Dark splotches and spots that dot the surface of the skin are common, especially in sunny Singapore. Known as skin hyperpigmentation, this general term refers to the presentation of a skin condition that increases pigmented spots in the skin.

In other words, the correct diagnosis of the underlying skin condition is important before initiating any form of treatment for the skin hyperpigmentation in order for the treatment to be safe and effective.

Let’s take look at some of the common causes of skin hyperpigmentation and how we can treat them.

Melasma

Melasma is a common skin disorder that affects mainly women after 30 years old. While causes are still not fully understood, it is thought to be caused by hormonal changes, triggered by UV exposure and genetically linked. It often develops or becomes worse during pregnancy, and may also occur in women who are taking hormonal pills and hormonal replacement therapy after menopause.

Melasma typically appears as poorly-defined brown patches over the cheeks and forehead. Sometimes, they worsen very quickly after excessive sun exposure.

It is a tricky skin condition to treat. For a start, preventing it from getting worse is important. That means adequate sun protection and diligent usage of sunscreen because UV exposure makes melasma worse.

Failing which, first line treatment usually consists of prescribed topical creams such as hydroquinone, tretinoin, steroid and azelaic acid. Anti-oxidant skin care products such as ascorbic acid can sometimes be useful.

Lastly, lasers targeting melanin, such as Pico laser and Q switch laser can be used to treat hyperpigmentation caused by melasma. Chemical peels can sometimes play a role in treating melasma as well.

Sun spots

Sun spots are sometimes also known as age spots, liver spots (although it has nothing to do with the liver) or solar lentigines. Caused by excessive sun exposure over time, sun spots appear as flat brown spots that develop on skin areas that are commonly exposed to the sun, like the face and hands.

Unlike moles, sun spots do not pose any risk to health because they are not cancerous. With the exception of cosmetic reasons, they generally do not require treatment.

If you do want to treat sun spots, then energy devices such as Intense Pulsed Light (IPL), Pico Lasers and skin resurfacing lasers are useful in treating sun spots. Chemical peels may sometimes be effective in improving sun spots.

Freckles

Freckles are sun spots are similar because they are both due to overproduction of melanin as a result of sun exposure.

However, freckles are genetically linked. If you have inherited a particular gene from your parents, your skin can form freckles after sun exposure. Freckle spots are usually smaller and lighter in colour, and appear earlier in life. In addition, freckles typically fade away with age while sun spots stick around.

Freckles are harmless, and do not need to be treated unless they stick around long enough to cause cosmetic concerns. Freckles can be treated effectively with energy devices such as Pico laser.

Post inflammatory hyperpigmentation (PIH)

PIH is a result of injury or inflammation to the skin. Common causes are acne, skin infections, cuts and burns. After the injury or inflammation recovers, the skin over the area usually becomes hyperpigmented.

Fortunately, PIH is usually temporary. it may take weeks or months to get better depending on the skin type, but it is generally harmless, even if it can be unsightly.

Treatment usually involves topical prescription lightening creams such as hydroquinone, retinoids and cysteamine. Pigment lasers such as Pico lasers can help speed up the recovery process.

During recovery, sun protection and sunscreen are also important because excessive sun exposure can prolong the duration of PIH.

Pigmented Birthmarks

Birthmarks appear at birth or just a few weeks after birth. Examples of pigmented birthmarks are cafe-au-lait, nevus of ota, Mongolian spots and nevi (moles). Mongolian spots tend to disappear by the age of 4 and do not require any treatment. However, the other types of pigmented birthmarks may persist into adulthood.

Unfortunately, birthmarks are difficult to treat and often do not respond very well to treatment. Assessment has to be done by an expert before any treatment, such as topical medications or laser treatment, is used. Some birthmarks, such as nevus of ota and nevi, will need to be monitored closely by doctors.

Dealing with Skin hyperpigmentation is complex. Therefore, it is key that patients get the right diagnosis in order to receive safe and effective treatment of their conditions. If you wish to have yourskin hyperpigmentation treated, make sure to consult a doctor before taking any action of your own.

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