1. What is the difference between melasma and hyperpigmentation?
Pigmentation is the discoloration of the skin. Melasma and hyperpigmentation are causes of pigmentation. Melasma tends to be related to changes in hormones such as during pregnancy or after menopause. It is also closely related to genetics and sun exposure. We only use the term “hyperpigmentation” in the context of post-inflammatory hyperpigmentation as a form of scarring following inflammation. Melasma itself is also distributed differently. It tends to appear in a butterfly-like configuration over the cheeks and sometimes spreading to the forehead. It also tends to be very symmetrical, even and diffused, whereas, hyperpigmentation is usually localized to the area of previous injury.
2. Is melasma curable? How about Home remedies?
A cure would mean a one-time treatment that causes all symptoms to go away forever. Most skin conditions are treatable but the underlying root cause has to do with the amount of environmental exposure such as sun exposure in one’s lifetime, genetics, as well as other factors such as hormones.
Some home remedies that have been proposed to treat melasma are quite dangerous. Apple cider vinegar has been proposed as one of the solutions as it contains acetic acid which is proven by research to be effective in lightening skin pigmentation. However, the method and form of acetic acid in apple cider vinegar only causes skin irritation, the most severe form being irritant contact dermatitis or even facial eczema and chemical burn.
The usage of aloe vera is unlikely to be harmful. However, many aloe vera products contain certain compounds such as alcohol that helps to maintain the product in a gel form.
The key thing to understand about these DIY remedies is that while the source and raw ingredients may contain an active ingredient, proven to lighten pigmentation in laboratory studies, it is often not in the correct form for it to be effective on the skin. It can also cause severe irritant reactions that can causes pigmentation to worsen.
3. How should one treat melasma?
For melasma to be effectively treated, you have to use a combination of therapies. To me, the most effective treatment is a combination of the use of a q-switched laser, a 1064nm laser toning device, spaced at weekly intervals, together with topicals, such as hydroquinone to help remove underlying pigmentation, and cosmeceutical skincare. The Radiancé Fluide™ Hydrating Emulsion contains oligopeptides that help reduce the hyperpigmentation while increasing the function of the pigment removing cells. The Vitá C GOLD™ Serum contains nano-formulated sodium ascorbyl phosphate, a stable and effective derivative of Vitamin C, well known for its amazing ability to treat hyperpigmentation and photoageing.
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr Teo, call us at +65 6355 0522, or email email@example.com. Alternatively, you may fill up our contact form here.
Struggling with dark spots? To treat them, you first have to know the kind of pigmentation you have.
Melasma is characterized by irregular brown patches on the skin and can typically be found on the forehead, upper lip, nose and the chin. Melasma is the result of an overproduction of melanin (the pigment that gives colour to our skin, hair and eyes).
Excessive sun exposure is one of the greatest contributors to melasma as melanin-producing cells are easily stimulated by UVA and UVB rays. Pregnancy, hormone treatments and genetic predisposition are other causes.
Postinflammatory hyperpigmentation (PIH)
PIH is the result of your skin’s melanin-inducing response to inflammation or injury, and appears at the injured site as a dark brown macule or patch. Such markings usually fade within a few months with appropriate treatment. However, the brown spots may darken or spread if not addressed. Sun exposure may also worsen PIH.
Skin conditions that can cause the above inflammation include acne vulgaris, atopic dermatitis (eczema) and psoriasis (red, flaky skin patches).
Freckles, also known as ephelides, are harmless small pigmented spots that are frequently found on the face, arms, neck and chest. Freckles are brown due to a diffusion of melanin into skin cells.
In winter, the activity of melanin-producing cells slows down. When exposed to UV radiation in sunlight, melanin-producing cells pick-up. As a result, freckles fade slight in the winter and darken in summer. Often, freckles partially disappear with age.
Genetics contribute to the formation of freckles. They are frequently observed in fair-skinned individuals, especially those with red hair.
Solar lentigines are harmless patches of darkened skin that are generally larger than freckles and have well-defined edges. They are caused by an accumulation of sun damage that leads to an increase in the number of melanin-producing cells and subsequent accumulation of melanin.
Solar lentigines are also associated with increased age. While freckles generally disappear over time, untreated solar lentigines are likely to persist indefinitely.
Dark Spots Treatments
For all dark spots, start by avoiding the sun and applying a sufficient amount of sunscreen every two hours. Use a lightweight sunscreen like Dr. TWL’s SunProtector™, which is dermatologist-formulated for the humid climate.
For melasma, consider a combination of topical therapies (outlined below) and chemical peels. Lasers should be considered last.
For PIH, first treat and prevent the skin condition triggering the inflammation. Then use topical treatments followed by chemical peels and lastly, laser and light treatments.
For freckles, use topical or laser/light therapies.
For solar lentigines, use ablative therapy with cryotherapy. Subsequent treatment options include topical agents and laser therapy.
Bleaching agents are often used to inhibit synthesis of melanin which is the skin pigment that contributes to the formation of dark spots. The most commonly prescribed ones are hydroquinone, azelaic acid and kojic acid.
Hydroquinone inhibits the production of melanin by binding to tyrosinase, the enzyme responsible for the first step in melanin production.
Azelaic acid acts on abnormal melanin-producing cells but leaves the healthy ones untouched, ensuring optimal melanin levels.
Kojic acid binds to copper, which is required by melanin-producing cells.
Topical retinoids are often used in combination with bleaching agents. Retinoids target pigmentation issues by inducing the death of melanin-producing cells, accelerating turnover of new skin cells and inhibiting the enzyme tyrosinase.
Chemical peels refer to the process of applying acids to the skin to destroy the outer skin layers. They accelerate the process of exfoliation by sloughing off dead layers of older skin and promoting smoother layers of new skin.
Superficial and medium depth peels are effective in treating pigmentation concerns. These peels differ in the depth of skin resurfaced. Superficial peels target only the surface skin layer while medium peels target the next layer.
To successfully achieve significant depigmentation, a patient needs to undergo at least 3 to 4 repeated peels. Common acids employed are glycolic acid, salicylic acid and lactic acid.
Laser and light treatments
Lasers are notably successful with solar lentigines, but less so with melasma and PIH. Such treatments damage the skin to stimulate growth of new skin cells.
To treat solar lentigo and freckles, use IPL, Q-switched lasers and fractional lasers.
To treat melasma and PIH (and only after topical therapy and chemical peels), try fractional radiofrequency, Q-switched or picosecond lasers, high-fluence/high-density non-ablative lasers, pulsed dye lasers, IPL, microneedling, and spot liquid nitrogen treatment.
If you are considering laser or light treatment, be sure to first consult an accredited dermatologist to recommend suitable treatments for the skin condition you are experiencing.
Patients who are not ready to commit to prescription treatments like laser can consider cosmeceuticals. These are over-the-counter cosmetic products infused with bioactive ingredients that are scientifically proven to deliver results to the skin. In fact, even with prescription treatments, cosmeceuticals are important adjuncts for the treatment of dark spots. Being very safe on skin, cosmeceuticals are suitable for long-term use in maintenance of the skin condition post-treatment and also during the treatment itself to enhance the effects of prescription treatments. For example, following laser treatments, skin cells are stimulated to rejuvenate and the availability of bioactive raw materials in cosmeceuticals on skin increases rejuvenation benefits during the healing process.
Bioactive ingredients that fight dark spots include vitamin C, niacinamide and oligopeptides. As an antioxidant, Vita C GOLD™ Serum helps fade dark spots on your face and neutralise free radicals that damage skin. Stabilised vitamin C, in the form of sodium ascorbyl phosphate, is particularly potent as an antioxidant (without the pitfalls of raw ascorbic acid that may cause skin irritation in higher concentrations) and found in our dermatologist formulation. Niacinamide and oligopeptides are both important skin-brightening constituents of the Radiance Fluide™ Hydrating Emulsion. They participate in different parts of the metabolic pathway in melanin synthesis to inhibit the pigmentary effects that form dark spots.
