Pigmentary disorders are very common in the Asian population. Most people have some form of pigmentary disorder at some point in their lives, be it sun damage, freckles, age spots or more extensive pigmentation such as melasma.
Whilst pigmentary disorders are generally benign and do not have a major impact on health, patients with extensive and serious pigment disorders can suffer from depression with low self-esteem. I have had patients who, prior to seeking treatment for their pigmentary problems, had not taken a picture in more than 10 years!
Pigmentary disorders are affected by various factors. These include sun exposure, hormonal changes, medications as well as genetics and lifestyle factors. Most patients have a mixture of different types of pigment disorders which require proper evaluation before treatment.
Types Of Pigmentation Frequently Seen In Aesthetic Practice
Melasma is common in our population and more common in women than in men. They present as large patches of pigments on the face, most patients get it on the cheeks, but a third of patient also get it in the central part of the face like the nose and forehead.
Commonly called age spots or sun spots. These are caused by skin aging as well as chronic exposure to sunlight and typically occur on more sun-exposed parts of the body such as the cheeks and forearms.
Cafe au Lait spots
These are common birthmarks which are well-defined patches of pigment. “Cafe au lait” in French means “Milk Coffee” and this aptly describes the colour of these pigments.
Hori’s Nevus are deep pigments that usually appear purplish/blueish. They are usually found on the cheeks.
Post Inflammatory Hyperpigmentation (PIH)
PIH is pigmentation deposited by the skin because of an inflammatory process. Commonly this can be due to acne, sensitive skin (eczema), or a complication of some aesthetic procedures (chemical peels, lasers). PIH is often self-limiting and resolves over time even without treatment
Most pigment problems require some time to treat and are hard to eradicate. Pigment production is our body’s natural response to external factors, hence treatment for pigments usually do not result in 100% resolution or “cure” of the problem, but only serves to improve the appearance of the skin.
However, with good skincare habits and lifestyle, chances, as well as the severity of recurrence of pigmentary problems, can be kept very low.
6 Common Ways To Improve The Appearance Of Pigment Problems
1. Use Sunblock
This is the most basic skin care product. In our tropical climate, it is important to protect your skin from sun damage that will worsen pigmentary problems. Choose a sunblock with an SPF of at least 30 to ensure adequate protection
2. Use Creams
Your doctor may prescribe you lightening creams to help you with pigmentation. Hydroquinone is one of the commonest depigmentation creams. It is effective but cannot be used in high doses for a long period (more than 2 months).
3. Vitamin A Derivatives Products like Tretinoin (Retin-A,
Vitamin A derivative products like Tretinoin (Retin-A, Stieva-A) or Adapalene (Differin) help to speed up the renewal of the skin cells and clearance of melanin.
4. Chemical Peels
Chemical peels help to speed up the removal of melanin by increasing skin cell turnover. However it is important to take good care of the skin after a chemical peel (avoid sunlight, good cleansing to prevent infection) to prevent accidental worsening of pigmentations.
5. Intense pulsed light (IPL)
Intense Pulsed Light or IPL was commonly used to treat pigmentary problems in the past, but these have fallen out of popularity due to the pain and downtime associated with the treatments, as well as the tendency to cause darkening of the pigmentation due to the heat generated.
6. Laser Treatments
Lasers have become increasingly popular over the past few years. Different types of laser treatments are required for different types of pigmentation. Lasers are more specific and targeted than IPL but also carry the risk of rebound of pigmentation and hypopigmentation, a condition in which white spots are formed due to the loss of pigment-producing cells in the skin.
No two skin types are exactly the same, and it is always advisable to seek the consult of your doctor to find out which treatment suits you the best before on embarking on a course of treatment.
Image credit: By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons