How can I prevent pigmentation spots from appearing on my face?
I have solar lentigos and some nascent melasma on my cheeks. I am very careful with sun protection and wear hats all the time, but new pigmentation spots keep appearing and seem to be growing larger. I’m pretty sure my condition is genetic, but I really want to manage it. I am also worried that acids will make my skin even more photosensitive. What else can I do?
I'm so sorry to hear that. This must be troubling you quite a lot. Let me briefly discuss how to prevent and treat facial pigmentation.
It's good that you are very meticulous with sun protection. This is one of the most important steps in preventing new pigmentation spots from appearing.
Prevention - Sun protection is key
In addition to what you are already doing for sun protection, I advise:
1) Regular Application of high quality SPF sun screen every 4-6 hours if you are exposed to the sun.
2) Also, do remember to apply sun screen at commonly neglected regions like around your eyes and neck.
3) Consider Oral sunblock like Heliocare, which provides another layer of sun protection in addition to topical sunblock.
In addition to solar lentigo and melasma, there are other types of facial pigmentation that can occur over time.
Freckles can also appear over time. It is commonly due to sun-damage.
This is Hori's Nevus. Also known as Acquired Bilateral Naevus of Ota-Like Macules (ABNOM). This is a condition seen almost exclusively in Asian Chinese skin type. It typically, appears as bluish-gray flat hyperpigmentation on the cheeks, but may involve the eyelids, forehead and nose as well.
This brings me to the treatment options:
1) Correct diagnosis leads to correct treatment.
As you can see, there are several types of pigmentation that might look quite similar. Especially Melasma and Hori's Nevus.
Please consult a doctor who is experienced in treating pigmentation.
2) Medical-grade creams (eg Hydroquinone)
By the time my patients come to consult me, they would already have tried several over-the-counter creams. In your case, medical-grade creams are the next step forward because your pigmentation seems stubborn.
3) Chemical peels (eg Jessner peels)
You are correct that chemical peels might make your skin more photosensitive, which will increase the risk of post-inflammatory hyper pigmentation. Hence, this is to be used with caution by an experienced doctor.
4) Oral medications like Tranexamic acid
Tranexamic acid is an oral medication that is proven to help melasma by reducing the vascular (blood vessel) components of melasma. As with any medicine, it is effective but there are also side-effects. Please discuss more with your doctor on this.
5) Pigment Lasers
Picosecond Lasers and Q-switch (nanosecond) lasers are 2 good classes of lasers that can help. Picosecond Lasers are newer that Q-switched lasers and have been in use for more than 3 years to treat pigmentation.
Common brands include PicoSure, PicoPlus, PicoWay and Discovery Pico.
A Taiwanese research study on melasma (a challenging type pigmentation) showed that Picosecond Lasers achieve “faster and better clearance rate” as compared to Q-switched lasers.
Don't be discouraged! As you can see, there are many treatments available. You might not need treatments like lasers first. You can always start with topical creams.
The key to successful treatment of pigmentation is to find a doctor who is experienced in treating pigmentation and who understands your medical history thoroughly.
Treating pigmentation is a marathon, not a sprint.
Dr Justin Boey
It is in fact quite common to develop pigmentations (eg solar lentigos, melasma, etc) on the face especially for Asian skin types, and from middle age onwards. Other than the usual excessive sun exposure, another reason can be genetic factors as you have pointed out.
It is very encouraging for you to adopt sun protection measures. However still, if your pigmentations keep recurring, it is best to let a doctor help you to manage and hand-hold you to further treat and prevent further recurrence.
Depending on the type and severity of your pigmentations, topical lightening cream alone can help to see good improvement. So you may not need chemical peels or laser treatments at all.
For now, I would recommend you to find an experienced doctor to discuss on the most suitable treatment options for you.
For more information on the treatments of solar lentigo and melasma, you can read more about them in my "Ultimate Guide to Pigmentation Treatment in Singapore".
Hope this helps!
Dr. David Ng CH