PIGMENTATION / UNEVEN SKIN TONE잡티, 반점, 주근깨등색소제거
Freckles, Lentiges, melasma and Pigments
Pigmentary changes on our skin is something nobody wishes to have. But unfortunately in our Asian population, hyperpigmentation (increase in pigment in our skin) is a common and sometimes distressing problem.
Much of the root of the problem comes from our tendency to sun exposure (UV radiation), and when coupled with factors like genetic predisposition, drugs and pregnancy, we can develop a variety of skin pigmentary changes.
In order to have optimal treatment, it is important to ascertain if the pigmentary lesions are epidermal or dermal. Many patients have a combination of both types of pigmentation. Examination under a Wood's lamp can help in our clinical assessment.
EPIDERMAL PIGMENTATION
Freckles and Lentiges
These are by definition, epidermal lesions on skin. (The epidermis is the outermost layer of our skin, as opposed to the layer beneath the epidermis which is called the dermis)
What are freckles and lentiges?
Freckles (or Ephelides) are very common and can be easily treated. They are small brown macules (flat lesions) on the face or other sun-exposed areas.
However most patients will have a combination of comedones and inflammatory acne and using a retinoid by itself may not be good enough. In such circumstances, our experience is that a combination of a topical retinoid such as Tretinoin (trans-retinoic acid; Vitamin A acid) together with potent home care products containing a variety of actives such as salicylic acid, benzoyl peroxide and Azelaic acid can show dramatic results. A course of oral antibiotics may be added if there are many red papules and/or pustules seen.
Lentiges are similar to freckles but are a different entity. They tend to be a darker shade than freckles. Solar lentiges can be found on the back of the hands, and face. There are usually associated sun related changes like wrinkling and dryness, and in combination are sometimes referred to as signs of photoaging.
How can freckles and lentiges be treated?
We use the Q-switched Nd:YAG laser system to treat freckles and lentiges . This laser targets epidermal melanin via the concept of selective photothermolysis.
Post procedure, the pigmentation will darken, develop a "scab" and eventually fall off in a few days to a week's time. Sometimes, a second session may be required for complete clearance. The use of a short wavelength pigment laser in darker skinned individuals with higher epidermal melanin content can pose challenges (increased risk of pigmentation worsening), hence the importance of skin conditioning.
With a smaller laser spot size, we can avoid stimulating normal skin around the pigmented areas and hence manage (and lower) the risks of new (and unwanted) pigmentation occurring post treatment. The only downside of 532nm settings is the small risk of post treatment hypopigmentation (less pigment) which may be transient and improve by itself. This risk can be minimized by keeping energy levels (or fluence) at moderate levels, avoiding unnecessary sun exposure post treatment, and adhering to our prescribed post treatment skin and wound care.
Topical lightening agents can also be used in combination with laser treatment.
How many sessions are needed?
Usually 1-2 session are sufficient. Post pigment removal, laser toning using 1064 wavelength is essential to facilitate good recovery.
Is there downtime?
No. There may be slight redness over the treated areas post laser but this will subside within a day. We may prescribe some mild steroids, healing creams, and antibiotics to speed up healing and prevent infection.Please visit Dr SM Yuen as he will sharehis expertise on pigmentation treatment.
DERMAL PIGMENTATION
Melasma
Melasma has been historically referred to as the "mask of pregnancy" because it was thought to occur as a result of pregnancy. However, we now know that it can happen to sun-exposed skin of both males and females. We still do not know the exact cause of Melasma but use of the oral contraceptive pills, hormone replacement therapy and other drugs have been associated with the condition. There may be a mixture of epidermal and dermal components in Melasma. Based on present evidence, epidermal melasma can be treated with a combination of topical creams. The dermal component of Melasma is more difficult to treat.
We use a combination of prescription lightening creams and an intensive laser toning programme to reduce, control, and improve Melasma.
Is it true it is "pointless" to treat Melasma?
No. Nothing in medicine is "pointless" to treat. Melasma is difficult, but not impossible to treat. It is important to develop a logical treatment plan in order to combat Melasma effectively.
Acquired Bilateral Nevus of Ota-like Macules (ABNOM)
ABNOM are also know as Hori's nevus (brownish or grayish in colour) and usually occur symmetrically over the upper cheek regions (what we call the malar region), just below and around the lower eyelids. Many people mistake this as freckles but they should not be confused with each other as the treatment is different.
These predominantly dermal pigmentation is best treated with a Q-switched Nd:YAG laser at 1064nm. This longer wavelength allows heat from the laser to penetrate deeper into the dermis (which IPL or a 532nm wavelength laser cannot effectively reach), and via selective photothermolysis, breaks up melanin.
We combine laser treatments with a treatment regime consisting of lightening agents like hydroquinone, arbutin and tretinoin for optimal results.
Is there downtime?
No. The treated skin may be slightly reddish for a few hours post treatment but should subside readily.
How effective is treatment and how many sessions are required?
Some patients can get very good clearance while some may see reasonably significant lightening. Multiple sessions are usually needed.
It is very important to follow a strict home care treatment and the use of sunblock, lightening agents and moisturizers are absolutely essential.
With discipline and patience, good results are possible.
TREATMENT OPTIONS
