Dr.’s Of­fice

A con­sul­tant der­ma­tol­o­gist an­swers your Qs about fa­cial pig­men­ta­tion

Shape (Malaysia) - - CONTENTS -

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.

IS A CON­SUL­TANT DER­MA­TOL­O­GIST AT SUN­WAY MED­I­CAL CEN­TRE IN PE­TAL­ING JAYA.

DR. LEE YIN YIN

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