Hyperpigmentation results in flat, darkened patches of skin that are light brown to black in colour, and can vary in size and shape. Types of hyperpigmentation include age spots, melasma, and post-inflammatory hyperpigmentation and even lentigo maligna, a form of skin cancer. Hyperpigmentation is one of the biggest skincare concerns today, so if you do have them, know that you are not alone. Read on as Dr Teo Wan Lin addresses your concerns on hyperpigmentation and pigmentation products.
Q1: Do most brightening products target only the top layer of the skin?
It is important to understand from a dermatologist perspective that pigmentation develops from primarily the layer of the skin we call the epidermis. The epidermis itself is further divided into layers, the bottommost layer is known as the stratum basale. It is important scientifically to distinguish that references to the top layer of the skin are actually not accurate because the top layer itself is further divided into five different layers. That being said, the origin of pigmentation is typically from the melanocytes. Melanocytes refer to pigment producing cells – this originates from neural crest cells during the development of the central nervous system via the process of embryogenesis. Pigmentation commonly localises to the stratum basale.
Q2: What are the differences between pigmentation products and brightening products?
In terms of brightening products, one does not use the word brightening in dermatology. However, I understand that it’s a colloquial expression of a topical, that when applied leads to removal of pigmentation, i.e. referring to pigmentation products. This would commonly fall under the category of active ingredients that inhibit the production of melanin, a process we call melanogenesis.
Q3: Do most brightening or pigmentation products make you more sun-sensitive?
I think it’s not to say most. If you were to just zoom in on the synthetic skin lightening pigmentation products, then yes. This is because the most prominent would be hydroquinone and retinoids, both of which could be sun sensitising. Tretinoin which is a form of retinoid and hydroquinone, primarily from its irritating side effects. Having irritated skin means you could be more susceptible to sun damage. On the other hand, botanical or nature derived ingredients that have been scientifically proven to help pigmentation, tend to have little to no side effects. For example, there are certain microorganisms like fungus or kojic acid, that is derived from a fungus in nature, which are helpful in inhibiting melanocyte activity.
Q4: What are the active ingredients in these brightening and pigmentation products?
Most of the active ingredients are tyrosinase inhibitors. Tyrosinase is an enzyme that is actively involved in the production of pigment. Brightening and pigmentation products refer to any active ingredient that has been proven to inhibit the process of melanin formation and melanocyte activity. This would include evidence-based ingredients such as hydroquinone. Hydroquinone has both an epidermal and dermal action when it works in certain conditions such as melasma. In melasma, it is important to emphasise that pigmentation can be both superficial i.e. the top layers, or deep i.e. the dermal layers.
Q5: When pigmentation products advertise that they can effectively treat the cause of hyperpigmentation, are we supposed to believe that?
I think it’s really any descriptive that brands can choose to use. The important thing is the active ingredients the product consist of and the ingredient’s validity based on credible sources. You can carry out a short literature review on the ingredients on a scientific database i.e. Pubmed funded by National Institute of Health (NIH) in the US. If it’s an active ingredient that is scientifically proven, you’ll be able to find more than one paper on that ingredient.
Do note that skincare and cosmetics are not regulated by any authority. The Food and Drug Administration (FDA) in the US and Health Sciences Authority (HSA) in Singapore essentially regulates the incorporation of toxics and banned substances in skincare. They however do not validate claims in skincare. Hence, it is important to first research active ingredients listed in the pigmentation products.
Q6: Do pigmentation products tackle the root of hyperpigmentation or simply “slough off the top layers”?
I believe “sloughing off the top layers” refers to epidermal cell turnover which is the turnover rate of the topmost layer of your skin. There are some active ingredients e.g. glycolic acid, which is a type of AHAs that works well for pigmentation due to its ability to interfere with epidermal cell turnover. Topical retinoids also work by regulating epidermal cell turnover, though via different mechanisms. It targets various pathways in the skin to increase skin elasticity, increase collagen formation as well as decrease deposition of pigmentation.