Melanin is the culprit behind the dark spots that give us an uneven complexion. It is a brown pigment found in the basal layer of the epidermis.
This pigment is synthesised by melanocytes. The process of melanin synthesis is termed melanogenesis. Melanocytes go through different stages of maturation, becoming more pigmented at each stage.
Certain stimulants trigger a gene to produce more of tyrosinase, a copper-containing enzyme that converts tyrosine into melanin. Stimulants that activate the melanocyte include hormones, inflammation (such as acne) and external environmental conditions (ultraviolet light that causes the production of free radicals).
One simple way to reduce melanin production is to use broad-spectrum sunscreens with zinc oxide, titanium dioxide or iron oxide. These substances help block UVA and UVB light, thus impeding the stimulation of melanocytes.
Pigmentary disordersfrom melanin
Common hyperpigmentation disorders that involve the darkening of an area of skin due to increased melanin include melasma, lentigo, and post-inflammatory hyperpigmentation.
Melasma is usually caused by chronic exposure to ultraviolet radiation or a spike in hormones due to pregnancy or the use of oral contraception. It can be found at the epidermis, dermal layer or mixed, depending on the location of the pigment.
A lentigo is a light or dark brown area of discoloration that can range from 1mm to 1cm across, and is caused by an increased number of melanocytes. Its outline is usually discrete, but can also be irregular. Simple lentigines arise mostly during childhood on areas not exposed to the sun. Solar (or senile) lentigines are found on the backs of hands or on the face, most commonly after middle age.
Post-inflammatory hyperpigmentation (PIH) is the skin’s response to inflammatory skin disorders. Common causes are acne and atopic dermatitis. PIH is caused by the overproduction of melanin caused by skin inflammation.
Treating hyperpigmentation from melanin
Hydroquinone: For 50 years, hydroquinone has been the gold standard treatment for hyperpigmentation. This compound inhibits tyrosinase activity, thus limiting the amount of melanin to be produced. It also alters melanosome formation, possibly degrading melanocytes.
However, prolonged use of topical hydroquinone has shown to have side effects such as ochronosis and permanent depigmentation. Ochronosis is a disorder with blue-black discoloration. As such, hydroquinone is banned in cosmetic formulations and only available through a prescription that should be carefully managed by an accredited dermatologist.
Retinoids are forms of vitamin A that can treat acne, photodamage and PIH. They have various pathways that lead to skin lightening effects, such as accelerating epidermal turnover, reducing pigment transfer and slowing the production of tyrosinase.
With common side effects being erythema, skin irritation, dryness and scaling, it is recommended to use a retinoid only under the supervision of an accredited dermatologist. Corticosteroids (steroid hormones) have anti-inflammatory abilities and are often prescribed along with retinoids to prevent excess irritation.
Arbutin is a botanically derived compound found in cranberries, blueberries, wheat and pears. Though arbutin is a derivative of hydroquinoine, it has shown to be a more controlled way of inhibiting the synthesis of melanin as it does not permanently destroy melanocytes.
Kojic acid is a naturally occurring fungal substance. Its skin-lightening ability works by inhibiting the activity of tyrosinase. However, frequent use can cause side effects of contact dermatitis or erythema (redness of the skin).
Azelaic acid is known to be effective for treating PIH and acne. Azelaic acid depigments the skin in several ways. It can inhibit tyrosinase or reduce levels of abnormal melanocytes. This means that azelaic acid does not influence normal skin pigmentation but only acts on the proliferation of unwanted melanocyte activity. Side effects are mild and only last for a short period of time. Irritation, burning sensation or mild erythema may emerge, taking 2 to 4 weeks to subside.
Niacinamide is a derivative of vitamin B3. It works by decreasing the transfer of melanosome to keratinocytes. Niacinamide is a stable ingredient as it is unaffected by light, moisture or acids. This ingredient is often incorporated into cosmeceuticals due to its safety profile.
