A dermatologist talks: Treating pigmentation

A dermatologist talks: Treating pigmentation

Spot on

Text: Teo Wan Lin

In the second of a five-part series on the fundamentals of understanding your real skin condition, Dr. Teo Wan Lin, an accredited Singapore dermatologist, separates the myths from the facts when it comes to treating pigmentation

Have you ever found yourself looking on in envy at models and celebrities, or even girls on the street, who just look effortlessly perfect and flawless? The self you see in the mirror somehow always has these patches of pigmentation, or maybe it's just this odd look of uneven skin. The next question that begets our attention is, why?

Pigmentation comes in all shades and sizes and it's the most common problem that my patients in the post-'30s age group seek treatment for in my dermatologist practice. A quick Google search of 'pigmentation treatment Singapore' throws up a bunch of ads and links from aesthetic clinics, and it is pretty hard to distinguish which ones are run by beauticians, general practitioners who also practise aesthetics, and which are actually links to dermatologists. One common theme though is that they all scream the same headline,"Erase your pigmentation now by a qualified specialist" or something along those lines.

Effective pigmentation treatment first begins with the correct diagnosis of the type of pigmentation because they are not all the same. Small round brown patches starting from childhood are commonly ephelides (or freckles in lay person terms), those that start in one's late twenties onwards are solar lentigo (sun spots which increase in size and number with more sun exposure and age), some are actually seborrheic keratosis (age spots) which dermatologists do not consider as a pigmentation problem at all, but are actually benign tumours of the skin which increase as one grows older. A more widespread form of pigmentation is melasma, which is a brownish-grey discoloration often in a butterfly shape across one's cheeks and forehead (in late stages) which is related to hormonal influences such as post-pregnancy.
Woman with freckles

Dermatologists are specialists trained specifically in the identification of pigmentation, and it is important that one is correctly diagnosed from the beginning because every single condition is treated differently. I have seen patients who were treated with the wrong types of lasers for various pigmentation conditions and ended up with scarring, which itself is a type of pigmentation known as post-inflammatory hyperpigmentation, often a bigger problem than the first. Besides, melasma when it is treated with an ablative laser — one that destroys the skin surface — simply gets worse! In addition, certain types of pigmentation is due to intake of chemicals and medication, which causes deposits of pigmentation in the second layer of the skin.

Never self medicate with whitening agents (especially from a non-medical source) because these often contain unregulated, toxic and potentially dangerous amounts of controlled bleaching substances such as hydroquinone, steroids and even downright banned and poisonous ingredients like mercury. Another misconception is that there is no use treating pigmentation because it all comes back even after treatment. This is not true. While recurrences do occur, it does not happen within a short time say within one to three years of doing the procedure, for most forms of skin pigmentation. Often it is simply that when a dermatologist treats the pigmentation you have, new patches arise from daily exposure to the sun, biological ageing (which means that one is growing older by the day) and accumulated environmental exposures such as sun damage, pollutants and a poor skin care routine).

If you already suffer from pigmentation, first of all, you need to be properly evaluated and diagnosed by a dermatologist (check your doctor's qualifications here). Never use non-prescription whitening creams as these could potentially contain whitening agents which could be dangerous without proper medical supervision, or otherwise be completely useless. One could also suffer an allergic reaction to these over-the-counter beauty products, and these could also contain banned poisons such as mercury which can cause harmful health effects.

Also, do your part by applying a dermatologically tested and formulated broad-spectrum SPF50 sunscreen, to prevent worsening of pigmentation and development of new spots, in addition to slowing down the harmful effects of UV-radiation on skin-ageing and pigmentation. Pigmentation can be and should be treated promptly.

Dr. Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, is an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist-grade cosmeceuticals Dr.TWL Dermaceuticals