Q7: Are the causes of pigmentation on the face and other areas of the body the same? What are the different types of pigmentation?
It is common for a layperson or a non-dermatologist to assume that an area pigmentation vs another area is the same. But to dermatologists, pigmentation itself is a very broad topic and there are 20 or 30 different types of pigmentation. The common ones are mostly cosmetic, thereabouts 4 or 5 types of pigmentation. The most common type of pigmentation is sun spots which is known as solar lentigo. Solar lentigo is dependent on age, genetics and amount of sun exposure. Another common type of pigmentation is ephelides, ephelides are genetically coded freckles which are more common in individuals with red hair.
The other common type of pigmentation in people of coloured skin would be melasma. Melasma is categorised into different types, depending on the various depths of the deposition of the pigment as well as the location of melasma. Other causes of pigmentation would be post-inflammatory hyperpigmentation (PIH) – a mark is left from a pimple or a surgery. PIH has to be treated differently from melasma, solar lentigo and ephelides. There are other types of pigmentation and even autoimmune diseases such as lichen planus. Lichen planus leads to hyperpigmentation of the skin. It is dangerous for anyone to assume that it’s a cosmetic problem and try to treat that with aesthetic dermatology treatment.
Q8: How do I eradicate dark spots and pigmentation on my face?
Firstly, it is important to get a correct diagnosis and knowing when the pigmentation becomes dangerous. It is crucial to not assume dark spots on your face to just be an aesthetic problem that you can burn or laser off. Dermatologists are trained to distinguish between various types of moles which are not obviously cancerous. Thus one should seek professional help before any assumptions are made.
A typical red herring would be a condition known as lentigo maligna. Lentigo maligna has been infamously diagnosed by dermatologists as an cosmetic pigmentation issue. However, it is a fairly aggressive form of skin cancer, melanoma. Melanoma has the ability to spread to your lymph nodes and if discovered at an advanced stage, at the very minimum, it causes severe disfigurement due to the extent of surgical resection needed. At worst, it can lead to mortality.
Q9: Lipodisq has been incorporated safely and efficiently to deliver potent skincare actives into deep layers of the skin. What are your views on nanoparticle drug delivery?
Lipodisq is a nanoparticle delivery system that is patented by a cosmeceutical company in the UK. To my knowledge, it is something which certain cosmetic manufacturers also utilise in the formulation of their products including pigmentation products to increase the cutaneous absorption of active ingredients.
In terms of nanoparticle drug delivery, I would say data is very much limited to the commercial interest that is driving the technology and hence the patent protections as well. Accordingly, I currently do not know of studies by the international dermatology community that independently verify these claims Nonetheless, from what we see with literature provided by the parent company that has researched this technology, the data does seem interesting and the technology itself, a safe and sound form of topical delivery.
In this series of articles, I shall expound on the science and chemical aspects of skin lightening agents used for hyperpigmentation, both prescription and over-the-counter alternatives such as cosmeceuticals. In the first installment, we shall cover the commonest prescription medications used for skin lightening – hydroquinone, and its derivatives.
Cosmeceuticals are topicals that have both cosmetic and pharmaceutical effects. They enhance the beauty through constituents that provide additional health-related benefit. Cosmeceuticals are commonly used for hyperpigmentation. Hyperpigmentation involves the need for skin lightening agents which includes cosmeceuticals. Cosmeceutical agents selectively target hyperplastic melanocytes and inhibit key regulatory steps in melanin synthesis.
Cosmeceuticals are commonly used for hyperpigmentation. Pigmentary disorders are the third most common dermatologic disorder and cause significant psychosocial impairment. These disorders are generally difficult to treat, hence, the need for skin lightening agents including cosmeceuticals.
Common active ingredients in cosmeceuticals for treating hyperpigmentation include the following: Ascorbyl phosphate (Vitamin C), Niacinamide (derivative of Vitamin B12) and plant-derived (phyto-antioxidants) which include grape seed extracts, white flower complexes and grape fruit extracts.
