Shedding Light On Pigmentation: The Facts Vs The Myths

Pigmentation is one of the most common skin issues that many have to deal with. In fact, pigmentary disorders are the third most type of dermatologic disorder that can cause significant psychosocial issues.

Epecially living in a tropical climate in Singapore, it isn’t uncommon to see both men and women seeing light brown or dark-coloured patches of skin that are darker than the rest.

Having discolouration can make someone look dull, older and more tired than they are. To help you get on the right track towards clear, blemish-free skin, here is a list of the top myths about pigmentation, and how it can end up harming your skin instead of healing it.

The three major factors: sun exposure, hormones and ageing

Pigmentation is primarily caused by melanocytes – the pigment-producing skin cells that give our skin its colour. The main symptoms of hyperpigmentation are patches of discolouration that vary in size and can develop anywhere on the face and body.

The condition can be caused by a multitude of factors; however, excessive sun exposure is the number one cause of hyperpigmentation. While melanin is naturally produced as a way to protect our skin from harmful UV rays, issues arise when excessive production causes parts of our skin to darken.

The most common types of pigmentation seen are:

Age spots (Sunspots): occurs most frequently in those over 40. Also known as solar lentigines, sunspots are related to genetic influences or excessive sun exposure over time. Generally, they appear as spots on areas exposed to the sun, like the hands and face.
Freckles: mostly an inherited characteristic, if you have a family history of pigmentation, you are more likely to develop freckles. Freckles are also more common in those with fair skin.
Post-inflammatory hyperpigmentation: occurs following skin injury or inflammation such as burns, acne, atopic dermatitis or chemical exposure. The skin is left darkened and discoloured after the wound has healed.
Melasma: believed to be caused by hormonal imbalances and most frequently seen in pregnant women or women taking birth control pills. Also known as the “mask of pregnancy”, it causes large brown patches of skin on the face, stomach or any area of the body. Though it is more common in women, melasma also affects men.

Pigmentation can be further divided into epidermal or dermal pigmentations, the latter being found deeper within the skin and hence can be more difficult to clear. While pigmentation is mostly a benign condition and harmless to our health, it is important to correctly diagnose the type of pigmentation you have and treat the underlying factors.

With that said, let’s dive right into the myths.

Myth 1: Avoiding the sun is enough to prevent pigmentation.

Although excessive sun exposure is the biggest cause of most pigmentation issues; as mentioned early, it can also be caused by a plethora of other factors.

However, it is still essential to avoid unnecessary UV exposure – ensure you apply a broad-spectrum sunscreen of at least SPF 30 that protects you against both UVA and UVB rays – even on cloudy days.

Getting exposed to sun rays over time can worsen existing pigmentation, and UV rays can still penetrate through windows. The same rules apply whether or not you are in the car, indoors or the office.

In addition, consider if your pigmentation is caused by factors such as illness and specific medications. For instance, a rare disease called Addison’s disease can result in hyperpigmentation that predominantly develops in areas of sun exposure. It can also be triggered by chemotherapy drugs, antibiotics, and anti-seizure drugs.

Myth #2: Only people with fair skin will get pigmentation.

False. Contrary to popular belief, people with darker skin can still get pigmentation if they are constantly under the sun – it’s just that they are often detected later.

Just remember: while you can’t control things like ageing and genetics, controlling your exposure to the sun, pollutants and harsh chemicals is key when it comes to preventing pigmentation altogether.

Myth #3: Laser treatment is the only possible solution.

Another related misconception is that expensive laser treatments are the only way to effectively get rid of all kinds of pigmentations. However, this is far from the truth.

The first line of therapy for pigmentation is usually a topical medication called hydroquinone, which has been available for more than 30 years and has proven to be effective in treating both dermal and epidermal pigmentations. It works by disrupting the pigmentation formation process and is one of the only few medically approved ingredients for treating hyperpigmentation.

However, hydroquinone can cause skin irritation and potentially cause post-inflammatory hyperpigmentation in people with fair skin, which is why it is only administered by doctors for short periods (4-6 weeks). On top of that, it can take a few months to see results.

There are other treatments available such as chemical peels, glycolic acid, topical steroids or retinoids that should first be considered before moving on to more intense treatments.

Because the majority of people have mixed pigmentations, a combination treatment approach involving the use of topical treatments, laser therapy and maintenance treatments often sees the best results.

In the case of laser treatments; however, the pico laser is undoubtedly the fastest and most effective way to get rid of both superficial or more deep-seated pigmentation such as in the case of Hori’s naevus. It works by directly target excess pigment and shatter it into tiny pieces that are naturally removed by the body.

Most importantly, work with a doctor to get a diagnosis and is well-trained to utilise the laser device – a good doctor will focus on using the appropriate power and setting while minimising the side effects according to your skin condition.

Myth #4: Once pigmentation is cleared, it will never return.

While doctors would love to tell you this, the truth is that pigmentation (especially melasma and freckles) can recur even after successful treatments. However, this has nothing to do with the efficacy of your laser treatment; but rather, how well you take care of your skin and whether or not you are protecting your skin from the sun.

While certain types of pigmentation can naturally resolve by itself, it can take anywhere from months to years to completely disappear on its own. For sustainable results, always follow your doctor’s instructions and advice on how to prevent new blemishes from appearing.

Paving the way for clear skin with PicoSure and PicoWay

The pico laser is one of the most technologically advanced treatments to reduce and clear pigmentation in fewer treatment sessions than traditional lasers.

Often compared to the Q-switched laser, which works in nanoseconds, the pico laser works in picoseconds (1000 picoseconds = 1 nanosecond). Due to its high peak power and ultra-short pulse durations, pico can effectively deliver more laser energy and shots in each second to quickly shatter and break down pigments.

While the Q-switched laser utilises photo-thermal energy, the pico laser uses photo-acoustic energy, which means that it treats the skin without causing heat injury to the dermis. In one particular study, a picosecond laser was shown to be faster and more effective in clearing melasma². In another study, picosecond lasers were also shown to result in fewer adverse side effects than a nanosecond laser³.

At the end of the day, pigmentation is a highly treatable condition – but only under the correct diagnosis and treatment strategies devised by a professional and experienced doctor.

With years of experience and training in employing various laser modalities, Dr Angeline is a dermatologist in Singapore that believes in providing holistic care and customised treatments based on each individual.

Depending on the severity and type of your pigmentation and goals, Dr Angeline is able to utilise both the PicoSure (755nm) and PicoWay (532nm, 730nm and 1064nm) laser to target all types of pigmentation at varying depths, as well as recommend suitable maintenance treatments to prevent any recurrence. While most clinics offer only one of the two devices, Dr Angeline is able to leverage the advantages of both devices for synergistic results.

This powerful hybrid treatment can even be used to simultaneously address skin laxity, acne scarring, enlarged pores, and fine lines and wrinkles due to its collagen-producing effects. Regain even and blemish-free skin by booking your first appointment today.

References

Halder RM, Nootheti PK. Ethnic skin disorders overview. J Am Acad Dermatol. 2003;48:S143–8.

Lee MC, Lin YF, Hu S, Huang YL, Chang SL, Cheng CY, et al. A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians. Lasers Med Sci 2018;33:1733-8.

Kim DG, Nam SM, Shin JS, Park ES. Effectiveness of the Pico-toning Technique for the Treatment of Melasma with a Low Fluence 1,064-nm Nd:YAG Laser in Asian Patients. Medical Lasers 2020;9:166-171.

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Shedding Light On Pigmentation: The Facts Vs The Myths