Skin PIGMENTATION | 皮秒激光

Skin pigmentation, what is it?

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How do I get rid of skin pigmentation on my face?

Skin lightening agents

Medical peels

IPL

Lasers

What are the 4 pigmentation in skin?

Red – oxyhaemoglobin

Blue – deoxygenated hemoglobin

Yellow orange – carotene

Brown – melanin

What is skin pigmentation on face?

Skin Pigmentation on face is commonly brown, dark brown or blue grey, and is a manifestation of melanin.

What is the cause of face skin pigmentation?

Genetics – cafe au lait, melasma, nevus

Sun exposure – freckles, sunspots

Injury – PIH

This segment will cover 

1) Pigmentation

2) Dark eye circles

3) Red, sensitive skin 

Under Pigments, I will discuss the common pigmentary woes affecting Asian skin. Key is the use of creams, peels and lasers for this type of condition. There are many lasers. And choosing the right laser will form the cornerstone in the treatment.

TOP 10 pigmentation concerns 

  1. Freckles

  2. Melasma

  3. Sunspots

  4. Hori’s Nevus

  5. Nevus of Ota

  6. Becker’s Nevus

  7. Tattoos

  8. Underarm pigmentation

  9. PIH (Post inflammatory hyperpigmentation)

  10. Acanthosis Nigricans

Lifestyle changes – 3 Ss

  1. Sunblock, Q 4 hours
  2. Shade, stay away from the sun. Stay cool, in the shade.
  3. Shield, sun glasses and wide brim hat, UV coated umbrellas when you head out for lunch especially

Pigments in the Asian Skin:

Dark spots, red spots, brown spots, blue spots, gray spots, what are they? I have had many patients asking me about those spots on their faces. So to help you learn more about your skin, and understand those spots you see when you look into the mirror, I have decided to walk you through some of the common pigmentary conditions.Allow me to first start with freckles, those brown spots that you get for working out in the sun since your schooldays.

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HOW DOES IT WORK?

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Pigmentation Solution: My 3 step FORMULA

1. Treatment: Laser/ light/ peels
2. Cosmeceuticals: Sunblock + Lightening agents – ORAL and topical
3. Skin renewal: Boost hydration and repair

 

Cosmetologist applying permanent make up on lips
Carbon peeling. Laser pulses.
SKINBOOSTERS

POST LASER WHAT TO EXPECT?

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Lasers and pigments
Here is a schematic cartoon showing how laser breaks down pigments into granules, which are subsequently engulfed by macrophages.

FRECKLES

What are they?

– Freckles are spots which commonly appear with sun exposure and are found on the cheeks and nose.
– They  darken with sun exposure.
– They show up in the teenage years, increasing with age.
– They lighten with sun protection and a combination of therapies.

How can we treat it? 

– In my opinion, treatment includes strictly avoiding the sun and using sun protection, using skin lightening agents and laser + light therapy.
– Here is an example of freckles.
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freckles

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FRECKLES
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MELASMA

So what causes Melasma?

– Melasma is very common with the Asian skin. It is multifactorial, with a strong genetic and hormonal component.

– It is worsened with sun exposure, OCPs and pregnancy.

– It tends to be distributed either over the cheeks or a central distribution from the forehead down to the chin.

How can we treat it? 

– There are many treatment regimens for melasma.
– Melasma is a condition that can be controlled and not cured. 
– It is a spectrum, and there is no one size fits all regime.
– A carefully personalised programme works best as every melasma is different.
– Personally, I would suggest an advanced treatment which consists of priming the skin with lightening agents for a month, +/- oral medication followed by careful chemical peels and lasers.
1. Use good sunscreen, apply it 15min before going out. And reapply it every 2 hours.
2. Use gentle lightening agents
3. Laser light +/- Cosmelan
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MELASMA
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Solar Lentigines/ Age spots

What are they?

– These are discrete lesions which progress with age. Prevention is the key with sun protection and sun avoidance.
– They  first appear in your 30s and can get increase in number with age.  
– Some age spots thicken and darken with time.

How can we treat it?