What Are Some Prescription Medications For Treating Hyperpigmentation?
Here are some compounds found in prescription medications that have been used to treat hyperpigmentation.
Hydroquinone competitively inhibits melanin synthesis by inhibiting sulfhydryl groups and acting as a substrate for tyrosinase and dermatologists have traditionally relied on prescription medication hydroquinone at concentrations of 1-4% to treat cases of hyperpigmentation.
What is hydroquinone and what is it used for?
Hydroquinone (HQ) is a chemical belonging to the family of phenols. Hydroquinone competitively inhibits melanin synthesis. Specifically, it blocks sulfhydryl groups and acts as a substrate (receptor) for tyrosinase, an enzyme involved in pigmentation.
Dermatologists have traditionally relied on prescription medication such as hydroquinone at concentrations of 1-4% to treat cases of hyperpigmentation, especially those related to solar lentigo, freckles (ephelides) and melasma.
It is also sometimes prescribed to treat post-inflammation hyperpigmentation. However, the use of hydroquinone is not without side effects of skin irritation. There have also been cases of skin de-pigmentation, a form of permanent scarring.
What are the concerns involving the usage of hydroquinone?
As hydroquinone is carcinogenic and may cause DNA Damage, over-the counter skin bleaching agents containing hydroquinone are banned, and should be used under strict medical supervision for a period of time only. Clinical studies supporting these side effects were based on ingested and injected forms of hydroquinone which are not used clinically in dermatologists’ offices. There has been no evidence of skin cancer or organ cancers developing as a result of hydroquinone applied topically.
However, I have phased out the use of hydroquinone for treating most pigmentation problems in my practice and relied more on over-the-counter active ingredients in cosmeceuticals which are mainly plant-derived and still demonstrate clinical efficacy for the treatment of pigmentation problems.
With the recent safety concern regarding the use of hydroquinone, the need for alternative natural, safe and efficacious skin lightening agents is becoming all the more necessary.
What is it?
It is a derivative of hydroquinone. Its mechanism of action is unclear. It acts as a substrate for tyrosinase, thereby inhibiting the formation of melanin precursors.
What is it?
A phenol that blocks tyrosinase activity (pigment cell producing activity).
1. Kojic Acid
What is it?
Kojic acid occurs in nature as a water-loving fungus byproduct. It helps to block the progression of pigmentation by stopping the production of the enzyme tyrosinase. It is also a powerful antioxidant which means that it engulfs free radicals that are responsible for skin aging.
What is it?
Arbutin is one of the most widely prescribed skin-lightening and depigmenting agent worldwide. It is a derivative of hydroquinone, and is a naturally occurring plant derived compound.
How does it work?
Arbutin prevents the growth and maturation of the cell component responsible for hyperpigmentation known as the melanosome. Notably, it is less toxic to the pigment cells than hydroquinone. Melanosomes are the pigment granules confer skin with colour and sun protection. They are also the cell engines whereby the body produces, stores and transports pigments known as melanin. The use of arbutin is limited by its concentration. While higher concentrations may be more effective, there is a greater risk for hyperpigmentation which can occur as a paradoxical side effect.
Is it effective?
Although there have been no randomized controlled trials on using arbutin for treating hyperpigmentation, it has been proven in many clinical studies to still be effective.
Dr.TWL Pharmacy is a proprietary specialist skincare pharmacy run by Dr. TWL Dermaceuticals, providing custom compounded prescriptive cosmeceuticals for common skincare concerns. It is located on-site at TWL Specialist Skin & Laser Clinic, a Ministry of Health accredited dermatology practice headed by dermatologist Dr. Teo Wan Lin. The pharmacy formulates skincare prescriptives for the treatment of various skin concerns including acne, hyperpigmentation, anti-ageing, excessive oil production, age spots and skin sensitivity/redness.
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.