Vitamin C or L-ascorbic acid is a naturally occurring antioxidant that helps with skin lightening. It prevents tyrosinase from converting tyrosine to melanin. Vitamin C is also favored for its anti-inflammatory and photoprotective properties. However, L-ascorbic acid is highly unstable and rapidly oxidized. It is not used in the treatment of PIH.
Stable forms of vitamin C include magnesium ascorbyl phosphate or sodium ascorbyl phosphate. For safe and effective results, consider a dermatologist-formulated serum VITA C GOLD™ Serum,a formulation tested for bio-activity in a laboratory.
As seen above, there are various treatment options to treat common hyperpigmentation disorders. Recognizing the underlying cause for pigmentation is critical for proper treatment and choosing the best-suited therapy. Visit an accredited dermatologist for effective and safe treatments catered to your condition.
Melasma is an acquired skin problem of hyperpigmentation, frequently faced by women in their reproductive years. The condition is characterized by hyperpigmentation primarily on the face, so we may observe irregular brown or blue-grey macules on the face. Common areas where the brown patches appear are cheeks, nose, forehead, jaw and the chin.
How prevalent is the disorder?
While melasma occurs in all ethnic and population groups, studies have shown that there is a higher prevalence among more pigmented phenotypes. These include Asians, Indian, Pakistani and Middle Eastern. In the Americas, those who suffer from melasma mostly live in intertropical areas where exposure to UV rays are greater.
What are the different types of hyperpigmentation?
You may be doing your research diligently to find out more about melasma, but there are different types of pigmentation, and they are not all the same. Apart from melasma, your face could be suffering from freckles, sun spots or age spots. Freckles, or ephelides, are small, flat and brown marks that are prevalent in childhood. Sunspots, or solar lentigo, only surfaces in our late twenties and can increase in size and number with increasing sun exposure. Age spots, or seborrheic keratosis, is actually not a form of pigmentation, but a non-cancerous skin growth that kicks in with age.
Melasma, on the other hand, can be identified with a greyish-brown discolouration, at times in the shape of a butterfly.
What causes melasma?
While the cause of the disorder remains unknown, current research point towards sex hormones and sun exposure as the greatest culprits.
These brown patches appear on our face as when there is an excessive production of a pigment called melanin. UV radiation induces the increase in melanin production to protect the skin from sun damage. This causes the development of pigmentation to take place on the skin. A leading cause of melasma is excessive sunlight exposure.
Hormones can also be another cause of melasma. You may develop this condition at the start of your pregnancy or if you are on birth control pills. Pregnant women experience higher levels of increased progesterone, estrogen and melanocyte-stimulating hormones. Melanocytes are cells that produce melanin in your skin.
Other causes can be due to certain medications, scented or deodorant soaps, or your toiletries. These products may contain an ingredient that causes a phototoxic reaction that can trigger melasma.
What are the types of melasma?
There are three types of melasma: epidermal, dermal and mixed.
The epidermal layer affects the outermost surface of the skin, and the easiest type to treat. It can be identified by the presence of excessive levels of melanin in that layer. Patches will be a darker brown colour, with a defined outline.
The dermal layer will affect a deeper layer of the skin beneath the superficial layer, and we can recognise it by the occurrence of melanophages throughout the dermis. Melanophages are cells that ingest melanin. The dermal layer can be more deep-rooted, and may not respond well to treatment. For this layer, patches have a less defined outline, with light brown or bluish colour.
A mixed condition of melasma would be having both the epidermal and dermal types, and improvements on the condition can be expected with treatment.
How to treat melasma?
The response of melasma to treatment can be slower if the condition has been present for a longer time.
Excessive sun exposure leads to the deposition of melanin cells within the dermis and can persist long term. Coming into contact with UV radiation will deepen the pigmentation as it will activate the production of more melanin, causing your brown patches to turn darker and harder to remove.
Generally, by including sun protection into your skin routine, hyperpigmentation can be resisted. With Singapore’s tropical weather, it is recommended to reapply sun protection every 2 hours with a broad-spectrum sunscreen having at least SPF 30. Consider bringing along sunglasses or a hat when you are outdoors.