 – They may be lightened with sun protection, lightening agents and lasers light. (sunspots, solar lentigo)
solar lentigo

solar lentigo
freckles

SOLAR LENTIGO/ SUN SPOTS / AGE SPOTS 
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Hori’s Nevus

What are they?

– This is a pigmentary condition characterized by multiple dark blue gray spots, commonly found bilaterally in the cheeks.
– They darken with sun exposure and childbirth.

How can we treat it?

– They can be lightened with a careful combination of sun avoidance, lightening agent and lasers.
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hori’s nevus

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HORI’S NEVUS
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NEVUS OF OTA

– Present at birth

– A blue grey pigmentation deep in the dermis

– They darken with sun exposure

– Can be lightened with sun protection, lightening agents and lasers.

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NEVUS OF OTA
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BECKER NEVUS

– birthmark commonly found in males
– one sided 
– epidermal nevus
– associated with hair growth 
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CAFE AU LAIT SPOTS

What are they? 

– These are light brown macules that can be found over jawline, neck, face. 
– Effectively treated with sunblock, lightening agents and pigment lasers, but can recur.
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It is vital to distinguish this from a melonocytic nevus – which can turn malignant.
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CAFE AU LAIT SPOTS
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TATTOOS 

– Q Switched lasers are good for black, blue, brown tattoos.
– No. of sessions depends on the location, size, age, colour of tattoo and whether it was performed by a professional or amateur tattoo artist.
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UNDERARM PIGMENTATION

Causes:

-Contact Allergy: From DEODORANTS commonly
–PIH from shaving: Tiny hair stubbles can also add to the darkening
–Infection: You might have a skin infection that causes darkening
–Acanthosis Nigricans. A skin condition that causes hyperpigmentation
–Hormones/Pregnancy. Changes in your body may cause discoloration
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POST INFLAMMATORY HYPERPIGMENTATION:

– As the name suggests, these are pigmentation that form after an injury, be it picking a pimple, derma-roller performed on a skin, injury to the face etc…
– It can happen anywhere.
– Treatment entails careful use of laser toning with lightening agents and strict sun protection.
– They take 3 months to improve. 
ACNE SKIN

(courtesy of skinperfectbrothers.com)

POST inflammatory pigmentation or PIH can happen anywhere on the body

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PIH

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ACNE PIH

PIH

PIH ( Post inflammatory hyperpigmentation)

BROWN PATCH

What is it?

It is an area of localised hyperpigmentation (excess melanin), as a result of damage to the skin from inflammatory process. It can range from light brown to black. It is temporary.

PIH

Distinguish PIH from PIE, which is post inflammatory erythema. This consists of superficial blood vessels that grow during the wound healing stage and is common after inflammtory acne, especially in lighter skin people. Darker skin folks would end up with Post inflammatory hyperpigmentation.

How can we treat it?

  1. Sun block
  2. Laser light
  3. Antioxidant and lightening agents

What are the causes?

  1. Sun
  2. Injury. This can be as a result of over zealous chemical peel, laser, or other energy based devices.
  3. Heat

ACANTHOSIS NIGRICANS

Hereditary vs acquired

Common acquired causes

  1. DM
  2. Obesity
  3. Drug induced

Common in skin folds,neck,axilla and groin.

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brown patch

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Here are treatment videos of laser, IPL for your pigmentation woes.

Pigment laser treatments involve a light laser that generates heat and penetrates into the deep layers of your skin to stimulate collagen production without damaging the dermis. 1064 laser is a highly advanced laser that can deliver highly controlled energy into the skin. It is able to combine high peak power and short pulse width, to target and get rid of pigments without allowing the heat produced to damage the surrounding tissue.

It is an effective treatment for skin conditions such as pigmented lesions, freckles, solar lentigo, age spots, sun spots, hori’s nevus, nevus of ota, cafe au lait, melasma, post inflammatory hyperpigmentation, skin redness, scars, tattoo removal, with minimal downtime.

So I hope this mini segment on pigmentary woes in the Asian skin has been useful. Remember, stay bold and beautiful. Dr Daniel Chang

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Dr Daniel Chang

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