As a dermatologist, one of the first signs of ageing I observe shows in the eye area, what we call the peri-orbital or peri-ocular region. The commonest complaints I hear from my patients old or young are “Is there anything I can do for my eye bags, dark circles and eye wrinkles?” This is tricky because while so many spas, medi-spas, aesthetics providers and skincare companies confidently brag about their treatments erasing eye wrinkles and waving eyebags goodbye, I often have to burst bubbles in my clinic when I tell my concerned patients their hopes may be misplaced in a single miracle product which probably doesn’t exist.
In my practice, I use a multi-dimensional approach to work the aged eye area — a combination of skin resurfacing (nitrogen plasma over laser for sensitive areas such as the eye region), injectables like botulinum toxins, dysport and Botox. This, in conjunction with an eye cream that I formulate for my patients to use on a daily basis for before and after care, with specific active ingredients to brighten, tighten, moisturise and anti-age periorbital skin, besides being tested for safety and efficacy to complement medical aesthetics treatments around the eye area.
Men and women alike are affected by concerns of ageing and looking older, there’s nothing vain about wanting to look like a younger version of one’s self. In fact, it has been shown that your skin starts to age at around the age of 25. Main areas of wrinkles are at the forehead, nose, mouth and especially around the eyes. Eye wrinkles are often noticed first and more evident as the skin in this area is thinner, making it susceptible to wrinkling. Regardless of gender, you are prone to getting wrinkles so start taking care of your skin to maintain your youthful appearance!
What is Plasma Skin Regeneration?
It is a non-laser treatment that uses a device to convert nitrogen gas into plasma energy, to rejuvenate skin by improving facial lines, wrinkles and pigmentation caused by photoaging. This technology offers a wide variety of single pulse energy levels with different options of frequency that can most efficiently improve the precision of plasma delivery. This function allows accurate temperature irradiation to drastically improve topical drug delivery for a variety of dermatological indicators.
Personalisation of settings to cater to different patients is available, as patients’ skin conditions differ in terms of downtime and receptivity to treatments. Through deep tissue re-modelling, the energy delivered by plasma skin regeneration is non-fractionated. This allows for even energy absorption, ensuring the consistency in treatments done to the skin. The high energy also supports significant skin tightening. With deep tissue re-modelling and accelerated healing, plasma skin regeneration usage is versatile and effective.
The handpiece first releases the nitrogen plasma pulses.
This causes it to transfer thermal energy to the skin, allowing for controlled heating of the tissue.
The controlled duration of the pulse and temperature then allows the treatment to happen optimally.
This then leads to the possibility of treatments of many dermatological conditions due to the carefully controlled time frame.
Nitrogen plasma technology has been tested and backed by evidence. It has over 3 years of pre-clinical and clinical testing, 16 separate studies conducted, more than 450 clinical study treatments which proved to cause no scarring or pigmentation, and one year of clinical histology. This intense and detailed level of testing is uncommon in the industry, whilst clinically proven to perform skin resurfacing and regeneration using plasma energy.
Drug Delivery Effect
There are many treatable indicators like anti-aging effects, pore size reduction, wrinkle reduction, skin tightening, stretch marks reduction, acne scar reduction and more. However, one key effect is the drug delivery effect. When the skin is exposed to the nitrogen plasma, the permeability of the skin increases. This allows for better absorption of the drug, enhancing drug delivery and making the drug more effective during and after treatment.
Plasma skin regeneration converts nitrogen gas into the fourth state of matter, plasma energy. It then emerges from the handpiece in controlled pulses and causes rapid heating of tissue. This allows for the transmission of thermal energy to the tissue.
The treated photodamaged skin layers undergo controlled thermal modification without additional harm. This allows for speedy healing and a natural layer of protection for the skin. At high temperature and energy, the skin epidermis breaks down and sheds, but only after a new healthier skin layer forms beneath. Plasma skin regeneration is non-invasive and will not cause any open wounds.