For clinical treatments, consultation with a trained dermatologist is recommended. A proper diagnosis of melasma should be conducted, and screened if there are any underlying conditions that may require treatment.
Prescriptions may be given to inhibit the formation of melanin. Hydroquinone is a controlled ingredient that is frequently included in medications to treat melasma, as it allows lightening of the skin. A precise concentration of hydroquinone should be administered for treatment, and may be professionally managed so by your dermatologist.
Procedural treatments for melasma can also be considered, such as chemical peels and lasers. Expected efficacy of each treatment can vary depending on the severity of melasma, with topical combination therapies being one of the most effective treatments for hyperpigmentation.
Speak to your dermatologist for a tailored recovery experience.
Vitamin C is likely to be no stranger to any of us, we see it present in plenty of fruits and vegetables like oranges, grapefruits or pineapple. Yet, it is rather new to most of us to have it on our face. This obsession with this skincare ingredient could be why you are googling up on this article now, and what we are about to tell you.
The vitamin brings benefits to the skin that we love: antioxidative, photoprotective, antiaging, and anti-pigmentary effects.
Vitamin C in our body
Vitamin C is the most abundant antioxidant in human skin. Antioxidants work to reduce the damage that free radicals can bring to our skin cells. We are unable to synthesize the antioxidant as we do not have the enzyme needed to do so. Even as we consume high doses of vitamin C supplements, only a small fraction of it will remain in our body and skin cells. This brings us to rely on external supplements, with topical application being the most common form.
What should the concentration of my Vitamin C be?
When choosing a product, you may come across different concentrations of the active ingredient available. Of what percentage of the ingredient should we be using? That really depends on the type of Vitamin C in use. Conventional Vitamin C formulations such as Ascorbic Acid in its raw form may require 10 to 20 percent to have any reasonable efficacy. This is limited inherently by the fact that higher concentrations, for instance above 20 percent, may cause irritation to the skin. On the other hand, studies have shown that a mere 1 percent concentration of Sodium Ascorbyl Phosphate – considered to be a new generation of ascorbic acid derivatives, has strong antimicrobial efficacy against acne.
What are the common forms of Vitamin C?
Out of all the various forms of Vitamin C, L-ascorbic acid is conventionally recognised as one of the most biologically active molecules. This compound is likely to be found at a pH below 3.5 for greater stability and permeability. Above that, the acid becomes very unstable in aqueous solutions and is prone to immediate oxidation, turning to a brown colour when oxidized.
Other formulations available are magnesium ascorbyl phosphate, ascorbyl-6-palmitate and sodium ascorbyl phosphate. These formulations are stable at neutral pH of 7. As a water-soluble derivative, magnesium ascorbyl phosphate is more stable in water but less potent than L-Ascorbic acid.
Sodium Ascorbyl Phosphate is one of the most stable and effective forms of available. As it will not oxidize as easily, it is a preferable choice for skin care formulations. A well-formulated product allows sodium ascorbyl phosphate to penetrate the skin epidermis without causing irritation. You may consider a dermatologist-formulated product such as Vita C Gold™ Serum, which is a Sodium Ascorbyl Phosphate formulation that has been tested for bio-activity in a laboratory, for safe and effective results.
Different formulations of Vitamin C exists, and you may decide which forms would be preferable in your skincare by weighing in on the cost, potency, texture or formulation. Although the conventional L-ascorbic acid is perhaps the most potent derivative of Vitamin C, it oxidizes too quickly when exposed to oxygen to be much efficacy on the skin. One may prefer newer Vitamin C derivatives – Sodium Ascorbyl Phosphate, which are much more stable and able to deliver better efficacy even at lower concentrations.
Vitamin C helps to produce collagen
The nutrient is required by our bodies to produce collagen, making it crucial for anti-ageing. Think of it as an anti-ageing shield your skin needs to reduce the damage your skin suffered, and also to prevent future damage. The vitamin also facilitates enzymes that lead to the stability of collagen fibers. In addition, it increases expression of collagen and synthesizes inhibitors to block enzymes from degrading collagen.
