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Causes of Skin Pigmentation and How to Get Rid of Them

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In tropical Singapore, it is hard not to be unintentionally tanned by the sun, unless adequate protection is taken to prevent the skin from being overly exposed to direct sunlight. While our skin tends to turn a shade darker under sunlight, the cause of darkened skin or skin pigmentation could be due to a number of causes.

Native skin pigmentation is due to the presence of “normal” amounts of melanin in the skin, normality being determined largely by ethnicity. Hyperpigmentation is due to the presence of increased amount of melanin in the skin.

Excessive exposure to the sun is often unavoidable, especially if one lives an active outdoor lifestyle taking part in sports and other activities. The common pigmentation problems in the skin are freckles, solar lentigines (sun spots), seborrhoeic keratoses (age spots), Hori’s nevus, melasma and post-inflammatory hyperpigmentation.

Causes of Skin Pigmentation

Freckles	Genetic causes
Solar lentigines	Exposure to the sun and age
Hori’s nevus	Age
Melasma	Genetic
Post-inflammatory hyperpigmentation	Inflammation of the skin in susceptible individuals

Abnormal skin pigmentation may be due to medical/non-aesthetic problems such as fungal infections of the skin, hormonal disorders or imbalances caused by insufficiency of the adrenal gland, or a tumour of the pituitary. Another cause may be the presence of liver diseases. Vitamin B3 deficiency can cause a hypersensitivity to sunlight resulting in skin darkening. However, this is rare in our urban setting.

TREATMENTS

There are a number of treatments to get rid of unsightly pigmentation in conditions like freckles or dark pimple scars. For example, prescription creams containing active ingredients like hydroquinone, tretinoin, glycolic acid, and salicylic acid, may be administered to lighten skin pigmentation.

Chemical peeling with peeling agents such as glycolic acid, salicylic acid, Jessner’s solution, Trichloroacetic acid will also help to lighten skin tones.

Intense Pulsed Light technique is also an effective procedure for skin lightening, while laser therapy with pigment laser, or CO2 laser, will also benefit the patient.

Apart from these treatments, judicious avoidance of exposure to sunlight is also important. In addition, there should be some form of protection from direct exposure to the sun, with clothing, a hat, and a good quality sunscreen lotion applied directly to the skin.

Some patients question the long-term results of laser treatment for the removal of unwanted skin pigmentation. The effect varies with the type of pigmentation problem treated. The pigment laser can produce a lasting clearance of freckles but since it is genetically determined, freckles can reappear after intense sun-exposure. The pigment laser can eliminate sunspots completely but new ones will appear if there is continued direct exposure to the sun. On the other hand, it is difficult to clear melasma which has a tendency to relapse.

One should be aware that if sunning cannot be avoided, then skin darkening will happen. Prescription creams and lotions will help lighten skin tones only to a certain extent; the real solution is a combination of lifestyle changes, acceptable treatments and keeping healthy.