A consultant dermatologist answers your Qs about facial pigmentation
Facial pigmentation may be lentigines, melasma, postinflammatory hyperpigmentation, acquired pigmentation such as Hori’s nevus and nevus of Ota, or perhaps even drug-induced pigmentation. Post-inflammatory hyperpigmentation may be due to an outbreak of acne or trauma to your skin.
Skin pigmentation can be categorised as epidermal (superficial), dermal (deep) or mixed (epidermal and dermal). Solar lentigines and ephelides (freckles) are epidermal pigmentation, whilst melasma and postinflammatory hyperpigmentation are examples of mixed pigmentation. Hori’s nevus and nevus of Ota, on the other hand, are classified as dermal pigmentation.
Pigmentation has to be examined thoroughly in order to diagnose its exact cause and depth in order to determine the most viable treatment plan.
I’VE HEARD THAT MELASMA IS COMMON IN WOMEN. WHY IS THAT SO?
Melasma— a.k.a. chloasma—is a chronic, symmetrical but blotchy, brownish pigmentation affecting the face. It is relatively common and attributed to the overproduction of melanin by pigment cells known as melanocytes. Sun exposure, pregnancy, and hormonal treatments including oral contraceptive pills and hormone replacement therapy are known melasma triggers. You’re generally more prone to getting melasma in your twenties to fourties, and the condition affects more people with brown skin – the color of most Malaysians’ skin – than those with either very fair or dark skin. Melasma can occur either in the epidermal (superficial), dermal (deeper), or dermal and epidermal layer of the skin. A Wood lamp may be used to identify the depth of the pigmentation.
HOW CAN I AVOID GETTING MELASMA?
Use adequate sun protection like a broadspectrum sun screen, and re-apply it every 2 hours when you’re outdoors. If you’ve been put on hormonal therapy, speak to your doctor about alternative treatments.
CAN MELASMA BE TREATED?
Doctors usually prescribe tyrosinase inhibitors because tyrosinase is an enzyme that stimulates the production of melanin. Hydroquinone (2% or 4%) may also be applied to your skin for approximately 3 months. Other topical agents include azelaic acid, kojic acid, ascorbic acid, arbutin, retinoid and corticosteroids. Currently, the most successful topical formulation is a combination of hydroquinone, tretinoin and corticosteroid.
Chemical peels such as alpha hydroxyacids, which include glycolic acid and lactic acid, and beta hydroxyacids (salicylic acid) may help. Some doctors may also suggest treating melasma orally with tranexamic acid, or with lasers and light-emitting devices. This treatment method works, ideally, by destroying pigments while leaving other cells intact.
DR. LEE YIN YIN