Vitamin C has anti-pigmentary effect
Vitamin C plays an important role in skin-lightening, as it inhibits an enzyme called tyrosinase. This enzyme works by converting tyrosine into melanin, so by reducing the activity of tyrosinase, our skin cells produce less melanin.
Should I DIY my own serum?
According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she says: “Concocting your own serum of Vitamin C can be dangerous as it can lead to phytophotodermatitis, a condition where itchy blisters and reddened patches appear on the exposed skin. The redness and blistering will settle down in a few days, but it leaves pigmentation at the same sites. Phytophotodermatitis results from the action of UV radiation on a plant chemical called furocoumarins. Citrus fruits such as lemon, lime or bergamot oranges are often responsible for the reaction.”
It is best to avoid DIY recipes or you may end up with rashes that scar for a long time.
Also known as the “mask of pregnancy”, Melasma pigmentation is the presence of either brown or grayish brown patches, that typically appears on both sides of the face, especially on cheeks, upper lip, nose, forehead or chin area. The excessive production of melanin from melasma causes the pigment in the affected skin area to tan, resulting in a brownish or grayish brown discolouration.
Who does Melasma Pigmentation affect?
Although anyone can have melasma, it is more common amongst pregnant women, women who consume oral contraceptives and people with darker skin types. Even though sun exposure is seen to be a triggering factor, experts believe that the pigmentation is caused by hormonal changes that occur when a woman begins to consume birth control pills or is on hormone replacement therapy or during her second or third trimester of pregnancy.
What should I know about Melasma?
The duration in which the melasma pigmentation fades, varies from individual to individual depending on the intensity and cause of Melasma. For some individuals, pigmentation caused by Melasma may worsen over time. For individuals who have been affected by Melasma during pregnancy or through the consumption of birth control pills or undergoing hormonal therapy, it may fade without treatment after childbirth or the discontinuation of such hormonal treatments. However, it is important to note that, Melasma can return with each future pregnancy, even if it fades after a prior child delivery.
What are the treatment plans available for Melasma?
Before starting any treatment against melasma pigmentation it is important to consult a trained and accredited dermatologist. This is important to confirm the diagnosis of Melasma and to check that there is no underlying or associated skin disease that would require immediate treatment. Secondly, as melasma pigmentation can worsen over time and even become permanent, by having a consultation with a dermatologist this can be prevented. Thirdly, as effective medical melasma treatments require a prescription — as these treatments may sometimes produce mild side effects — these medications need to be consumed under medical supervision.
There are 3 ways that are used to treat Melasma:
Cosmetic: The use of cosmetics such as colour correctors, concealers and foundations to cover the dark areas. However, in the long haul, this method does not help melasma to fade.
Medical: Prescription medications such as those containing hydroquinone. These medications are aimed at inhibiting melanin production selectively, therefore causing a depigmenting effect, allowing Melasma to fade over time.
Physical: The use of topical agents such as chemical peels and lasers.
Dermatologists may recommend undergoing ‘combination therapies’ such as creams that combines a few active ingredients, in conjunction with laser treatments and chemical peels. This prescription treatment is able to lighten moderate to severe melasma quickly and effectively.
How to prevent Melasma from getting worse?
As tanning of the skin occurs when the pigment in the skin — melanin — absorbs the ultraviolet rays produced by the sun, with constant exposure to the sun, Melasma has a tendency to get darker. It is recommended that one avoids exposure from the sun to prevent further darkening of existing melasma as well as the formation of new patches. By protecting your face from harmful UV rays of the sun by either wearing a hat or a dermatologist tested sunscreen with SPF30 or higher, the possibilities of melasma pigmentations darkening could be further reduced. Using cosmeceutical antioxidant skincare such as stabilised Vitamin C would also have benefits in lightening and preventing aggravation of pigmentation.