by Dr Loo Han Woen

Models with translucent clear skin are the envy of all women, evoking emotions of beauty and purity.  Skin pigmentations taint complexions and are ubiquitously associated with ageing.  Obsessive women and men alike spend thousands yearly on de-pigmenting creams and lotions, contributing to a booming skin care industry. 

The combination of our genetic makeup as well as our tropical climate make Asians susceptible to sun-damaged skin manifested as various pigmentation problems.  These problems are compounded by inadequate or improper skin care.

There are many fallacies associated with medical treatment of skin pigmentation.  I shall attempt to address some of these in this article.

  1. Skin pigmentations are ALL the same!

Contrary to the popular belief of many patients, just because pigmentations are black or darkened in appearance does not mean that they are all of the same type and etiology.  Freckles on teenagers are NOT the same skin ailment as liver spots on elderly patients.  Pigmentations are generic lay terms for such problems.  Because they behave different, their clinical management differs.

  1. Skin pigmentations can be “Lasered” off!

Many patients walk into my consult room expertly telling me to “Laser” off their various skin pigmentations.  While it is true that IPL (Intense-Pulsed Light) and Laser machines can effectively treat freckles and certain sunspots, the bulk of pigmentation problems require multiple Laser sessions and many do not achieve complete resolution and remission.  Occasionally, complications may arise from these treatments that render the original skin condition worse.

Skin pigmentation conditions like melasma should be managed chronically with frequent follow-ups and tweaking of management strategies, much akin to the Endocrinologist managing a diabetic patient on long-term insulin therapy.  To expect pigmentation to disappear in one magical wave of the Laser gun is unrealistic and in many occasions impossible.

  1. No need follow-up discipline and skin care after I leave the Doctor’s room!

Many patients believe the Doctor and their expensive state-of-the-art Laser machines are almighty and capable of “zapping” away all the blemishes on the skin.  They gladly pay thousands of dollars for these treatments but neglect the fact that post-treatment skin care is crucial for proper recovery and remission.  Even before visiting the Doctor for pigmentation treatment, the patient should be embarking on a carefully crafted skin care regime complete with sun exposure abstinence.

  1. I put sunscreen, I am indoors, and therefore I am well protected from the Sun!

Sun exposure is the common inciting factor causing or contributing to skin pigmentation.  Most patients know they need to avoid sun exposure and apply sunscreen.  However many are unaware sunscreens need to be reapplied constantly for proper ultraviolet radiation protection (approximately every 2 hours according to 1 reputable clinical study!).  Indoor activities do not exempt ultraviolet exposure as fluorescent lights emit them as well.

Skin pigmentations are complicated chronic conditions that should not be trivialized.  As Doctors understand more about them and work on managing them more effectively, it is important for patients seeking treatments to be patient and above all, listen to the Doctor.

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