Everything Singaporeans need to know about skin pigmentation. By Dawn Chen
Photo: Manin Leuangingkasut / www.123rf.com
Uneven and splotchy skin, and random brown spots that appear. Pigmentation is hard to avoid, but there are steps you can take to reduce their occurrence. Here’s your guide to understanding why pigmentation forms and what your best bets to lightening those spots are, as explained by Dr Tay Liang Kiat, a consultant dermatologist and dermatologic surgeon at Dermatology and Surgery Clinic.
What are the most common causes of pigmentation in Singapore?
Dr Tay: Through our lifetime, everyone will notice the gradual appearance of dark spots and patches on our faces, even with the best sun protection measures. In Singapore, the most commonly seen ones are melasma, lentigines (sun spots) and flat seborrheic keratoses.
Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation. It is most commonly found on the cheeks, bridge of nose, forehead, chin, and above the upper lip. Lentigines are tiny dark spots found on the face, usually more prominent over the cheeks and forehead. Seborrheic keratoses are dark harmless skin growths that appear with age, some flatter types can be mistaken as sun spots.
All these common pigmentation conditions are invariably a result of cumulative sun exposure and ageing process. Another common cause of pigmentation is post-inflammatory hyperpigmentation, a result of any facial rashes, eczema, acne or wounds which have settled to leave these brownish stains and ‘scars’.
Given Singapore’s high UV index, is it really possible to prevent pigmentation?
Dr Tay: Everyone responds to UV radiation differently. Some people develop melasma and sun spots at a much younger age, especially when they have jobs or hobbies that involve spending a large amount of time out in the sun.
In year-round hot and sunny Singapore, we unfortunately get UV radiation round the clock so it is not possible to totally prevent pigmentation in most people. However, there are lots of measures we can adopt in our daily lives to prolong the onset of pigmentation or slow its progression (such as seeking shade whenever possible and using quality sunscreen).
What are the most effective ingredients one should look out for in brightening skincare products?
Dr Tay: There are many over-the-counter topical brightening products that may work to lighten pigmentation. These include kojic acid, arbutin and ascorbic acid (vitamin C).
However, the most effective topical treatment for pigmentation is still prescription-only creams containing hydroquinone, which prevents new pigment formation by inhibiting melanin formation. Hydroquinone is usually applied to pigmented areas at night over a few months. It should not be used in higher concentration or for prolonged courses to prevent adverse effects.
Can applying a product topically help to fade or lighten pigmentation?
Dr Tay: Just as everyone responds to UV radiation differently, individual treatment response to topical lightening creams alone also varies. In some patients, especially those with melasma, using topical creams alone is often insufficient and combination treatment methods tend to be more effective.
These include chemical peels – best performed by a dermatologist to prevent post-inflammatory hyperpigmentation – oral treatment of melasma and lasers and light devices.
Realistically, how long does it take to fade a pigmentation spot?
Dr Tay: Smaller pigmentation spots like lentigines (sun spots) or some melasma may lighten by just using topical creams in some patients, usually over several months. Lentigines usually also respond well to single or repeated laser treatment sessions, although most tend to recur over time.
Can pigmentation from scarring (such as from acne spots) ever fully fade?
Dr Tay: Such post-inflammatory hyperpigmentation, unlike melasma or lentigines, may gradually fade with time on its own. That said, this process usually takes a very long time from months to years, and the pigmentation may still never fully fade. Topical de-pigmentation treatment can help in lightening the hyper-pigmented scars, together with proper sun protection. In some patients, the use of laser toning may help.