What's Causing Your Stubborn Pigmentation?

by Dr Wan Chee Kwang
April 30, 2024

Stubborn pigmentation can be a persistent source of frustration for many, as it often proves difficult to remove and can leave lasting marks on the skin. Whether it's freckles, age spots, or melasma, these pigmentary irregularities can affect both men and women, leading to self-consciousness and a desire for clearer skin.

Understanding what contributes to stubborn pigmentation is the first step to effectively treating it. In this article, we shed light on the causes of pigmentation.

What is stubborn pigmentation?

Stubborn pigmentation refers to areas of darker or uneven skin tone that resist conventional treatments or persist despite efforts to lighten them. These pigmentation issues can be challenging to manage due to various contributing factors. Here are some examples of them.

Types of stubborn pigmentation?

Café au lait spots

Café au lait spots are common pigmented birthmarks that appear as flat patches on the skin. They are typically light brown and can vary in size. These spots result from an overgrowth of melanocytes, which can make complete removal difficult.

Café au lait spots are usually harmless and can appear anywhere on the body. However, they may be associated with certain genetic disorders, such as neurofibromatosis, when multiple spots are present or if they are larger than usual.


Melasma is a common skin condition characterised by brown or grey-brown patches on the face, particularly on the cheeks, forehead, chin, and upper lip. It is more prevalent in women and is often triggered by hormonal changes, sun exposure, or certain medications. Melasma occurs when melanocytes become hyperactive and produce excess melanin in the skin.

Melasma can be hard to treat due to its tendency to recur even after successful intervention.

Large pigmented birthmarks involving hair follicles

Large pigmented birthmarks involving hair follicles, such as congenital melanocytic nevi, are characterised by dark, pigmented patches of skin that are present at birth or develop shortly afterwards. 

These birthmarks present unique challenges due to their size and depth within the skin. Surgical excision, laser therapy, or combination treatments may be considered to reduce pigmentation and improve skin appearance. However, complete removal may not always be achievable, and the risk of scarring or pigment changes must be carefully weighed. 

Post-inflammatory hyperpigmentation (PIH) outside the face

Post-inflammatory hyperpigmentation (PIH) is a common condition characterised by the darkening of the skin following inflammation or injury. While PIH most commonly affects the face, it can also occur on other parts of the body, including the neck, chest, back, arms, and legs. 

PIH on areas beyond the face often persists longer and may be more severe than facial pigmentation. This persistence can be attributed to factors such as thicker skin, increased friction, and slower cell turnover rates in areas like the chest, back, arms, and legs. Such PIH may also be harder to treat as conventional solutions like laser treatment can sometimes darken the pigmentation further. 

Causes of stubborn pigmentation

Biological factors

Genetics determine an individual's susceptibility to pigmentation issues. Some people may be predisposed to overproduce melanin, the skin colouring pigment. 

Additionally, certain skin types, such as melanin-rich skin, are more prone to pigmentation concerns. Darker skin tones naturally have more melanin, providing greater protection against UV radiation but also rendering them more prone to pigmentation irregularities.

Hormonal changes

Hormonal fluctuations that occur during pregnancy or due to consuming oral contraceptives can trigger pigmentation issues such as melasma, also known as the "mask of pregnancy." This condition causes dark patches on the face, particularly the cheeks, forehead, and upper lip. 

While pregnancy triggers pigmentation through hormonal changes and physiological processes in a woman's body, oral contraceptives contain hormones that can influence melanin production and distribution in the skin. This hormonal imbalance may lead to some people developing or worsening pigmentation issues.

Environmental factors

Exposure to sun ultraviolet (UV) radiation is a primary environmental factor contributing to pigmentation irregularities. UV exposure stimulates melanocytes, the cells responsible for producing melanin, forming sunspots and freckles. 

Once these pigmented lesions have formed, they may persist for an extended period, requiring consistent and targeted treatment to achieve noticeable improvement.

Skin trauma

Injuries to the skin, such as burns or acne, can trigger inflammation and stimulate melanin production, leading to post-inflammatory hyperpigmentation (PIH).

When the skin is injured, it starts an inflammatory response as part of the healing process. During this inflammatory phase, melanocytes, the pigment-producing cells located deep in the epidermis, become activated and increase the synthesis and transfer of melanin pigment to the surrounding skin.

As a result, the affected area becomes darker in colour, manifesting as hyperpigmented patches or spots. This type of pigmentation can persist for months or even years.


Age spots, liver spots or solar lentigines commonly manifest sun-induced pigmentation changes in older individuals. 

Ageing skin undergoes changes in structure, including decreased collagen and elastin production, slower cell turnover, and reduced repair mechanisms. These changes make the skin more prone to damage and less capable of repairing itself, allowing pigmentation irregularities to develop more quickly.

Lifestyle factors

Certain lifestyle habits, such as poor dietary choices and inadequate hydration, can make pigmentation more noticeable.

A diet lacking essential nutrients, vitamins, and antioxidants can compromise the skin's ability to repair and regenerate itself, leading to various issues, including pigmentation irregularities. 

For instance, diets high in processed foods, refined sugars, and unhealthy fats can promote inflammation within the body, which may manifest as skin redness, blotchiness, and increased susceptibility to pigmentation.

Skincare Habits

Inappropriate skin care practices can give rise to stubborn pigmentation. 

For instance, abrasive exfoliants can damage the skin's protective barrier and exacerbate pigmentation. 

Not using sunscreen to protect your skin will expose it to harsh UV rays. UV radiation from the sun is one of the primary triggers for pigmentation issues. Failing to protect the skin from UV exposure can worsen existing pigmentation problems and lead to the development of new ones. 

Pigmentation Removal Treatment in Singapore

Stubborn pigmentation can be frustrating, but the right approach can achieve clearer, more radiant skin. Seeking professional treatment from a reputable clinic like 1Aesthetics can make a difference. 

1Aesthetics offers a range of pigmentation removal treatments in Singapore to target pigmentation at its source, delivering safe and effective results.

Some of the pigmentation removal treatments we provide are:

  • Laser therapy: Laser systems target melanin deposits in the skin, breaking them down and promoting the natural fading of pigmentation. At 1Aesthetics we have a range of laser treatments to deal with the different pigmentation issues covered above, such as Discovery Pico Plus and Fractional Thulium Laser. With every treatment, we use a range of diagnostic tools, such as a dermatoscope and a polarised loupe.
  • Chemical peels: Chemical peels containing exfoliating agents slough off dead skin cells and fade pigmentation irregularities. 
  • Intense Pulsed Light (IPL) therapy: IPL delivers broad-spectrum light energy to target pigmentation and stimulate collagen production. 

Dr Wan, the medical director of 1Aesthetics, has years of experience in treating pigmentation and other skin issues. Before undergoing any pigmentation removal treatment patients go through a thorough assessment with him to determine the most suitable approach for their concerns. 

To learn more about pigmentation treatment at 1Aesthetics, schedule a consultation now.

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