The Dermatology Practice.

Skin Pigmentation

There are many causes for brown patches on the skin (pigmentation).
What are freckles and lentigenes?

They are also called ‘sun spots’. Freckles are small brown spots often scattered on both cheeks and nose and they darken and lighten depending on how much sunlight the skin is exposed to. Lentigenes do not lighten much on their own despite sun protection. Additional steps listed below are required to remove lentigenes.

What are Hori’s Nevus?

These are grayish brown small circular spots on both cheeks. It tends to occur in other family members too.

It can be treated with the appropriate laser. Repeated sessions are required for the pigmentation to clear.

What is melasma?

Melasma appears as brown patches of skin affecting the cheeks, forehead, upper lip, nose and chin. The neck and, rarely, the forearms can also be affected. Areas of melasma are not raised.

What causes melasma?

The exact cause is not known, but several factors contribute. These include pregnancy, hormonal drugs such as the contraceptive pill, and medical conditions affecting hormone levels.. Sunexposure usually worsens melasma.

How is melasma diagnosed?

Melasma is usually easily recognized. Occasionally, your dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) is removed for examination under the microscope (a biopsy) in order to exclude other diagnoses.

Can melasma be cured?

At present there is no cure for melasma, but there are several treatment options which may improve the appearance. Superficial pigmentation is easier to treat than deep pigmentation.

How can all the above pigmented skin patches be treated?
  • Avoiding known trigger factors, such as the oral contraceptive pill or perfumed cosmetics.
  • Adopting appropriate sun avoidance measures and using sun-block creams.
  • Skin-lightening agents.
  • Chemical peels, microdermabrasion and laser treatment.
  • Cosmetic camouflage.

Skin Pigmentation darkens more than the surrounding skin with exposure to sunlight, so sun-avoidance and sun-protection are important. Broad-spectrum fragrance-free sunscreens, with a sun protection factor (SPF) of 30 or greater and a high ultraviolet A (UVA) star-rating, should be applied daily, and broad-brimmed hats are recommended. In particular, avoidance and protection measures should be employed during the period of most intense sunlight ( eg between the hours of 10am to 4pm)

Skin lightening creams and medication

Certain chemicals can reduce the activity of pigment-forming cells in the skin, and of these, hydroquinone is the most commonly used. Hydroquinone creams may cause irritation, and care must be taken to ensure that they are not used for too long.

Topical retinoids help to smoothen skin texture and reduce pigmentation. They also complement the other treatments such as laser therapy to decrease side effects and optimize the results.
Cosmeceuticals contain glycolic acids, antioxidants such as vitamin c, arbutin, kojic acid and certain peptides amongst others to control and improve the signs of skin pigmentation.
For melasma, an oral medication may be used to help lighten the patches. Not all patients are suitable for this treatment so check with your doctor.

Chemical Peels, Dermabrasion, IPL, Laser-treatment

Chemical peels and dermabrasion can improve pigmentation by removing the cells of the epidermis which contain the excess pigment. Some types of laser also remove the outer layer of skin, whereas others specifically target the pigment-producing cells. Multiple sessions with various methods can be used and your doctor will recommend what is most suitable for you.

If your skin pigmentation improves with treatment, in order for the improvement to be maintained you should continue to protect your skin from the sun and keep to a recommended skin care regime