Skin Pigmentation, Discolouration & Spider Veins (Telangiectasia)

Skin pigmentation and telangiectasia are among the top skin problems in Singapore. Dr Tan Hiok Hee, a dermatologist at the Thomson Specialist Skin Centre in Singapore, gives you an overview on melasma and other common skin pigmentation issues affecting people in this region.

Freckles

• These are light brown small flat spots that appear on areas of sun exposed skin.

• Common areas affected by freckles – cheeks and nose.

• This skin condition is usually present in childhood. Patients often notice an increase in freckles a few days after sun exposure. Freckles can also increase with ageing. Conversely, some freckles may also fade when the person stays away from sun exposure for a period of time.

• Freckles can be reduced and lightened by avoiding sun exposure and with the regular use of sunscreens and skin lightening creams which offer protection against the harsh ultraviolet rays that cause them.

• Freckles can be safely removed with intense pulsed light therapy (IPL) or pigment laser treatment. Usually two to three sessions are required for effective removal.

Age spots (solar lentigines)

• These are discrete brownish spots and small patches of pigmentation that occur on the face, arms, legs, and other sun-exposed skin as a result of chronic sun exposure.

• Age spots tend to appear after the age of 30, hence they’re also called age spots.

• These spots can progressively increase in number and become more visible with age.

• Some age spots can become slightly thickened with time, developing into a lesion called a seborrheic keratosis.

• Age spots are harmless and do not turn cancerous.

• Regular use of sunscreen and sun avoidance can help prevent age spots.

• Age spots can be treated with lightening creams, as well as topical tretinoin (e.g. Retin A).

• They can also be treated with intense pulsed light therapy (IPL) or pigment laser treatment. Again, several sessions may be required for effective removal.

• Topical anaesthesia is used during these treatments.

• With pigment laser treatment, the patient may feel a mild snapping sensation on the skin.

• During IPL treatment, a bright flash of light is sensed (patient will wear protective goggles during treatment)

Melasma

• This skin condition tends to affect mainly Asian skin.

• Melasma appears as brownish patches over the cheeks. The forehead, temples, nasal bridge, upper lips, and jawline may be affected as well.

• This pigmentation is more diffused and not as well-demarcated compared to age spots or freckles.

• Melasma is caused by a combination of genetic and hormonal factors, as well as sun exposure.

• Women are more commonly affected compared to men.

• Melasma is often worsened after sun exposure, pregnancy, and the use of oral contraceptives

• This skin pigmentation is more challenging to treat as recurrence after an initial round of successful treatment is high.

• It is best controlled with regular use of sunscreens, sun avoidance, and lightening creams.

• Other treatments for melasma include chemical peeling, intense pulsed light therapy (IPL), and certain forms of laser therapy.

Hori’s naevus

• Hori’s naevus is a particular pigmentary disorder that affects mainly Asian women between the age of 30-50 years.

• It appears as a discrete brown-to-greyish spot over the upper cheeks and nasal bridge.

• This pigment is darker than the pigmentation seen in melasma.

• Genetic and hormonal factors play a role in this skin condition.

• Pigmentation is located deeper within the skin, thus treatment with creams is usually ineffective.

• Hori’s naevus can be effectively lightened with the pigment laser although multiple treatment sessions (about 7 to 10) are required for full effectiveness.

Spider veins (telangiectasia)

• Spider veins are a skin condition in which small dilated blood vessels near the surface of the skin cause threadlike red lines or patterns on the skin. These blood vessels measure between 0.5 to 1mm wide.

• They are common in areas that are easily visible, such as the face (the cheeks nose, and chin), as well as on the thighs and legs.

• Their presence might be due to genetic factors, but they can also occur in association with conditions such as rosacea, excessive topical steroid use, following excessive sun or cold exposure, and after radiation and chemotherapy treatments for cancer.

• Very superficial vessels can be treated with the long-pulsed Nd-Yag laser. The treatment is painless and does not require anaesthesia. One to two sessions may be needed for effective treatment.

• Thicker blood vessels may require sclerotherapy – where a chemical is injected into the blood vessel to seal it.

Common treatments for pigmentation

If you’re undergoing pigmentation issues, you can look for appropriate skin treatments to remove the dark spots on your face. You have a wide range of options – including topical creams, lasers, or a combination of both – that can treat melasma, age spots, freckles, and more.

1. Sunscreens

• Sunscreens are creams, lotions, or oils that protect the skin from the damaging effects of ultraviolet radiation of the sun by providing a chemical or physical barrier to sunlight.

• A broad-spectrum sunblock is recommended as it needs to protect the skin against both UVA and UVB rays.

• General recommendations – one with an SPF of 30 and above

• Chemical sunscreens absorb ultraviolet radiation, ensuring that ultraviolet light reaches only the superficial layers of the skin.

• Physical sunscreens reflect and scatter light, thus preventing the ultraviolet radiation from penetrating the skin.

2. Lightening creams

These creams contain substances such as hydroquinone and arbutin. Some creams combine hydroquinone with tretinoin and a steroid. Some may also contain alpha hydroxy acids. These ingredients combine to penetrate into the skin surface and “lighten” the skin from within.

3. IPL

• IPL uses light to treat pigmentary disorders. The light device is not a laser but a broad-band light source with a range of wavelengths, which can target different skin lesions at the same time. The improvement is more gradual and subtle than compared to laser therapy.

• The number of treatments required with IPL depends on the skin condition and its severity. To achieve significant noticeable results, multiple treatments are usually necessary. The skin should be treated at intervals of 4 – 6 weeks for 4 – 6 times

• Is IPL treatment painful? There is usually a mild discomfort when the pulsed light hits the skin surface. An anaesthetic cream is applied one hour before the treatment to minimise this discomfort. A mild burning sensation may still be felt for some people. Most of the time, it is very well tolerated.

• What are the possible side effects of IPL treatment? The overall risk of side effects is low. The treatment is associated with very little downtime and the patient can resume daily activities almost immediately. Following the IPL treatment, there is usually mild skin redness which lasts one to several hours.

4. Lasers

1. Q-switched Nd-Yag laser

• This laser can be used to treat freckles, age spots, and spider veins.

• When the laser hits the skin, you may feel a pricking pain, somewhat like a rubber band snapping on the skin. The pain is usually bearable and short-lived. An ice pack can be used to minimise the pain immediately after the procedure.

• Pigment laser treatment often causes mild damage to the superficial layer of the skin (epidermis). This appears as redness and swelling soon after the laser procedure and lasts for several hours

• Over the next few days, superficial scabs that form over the treated areas will fall off.

• If the laser is used to treat a deeper pigmentation using a deeper penetrating laser wavelength, superficial pin-point bleeding on the surface of the skin may result instead of superficial scabs. This will take 3-5 days to heal.

2. Gentlemax® (Alexandrite and Long pulsed Nd-Yag laser)

• Used for photorejuvenation and skin tightening, as well as to treat freckles, age spots, and spider veins.

• Mild scabbing can occur when removing freckles and age spots.

• Discomfort or pain felt when using this laser is usually very mild and well-tolerated.