The term “skin lightening”, along with “whitening” and “fair” have often been marketed in products, particularly in Asia. Aside from being unhealthy and unsustainable, skin lightening treatments and procedures can often be dangerous. In this article, dermatologist answers 5 common questions on skin lightening, shedding light on dangerous practices, and giving tips on how to even skin tone instead of whiten it; including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.
Can you actually lighten your skin?
In the context of achieving a fairer skin tone, I think it is important to define if we are talking about eliminating uneven pigmentation, for example, or actually bleaching one’s skin to go to a lighter skin colour. The latter I do not recommend but in terms of making one’s skin tone more even and eliminating dark spots, there are various forms of pigmentations that you should know about including sun spots – otherwise known as solar lentigo, freckles, other medical conditions such as post inflammatory hyperpigmentation and melasma.
There are specific topical medications, lasers, as well as pills that one can use to treat these conditions. For the case of actually going to a completely lighter skin tone that is not natural for one’s genetically determined skin type, I do not recommend that and we can address that later in this chapter
What are the steps to take to achieve a fairer skin tone? Can we break it down into lifestyle, treatments and skincare?
To achieve a fairer skin tone, I will focus on how to enhance one’s skin health, so that you get less of the common hyperpigmentation conditions. We start off with genetics. Everyone is born with a certain skin type – we call that phototype. The dermatological grading of this is the Fitzpatrick phototype. For Asians, we tend to be between type III to type V. When it boils down to why people of a certain skin type, for example in phototype III, have varying amounts of skin fairness or pigmentation, it is said to be influenced by various factors.
Lifestyle certainly plays a role, as our skin contains melanin, a light-absorbing pigment molecule that also gives our skin its color. When we are exposed a lot to the sun, we activate the melanin-producing cells, melanocytes, that can cause one’s skin tone to get darker. The amount of exposure to sunlight is therefore one important factor.
Other lifestyle habits like smoking, exposure to pollution and stress for example, can lead to a process known as free radical generation in our skin and this can increase one’s risk to hyperpigmentation or risk of existing areas of pigmentation to get even darker. Unhealthy lifestyle is definitely part of factors that cause our skin to be less radiant and can also cause the skin to appear as a dull complexion with uneven skin tone.
In terms of treatment, chemical peels and lasers help to stimulate one’s skin cells, restoring it to a normal cell cycle of a young person. Overall, this causes skin to look much more radiant with an even skin tone and a fairer complexion, whilst also reducing the amount of skin surface irregularities. The lasers work by causing the skin’s natural cells to eat up areas of pigmentation – this is beneficial for those hoping to achieve more even skin tone.
Certain skincare ingredients have shown effectiveness for even skin tone. For example, retinoids (which are prescription only), and oligopeptides which is what I incorporate in my skincare as it is non-irritating with potent anti-ageing properties and stimulate one’s immune cells to eat up pigmentation and has been proven to cause lighter skin tone.
Is it realistic to maintain a lighter skin tone than you’re naturally born with?
This is a very important question as it goes back to the premise of this series. Our skin tone is genetically determined and we refer to the Fitzpatrick phototype classification as mentioned above. It is unhealthy to want to bleach one’s skin and remove one’s natural melanin which is protective. There are ways to achieve that, but it is not practised in dermatologist’s offices because it is a dangerous method. The only indication for using bleaching creams will be to lighten small areas of hyperpigmentation such as sun spots or in cases of the medical condition – melasma.
To want to lighten one’s skin entirely, it is very dangerous because it can increase your risk of skin cancer as well as accelerate skin ageing. Such treatments are reserved for medical conditions such as vitiligo whereby one has lost significant amount of skin pigmentation through an autoimmune disease and is cosmetically disfiguring. In those cases, if the body surface area is involved very significantly, it can be an indication for the dermatologist to lighten the rest of the skin as well to help the overall cosmetic appearance.
What is the fastest way to lighten my skin tone naturally?
One’s skin tone often appears dark because of uneven pigmentation that has developed over the years with ageing and sun damage, as well as having dull skin. A quick in-office treatment will be a chemical peel performed by a dermatologist, using glycolic or lactic acids in combination with a laser treatment. In my clinic, we do both as part of a skin rejuvenating treatment on the same day. The results of this is usually apparent right after treatment, especially after applying the Amino Acid Masque which contains Vitamin C and various plant extracts that helps to shrink the pores and helps in brightening the skin tone.
To shed light on them, what are some controversial skin whitening and skin lightening methods?
More than controversial, some alternative skin lightening methods can be dangerous. In particular, do be wary of cosmetic products that promise exaggerated or miraculous results, as recommended by the Health Sciences Authority with some recent high profile cases of illegal cosmetics. Such products when purchased from unfamiliar sources may be prohibited, for example due to the dangerously high levels of mercury. This toxic heavy metal is in fact prohibited as an ingredient in skincare formulations as it can cause rash, skin discolouration and blotching. Chronic exposure to mercury may also cause damage to kidneys, digestive and nervous systems.
