Hyperpigmentation is a common issue in Singapore, thanks to our sunny climate. Asians are also more prone to having hyperpigmentation problems. Diagnosis of the type of hyperpigmentation is of great importance, as different types of hyperpigmentation requires different sets of solutions.
Most pigmentation issues tend to worsen with sun exposure. Hormones also play a role, as some find that their hyperpigmentation problems get worse after starting on a course of oral contraceptive pills or after getting pregnant.
TYPES OF SCARS
We will briefly discuss the common types of hyperpigmentation and how they can be treated.
Freckles have the appearance of superficial, small, brown spots. They commonly appear during childhood or teenage years and worsen with sun exposure. Diligent sun protection and whitening creams can lighten them. These also usually respond well to laser treatments.
Also known as sunspots, lentigines are brown, superficial spots and patches that are typically larger than freckles. They usually appear on sun exposed areas, and may become more numerous, darker and bigger with age. They tend to be more stubborn than freckles but can also respond well to laser treatments.
These are large, brown patches that typically occur at birth or during childhood. Laser treatment may be attempted to lighten them, but results are highly variable, with significant chances of recurrence.
Nevus of Ota
These are hyperpigmented patches, appearing on one side of the face, usually on the cheeks or forehead of patients. They have a bluish grey appearance. They usually appear at birth, or around puberty. As the pigmented cells lie very deep in this condition, creams are not effective in its treatment. Only lasers are effective in lightening or removing them.
These have the appearance of brown, grey or bluish spots on both sides of the face, commonly on the cheeks, but sometimes on the temples, nose and forehead too. They usually start appearing during adulthood and are common among Asian women. They can be quite stubborn to treat, frequently requiring many laser sessions for a good improvement.
Melasma is a common condition in Singapore, particularly among women, but sometimes among men too. They have the appearance of brown irregular patches, commonly on the cheeks, but also on the temples, forehead and nose. They are affected by sun exposure, female hormones and genetics. There is no permanent cure for melasma at this moment, but there are a few ways to tackle it. Whitening creams, chemical peels, gentle laser, and tranexamic acid tablets have been found to be helpful. Aggressive treatments should be avoided as they may cause darkening of the melasma patches.
STEP 2A - PICOSECOND LASER
This is followed by a laser treatment. We will first start with a Long Pulsed Laser to decrease the vascularity of the skin. This is followed by a Picosecond Laser treatment to tackle the pigmentation that are already there.
Skin with melasma tends to be very sensitive to irritation and can darken easily if the appropriate settings are not used. It is thus extremely important to be treated only by someone who has experience in managing this condition.
STEP 2B - MELA PEEL
In the Astute Programme, we alternate Picosecond laser sessions with the Mela Peel sessions every 2 weeks. The Mela Peel targets the pigmentation at its superficial layers. By alternating Picosecond lasers and Mela Peel, it allows us to effectively treat pigmentation issues at multiple depths.