation in Singapore

Post-inflammatory hyperpigmentation

Post-inflammatory hyperpigmentation are dark patches that develop after inflammation or injury to the skin. This inflammation or injury could be a result of an increase in the formation or redistribution of melanin from acne, eczema, scratches or bacterial infections. I must add that patients with darker skin are more susceptible to post-inflammatory pigmentation too.

Melasma

Melasma presents as irregularly shaped brown-black patches on the cheeks, chin and forehead. It’s commonly found in women; especially after pregnancy or from hormone supplementations like birth control. Melasma is one of the more complicated pigmentations to treat as it tends to recur and comes in three different types, namely:

  • Epidermal melasma — epidermal melasma is superficial in nature and appears as brown patches. May be easier to treat. 
  • Dermal melasma — dermal melasma concerns the dermis and may affect fine blood vessels in the skin. 
  • Mixed melasma — as its name suggests, mixed melasma is a combination of epidermal and dermal melasma. It happens to be the most common type of melasma in Singapore. Because it’s mixed, treatment may require a combination of solutions.

Solar lentigo

Solar lentigo is frequently found in older patients due to chronic sun exposure. Thus, solar lentigo spots are commonly referred to as ‘age spots’ that you find scattered on an elderly person’s body, such as his/her hands.

Treatment options for pigmentation

Topical treatments like medical-grade creams are usually first in line for treating mild pigmentation. These medical-grade creams, which can only be prescribed by a doctor, work by inhibiting tyrosinase, melanin transfer and speeding up the clearance of melanin. Tyrosinase is the enzyme that produces melanin. Some common tyrosinase inhibitors are vitamin C, hydroquinone, Kojic acid, azelaic acid, arbutin and cysteamine cream.

With medical-grade creams, patients can expect pigmentation to start lightening within 6-12 weeks, although they might come with side effects like redness and itching. If you’re particularly anxious about these side effects, you can try oral medication like tranexamic acid instead. Tranexamic acid can have similar or better effects as medical-grade creams particularly for conditions like melasma; it should not be prescribed to patients who are prone to blood clots.

However, I would encourage patients with freckles and solar lentigo to use topical and/or oral treatments in conjunction with lasers. Lasers are often used for persistent or more severe pigmentation and can give faster, much more obvious clearance. Most clinics in Singapore use medical-grade lasers like the pico laser or Q-switched Nd:YAG laser as they can treat a diverse range of pigmentation issues, especially Hori’s naevus. Other lasers like the fractional thulium or fractional ruby laser are only available at selected clinics. In fact, Hori’s naevus usually must be treated by lasers as the pigmentation is located deep within the skin.

Tips for dealing with pigmentation

Tip 1: Understand that pigmentation might recur despite treatment

Depending on the type of pigmentation you have, it might recur even after treatment, with the possible exception of Hori’s naevus or post-inflammatory hyperpigmentation. On the other hand, for conditions like freckles, solar lentigo and particularly melasma, there is a high chance of recurrence as they are easily triggered by sun exposure. This leads me to tip number 2.

Tip 2: Always ensure proper after-treatment care

Strictly adhere to your doctor’s advice on post-treatment care — this includes applying sufficient sunscreen. In general, use a sunscreen with SPF 30 or higher and look out for those with the label “PA+++”. Make sure you also apply a sufficient thickness and amount of sunscreen to enjoy full SPF benefits. The recommended thickness is 2mg per cm of your body — about a shot glass’ worth of sunscreen.

Tip 3: Look for an experienced doctor

Make sure your doctor has experience in dealing with your type of pigmentation. Enquire on how many types of patients the clinic has seen, request for before and after photos, and find out more about treatment options — how were these patients treated? Did they all go through the same treatment process? These are things you want to find out before committing to a clinic and doctor, as I would not recommend patients to doctor-hop.

References

  1. https://pubmed.ncbi.nlm.nih.gov/28374042/
    Kim, H. J., Moon, S. H., Cho, S. H., Lee, J. D., & Kim, H. S. (2017). Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review. Acta dermato-venereologica, 97(7), 776–781. https://doi.org/10.2340/00015555-2668
  2. https://pubmed.ncbi.nlm.nih.gov/30027914/
    Aurangabadkar S. J. (2019). Optimizing Q-switched lasers for melasma and acquired dermal melanoses. Indian journal of dermatology, venereology and leprology, 85(1), 10–17. https://doi.org/10.4103/ijdvl.IJDVL_1086_16