Differentiate The Different Types Of Pigmentation

Are you fretting about the pigments on your face? Are there pigments you suddenly noticed overnight? If you are wondering how you got these pigments and how to treat them, fret not. Here’s a simple guide on some of the most common types of pigments on our faces.
– Dr YX Lum (Medical Professional at IDS Clinic)

Acne PIH

PIH stands for Post Inflammatory Hyperpigmentation.

This is a common problem that plaques many of the teenagers and young adults in Singapore and amongst Asians. These PIH spots happen more often in darker skinned individuals.

How do these PIH spots form?

The inflammatory response acne goes through causes more build-up of melanin, melanin being the pigment in our pigment cells. These then leave behind the brownish reddish blemishes on the skin which can occur anywhere on the body, the face, chest and back being the most common areas. These marks can stay on for a few weeks to even months or years! The older we get, the slower the healing rate, the longer the pigmentation will stay.

How do we prevent this PIH from forming?

The best way to prevent acne PIH from forming is to treat the acne fast, at the same time prevent new acnes from forming. Acne can be treated in various forms. Start by using a good skincare regime. More severe forms of acne may require combination therapies with oral medications or even lasers and light therapies.

An important habit to kick will be to stop oneself from popping and squeezing the acne. Squeezing and popping acne lesions result in more inflammation and that results in the melanin formation. It is tempting to squeeze the acne when one is stressed but it’ll only do more harm than good.

Wearing adequate sunscreen and protecting from the sun at all times help prevent the blemishes from getting darker and more difficult to treat.

Can we treat these Acne PIH?

Yes! Fortunately, there are many ways to treat these PIH.

1. Topical creams that contain Azelaic Acid or Hydroquinone – though the latter is not as highly recommended, can lighten the marks from the acne PIH.

2. If the acne PIH is very persistent despite topical creams or if patients desire quicker results, light treatments like IPL and Q-Switched laser can help reduce the blemishes too.

Freckles

In the West, freckles are often associated with youth and even add a unique “quirk” to the person’s look such as with the likes of celebrities like Emma Stone and Emma Watson. In recent years, it’s even become a beauty trend where freckles are recreated by drawing them on using eyeliners. However, in the pursuit for fair and clear skin, freckles are much frowned upon.

What exactly are Freckles? How do they come about?

Freckles are small, brown spots that appear on sun-exposed skin after prolonged exposure to the sun.

Freckles, also known as ephelides, do not occur at birth. They can occur around 2-3 years of age. Freckles are more common in people with fair complexions. There are also certain genes that pre-dispose some to having freckles more easily. One of those genes is the MCR1 gene, also commonly referred to as the ‘red hair’ gene, which may explain the common occurrence of freckles in these individuals.

Freckles may fade with age and in the winter months.

Are Freckles dangerous?

Freckles are not dangerous. They aren’t cancerous. However, if one is predisposed to the risk of getting freckles, they have a higher risk of getting skin tumours so it will be good to monitor these more closely. Patients who belong to this group should be more diligent in applying sunscreen.

Can Freckles be treated?

Yes, they can! In fact, the prognosis is good.

1. Topical creams that contain ingredients like Azelaic Acid and Hydroquinone can help to lighten the freckles.

2. Using good skincare on a regular and long term basis like a good vitamin C and vitamin A product can lighten and prevent the freckles from enlarging or darkening.

3. Procedures like IPL and lasers can help to fade these freckles further. Often, the freckles will form a scab after the laser and fall off.

Freckles Are Often Mistaken For Other Types Of Lesions Synch As Moles And Seborrhoeic Keratosis.

Moles are small raised brown to black bumps on the skin. They are benign and can appear in different numbers in different parts of the body. There is a chance that these moles may become cancerous especially in people with higher risk with more than a 100 moles. It’s advisable to get a mole check by a doctor annually if you belong to the group with higher risk.

Seborrhoic keratoses are raised, brown crusty bumps that frequently occur in people over the age of 40. They can range in colors from white to brown to blackish. They vary in sizes too and tend to become bigger overtime. They are sometimes referred to as “barnacles”.

Lentigo

Lentigines are small pigmented flat or slightly elevated spots on sun-exposed areas of the skin. They usually have clearly defined edges.

Lentigines are brought on by excessive sun exposure and photo-damage of the skin.

Unlike freckles, lentigines usually happen in middle age. Over time, people may notice that they have more and more of them. They are commonly found in areas where we are more exposed to the sun like our faces, arms, forearms, hands, and legs. Also, in comparison to freckles, they are also larger in size. Lentigines tend to persist throughout life.

Lentigines are benign and harmless. However, it may be difficult to distinguish them from malignant lesions. If in doubt, the doctor can perform a biopsy of the lesion to ensure that the lesion is not cancerous.

Prevention of lentigines is similar to that for other different types of pigment. Prevention starts with careful sun protection with daily use of broad spectrum sunscreens and wearing sun-protective gear and outfits.

Treatment of lentigines is similar to that of freckles.

Melasma

Melasma is a chronic skin condition with patches of brown pigmentation on the skin. It is more commonly found on Asian skin and can be extremely frustrating for those suffering from it.

How is Melasma present?

It appears as flat brown patches in a few different kinds of distributions:
1. Centrofacial: Forehead, nose, cheeks and lips
2. Malar: cheeks and nose
3. Lateral cheek patterns
The centrofacial and malar patterns are more common.

There are 3 main reasons why people may get melasma:

1. Genetic predisposition: it has been found that about 30 percent of the sufferers of melasma report that melasma is found in other family members.

2. Sun exposure: Prolonged sun exposure causes melanin to be deposited in the dermal layer and these kind of pigment can be very stubborn to treat.

3. Hormonal changes: pregnancy and menopause causes the hormone levels in the body to change and that can trigger the pigmentation or make it worse.

Treatment of Melasma tend to be slow but there are ways to treat and reduce the appearance of Melasma.

1. Topical products like vitamin A and vitamin C are very good ingredients to reduce the pigments and prevent the pigmentation from getting worse.

2. Topical products that contain ingredients like Hydroquinone, Azelaic Acid and Tranexamic Acid can help to lighten the pigmentation.

3. Adequate sun protection with sufficient topical and oral sunscreen.

4. Oral medications like oral tranexamic acid.

5. Procedures such as lasers.

The latest laser technology for treating hyperpigmentation is the Picosecond lasers. The conventional nanosecond laser delivers the laser in one billionth of a second. Picosecond lasers deliver the laser beam in one trillionth of a second, much shorter in duration, making It much more effective in clearing the pigmentation without causing damage to the surrounding skin.

Acne PIH and Freckles usually appear on the epidermal layer of the skin. Melasma, on the other hand, is common in the dermal layer, which makes it more difficult to treat.

If you experienced new spots or pigments on your face that you are unsure of, do speak with your aesthetics professionals to learn more!

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