Another controversial method would be skin lightening creams containing ingredients such as hydroquinone and retinoids (tretinoin), which which can cause serious adverse reactions. While these substances may be commonly used in a dermatologist’s office as treatment for skin conditions, the potency requires it to be prescribed only by an accredited medical professional under strict medical supervision.
Other means of skin lightening such as intravenous glutathione treatments (injection) can be unsafe. Glutathione is an antioxidant naturally found in our cells and has skin-lightening abilities by converting melanin to a lighter color and cause reduction of melanin production as a whole. As with any treatments involving direct delivery to the bloodstream, additional caution should be exercised in consultation with an accredited medical professional. While glutathione has been proven safe for oral and topical treatments, we cannot say the same when it is injected into the bloodstream, given the inadequate safety data presently. Serious skin disorders, kidney dysfunction and thyroid function impairment have been reported in some cases.
Custom beauty? You have probably heard this term recently, with the launch of multiple custom skincare lines. Fresh off the press for us at Dr.TWL Dermaceuticals though, is our new division of Custom Cosmeceutical Makeup. Read on in the first of a 2-part interview with our founder, accredited dermatologist Dr. Teo Wan Lin
What is the Pi-π Cosmeceutical Custom Makeup Lab about?
ThePi- π Cosmeceutical Custom Makeup Lab offers scientifically created skin-tone matched cosmeceutical makeup, including colour correction concealers, as an extension of my established skincare arm, Dr.TWL Dermaceuticals. Our Flagship offering includes an in-house Dr.TWL Lip Lab which features a 100% edible, anti-ageing cosmeceutical, the LipSerum Stick™, which is a solid state lipstick customised to any shade you want! Our advanced colour science system recommends different shades of each color- pinks, berrys, reds, nudes and corals that would uniquely flatter different skin tones.
Why does makeup— including concealers, foundations, lipsticks— need to be customised? Why not a generic “works for all” product, like most mass produced brands?
Why a generic “works for all” product is not ideal for makeup is because of the variety and uniqueness of skin tones. Every individual’s skin tones is different—based on our scientific database, we have on record at least 100 shades of distinct skin tones, whereas most makeup brands have at most 6 or 7 colour shades for foundations and concealers. This variation in skin tones translates into different shades of each lipstick colour that would work ideally for each individual.
What are the advantages of the LipSerum Stick, compared to store bought lipsticks, other than the fact it can be customised to any colour?
Store bought lipsticks cause allergies in individuals with existing lip conditions like eczema and cheilitis. The lips are also one of the first areas to suffer ageing related concerns such as lip discolouration, wrinkles and loss of volume. I then came up with the idea of a topically applied lip cosmeceutical serum with anti-ageing salmon roe DNA, which is also suitable for eczema sufferers, that could also be customised with your favourite lip pigment.
What are the limitations of traditional lipstick selections?
Lipstick brands have a limited selection of colours. Everyone has a favourite colour for a different mood—pinks, berrys, reds, nudes and corals— but did you know that different shades of each can be created to flatter different skin tones? We worked with veteran makeup artists and scientist to create the Dr.TWL Advanced Colour Science System to recommend the perfect lip colour match for each skin tone, whether you want it classic, sweet, sexy or nude.
What’s so unique about this custom makeup lab? Is it just custom blend makeup?
It’s the first dermatologist-led custom makeup laboratory in the world which fuses both skincare and makeup, via the use of cosmeceutical bases and unlimited variations of colours for foundations, concealers, colour correctors to match every skin tone, via our Advanced Colour Science System developed by our team of scientists, in consultation with veteran makeup artists. It’s not just custom blended for you, it’s cosmeceutical base is adjusted to target underlying skin conditions such as pigmentation, blemishes and ageing.
What was your inspiration for the Custom Cosmeceutical Makeup Lab?
My patients who I treat for a variety of skin conditions such as acne, pigmentation, rosacea, eczema and sensitive skin. There is a lack of sensitive-skin compatible makeup for these patients who need coverage and camouflage during the skin healing process. Besides, Singapore has a diverse ethnic mix which includes darker skin tones that many makeup brands do not cater for. I treat a lot of darker skin toned patients in my practice who cannot find their perfect foundation/concealer match.
What were some of the problems with the mass market makeup products that you faced?
Previously, I would recommend patients with sensitive skin/eczema issues to use pure mineral makeup, which has the lowest risk for causing skin irritation and allergies, as pure mineral pigments are chemically stable/inert with no reactions. However, I soon realised that the these commercial brands also had additives such as bismuth oxychloride and talc which function as bulking agents, and these were irritating to skin, with some even reporting that they felt the texture was that of “cut glass”!
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.
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.