Treats the Whole Skin Structure
Plasma skin regeneration can treat the entire skin structure. It ensures that the entire skin surface is regenerated and produces conditions favourable for optimal results. It is associated with neocollagenesis and neoelastogenesis. Neocollagenesis is the process of making more collagen while elastogenesis refers to the mechanisms that drive elastic fiber formation for our skin.
Ideal for Eyelids Treatment
The skin around our eyes, our eyelids, are especially sensitive and thinner than the rest of our skin. Thus, not all treatments are suitable to prevent eye wrinkles and eye bags. However, plasma skin regeneration, with its precision safety and efficacy, is suitable for treatment of the eyelids to reduce wrinkles and achieve an anti-aging effect, whereas previous technologies might be less safe for sensitive thin eyelid areas or even deliver inconsistent and ineffective results. In addition, due to the significant skin tightening effect from skin regeneration, deepening of the eyelids (with a look of deeper-set double eyelids) is also achieved.
Long Lasting Effects
Plasma skin regeneration has been proven to show neocollagenesis and reduce elastosis (abnormal elastic tissue in the skin which is a result of excessive sun exposure). Elastosis can cause your skin to have wrinkles and even pigmentation. The nitrogen plasma technology has post treatment effects that can last for more than a year.
With its reliable and advanced technology, plasma skin regeneration can produce anti-aging and long-lasting effects with its non-invasive methods, helping you to achieve a bright and youthful appearance.
With the festive season just around the corner, we can expect our time spent hopping from one party to another. Eating one too many nibbles, and all those glasses of fizz – we want to look ready when we hit the party scene. You may have got what to wear sorted, so turn your focus to your skin. Whether you are celebrating with family and friends or getting ready for the office party, get your party-ready skin and look your best this festive season with these beauty upgrades.
With multiple treatment types available, it is recommended to familiarize yourself with the options available before making the best decision for your concerns. Cut through the confusion and get the facts that you need for an informed decision.
Improve and smooth the texture of your skin with a chemical peel, which removes the outermost layers of the skin with a gentle peeling solution derived from fruit or milk acids. When performing the treatment, this solution is applied to the skin for a duration of time ranging from three to seven minutes. The solution can include alpha-hydroxy acids, glycolic acid, lactic and salicylic acid.
With the application of the acids, the skin undergoes microscopic peeling, whereby dead skin cells which are usually shed with time, are induced to shed earlier, resulting in a fresh and radiant complexion. One should know part of the normal skin ageing process results in a longer duration of skin cell( keratinocyte) turnover, resulting in slower shedding, and this can contribute to dull looking skin. Skin cells from the deeper layers of the epidermis regenerate after the peel, allowing smoother skin with fewer wrinkles, as well as stimulating collagen in skin.
According to Dr.Teo Wan Lin, an accredited dermatologist, “I recommend the chemical peel for those experiencing acne, or as a form of anti-ageing treatment to maintain youthful skin, either alone or in combination with lasers and cosmeceuticals. My patients who come for chemical peels also look to minimize damage caused by sun damage, such as wrinkles, or other problems such as dark spots, dull or uneven skin texture, freckles and fine lines. As compared to other treatments, chemical peels can be more cost-effective as a form of maintenance and as an adjunct treatment.”
Ensure that this treatment is performed by a medical professional, and go for a professional evaluation before going for the treatment. The concentration of the acid solution applied to the skin has to be controlled, and results may vary according to either commercial brands used. A specially compounded in-house chemical peel solution is used at the clinic, tailored either for lighter, caucasian skin types, or darker asian or hispanic skin types as each as different requirements. Darker skin types should be particularly cautious as stronger peels, when used inappropriately can result in pigmentation instead.
