What is pigmentation?

Pigmentation refers to the natural colouring of your skin. This colour is determined by a pigment called melanin, produced by specialised skin cells known as melanocytes. The amount and type of melanin these cells produce determines the colour of your skin, hair, and eyes.

Pigmentation issues happen when some areas of your skin become darker or lighter than your usual skin tone. This usually occurs because your body is making too much or too little melanin; several factors can cause this. According to a 2019 survey, 68.52% of Singaporean women over 44 highlighted pigmentation as their primary skincare concern. Some of the common benign pigmentation issues in Singapore include: 

• Freckles: small brown spots that appear in large numbers, especially on people with lighter skin who have a genetic tendency for them. They usually appear early in life, often during childhood, and can cover the entire face.
• Solar lentigo (sun spots/age spots): these are darker, well-defined spots that can appear alone or in small groups. They typically develop as people reach middle age or older and usually appear on the cheeks and temples.
• Melasma: melasma usually manifests as symmetrical dark patches on the skin. It most commonly affects the cheeks and upper lips. This condition is strongly linked to hormonal changes and often occurs in women during pregnancy and menopause. 

What causes hyperpigmentation? 

Some hyperpigmentation results from excess sun exposure; UV rays stimulate cells called melanocytes to produce more melanin as a protective response. This process is helped by an enzyme called tyrosinase, which converts an amino acid called tyrosine into melanin. The extra melanin is then spread to nearby skin cells, causing those areas to darken. Other instances where hyperpigmentation occurs also include hormonal changes, inflammation (known as post-inflammatory hyperpigmentation), or certain medications that change melanin synthesis in the body. 

Who is at risk of pigmentation in Singapore?

In Singapore, several factors can increase your risk of developing pigmentation issues:

• Sunny weather: Singapore’s tropical climate means lots of sun year-round. Too much sun can lead to dark spots because your skin produces more melanin to protect itself.
• Outdoor lifestyle: if you spend a lot of time outside, you’re more likely to develop pigmentation issues due to increased sun exposure.
• Family history: if your family has a history of pigmentation disorders like melasma, you might also be more likely to develop them.
• Pregnancy: hormonal changes during pregnancy can cause melasma, known as the "pregnancy mask," which appears as dark patches on the face.
• Birth control and hormone therapy: hormonal medications can also lead to changes in skin pigmentation.
• Sun-sensitive drugs: some medications, like certain antibiotics and chemotherapy drugs, can make your skin more sensitive to sunlight, increasing the risk of pigmentation issues.
• Post-Inflammatory hyperpigmentation (PIH): skin conditions like acne can leave dark spots after the inflammation heals.
• Skin trauma: injuries such as cuts, burns, or any trauma to the skin can result in pigmentation changes as the skin heals.

How is hyperpigmentation diagnosed?

Diagnosing pigmentation involves a few important steps to accurately understand the condition and rule out more serious skin conditions. Dr. Hoe will typically assess her patients’ medical history to comprehensively collect data on when patients first noticed the development of pigmentation, if there are changes with sun exposure, and if there's a family history of similar conditions.

She also analyses patients’ skin using the Lifeviz 3D photography system to observe the pigmentation’s colour, size, shape, and pattern.

Dr. Hoe is highly experienced in treating hyperpigmentation, as this is one of her clients' top concerns. She continues to treat a high volume of cases. She takes a hyper-personalised approach, recommending a bespoke treatment plan that takes into account the client’s skin type, skin condition, lifestyle, and previous treatment outcomes. 

What are the treatment options for hyperpigmentation in Singapore?

The treatment module for pigmentation issues will depend upon the type of pigmentation and severity. Some of the treatment options offered include: 

• Skincare and supplements:

• Serums: Vitamin C serums such as Skinceuticals CE Ferulic or Skinceuticals Phloretin CF provide potent antioxidants to repel UV and environmental aggressors, reducing pigmentation and delaying skin ageing. 
• Oral supplements: such as Heliocare Luminance or Miriqa Skin, contain botanicals (e.g., white tomato extract, fern extract) that provide UV resistance and promote vibrant skin. 

• Lifestyle changes:

• UV avoidance: avoid outdoor activities when the UV index is high. Additionally, adequate sun protection measures, such as wearing  UV protective clothing (long sleeves, visor, cap), will be recommended. 
• Sunscreen: a high-quality sunscreen such as the Heliocare Pigment Solution SPF 50 PA++++ needs to be applied daily and reapplied regularly.

• Procedural treatments:
• Laser treatments: lasers are the backbone of pigmentation treatment. Various lasers may be required to target different layers of the skin and achieve an optimal result.

• Injectables: Teosyal Redensity 1 skinbooster (link to service page) contains hyaluronic acid, amino acids, minerals, vitamins, and antioxidants. Delivered as an intradermal injection, skinboosters improve skin hydration, quality, and tone. 

• Combination treatments: often, a combination of treatments is used to achieve the best results, depending on the individual's skin type and the severity of pigmentation issues.