According to Dr. Teo, ” One should be wary that over the counter DIY cosmetic skincare which tout various acids, such as lactic, salicylic acids, and AHAs all contain sub-therapeutic levels of the ingredients, as higher concentrations are illegal to be used at home without medical supervision.What this results in is simply drying out the skin, which very often does not treat acne, result in antiaging but merely causes a form of eczema known as irritant contact dermatitis. I would avoid using skincare with any of these ingredients on a long term basis without consulting a dermatologist. “
For facial rejuvenation and reversing signs of ageing, you may consider going for laser therapy. This treatment can help to reduce wrinkles, age spots, acne scarsand help to tighten your skin. When a laser is used, a concentrated stream of a invisible wavelength penetrates the skin. The laser treatment can target either the surface layer or deeper layers of your skin, depending on the results you are looking for. Lasers that work beneath the surface skin layer are called non-ablative lasers.
Non-ablative lasers help to remove skin discolouration, reduce redness from rosacea and improve fine lines and wrinkles. With multiple treatments, it can also help to stimulate collagen production.
Ablative lasers work by targeting the surface layer of your skin by ‘ablating’ the surface of your skin. Such lasers can make a greater difference in your skin replacing damaged skin from sun damage with healthier, new skin. Follow-up care is necessary with ablative lasers to ensure smooth result and needs at least two weeks for full recovery. If you are rushing to be all ready for the festive period, it is recommended to postpone your ablative laser treatment.
In the hands of accredited dermatologists, laser treatment will help to dramatically improve your skin appearance. Lasers advertised by spas or aestheticians may not even be medical grade, as the HSA does not allow therapeutic lasers to be operated by aestheticians. Such “laser facials” may hence be ineffective or even outright dangerous.
HIFU is ideal for the tightening, lifting and rejuvenation of facial skin. It is safe and effective and is a popular alternative to a surgical face lift to help improve lines and wrinkles. With high intensity focussed ultrasound energy, two particular layers below our skin are targeted – the superficial muscular aponeurotic system (SMAS) and the dermis. The SMAS is a layer of facial muscles that is tightened during a facelift, while the dermis layer is made up of collagen and elastin fibres that provide the skin with strength and elasticity.
Using the power of ultrasound, HIFU is able to this energy to safely tighten and lift the skin. The safety of the treatment comes from being able to protect the surface of the skin whilst still penetrating precisely deep into the skin to treat beyond the surface layer. No damage will be done to the surface layer or any adjacent tissues.
Targeted skin tissues will be subjected to thermal heat that promotes healing, stimulating optimal levels of collagen production. Response to the thermal heat can lead to the desired effects of lifting and tightening, allowing HIFU to be a viable alternative to surgery. Energy emitted from ultrasound lasers would also melt facial fats during the treatment.
Finally, are you tempted by those advertisements offering aesthetic treatments like an ‘a-la-carte’ menu? One word of warning by our dermatologist though, “For safe and effective results, all these aesthetic treatments are regarded as medical interventions still and a trained dermatologist will not administer any of these without a thorough consultation discussing risks, benefits, costs involved and the overall maintenance required for a proper anti-ageing regimen, so as to ensure the treatment is tailored to your needs.” Armed with this guide, you are well on your way to look party-ready this festive season.
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.
Laser Therapy is the use of different invisible wavelengths of light to stimulate distinct layers of skin in order to rejuvenate and anti-age skin. Pigmented lesions can also be effectively removed with specific lasers that cause crusting and stimulate pigment cells (known as melanocytes) to disseminate.
Who is Laser Therapy for?
Laser Therapy is indicated for the following skin concerns.
Minimisation and/or the elimination of veins and redness
Non ablative lasers differ from regular forms of laser therapy. Instead of heating and removing the top skin tissue, non-ablative or non-wounding lasers work beneath the surface skin layer. They aim to improve skin texture and tone and minimize fine lines present with minimal side effects and recovery down time. Primarily used to treat facial skin rejuvenation and acne scars, according to a patient’s skin type and condition, non ablative laser therapies computer-control the parameters of light energy delivered from light-based devices.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, 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.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email firstname.lastname@example.org. Alternatively, you may fill up our contact form here.