Facial Pigmentation

What are the different types of facial pigmentation?

Pigmentation is not a diagnosis in itself but a description of increased pigment in the skin. There are many types of facial pigmentation. The commonest ones are freckles, solar lentigenes, melasma and Hori’s naevus. These are often due to sun exposure, genetic and hormonal factors. It may be difficult for the layman to diagnose the specific type of pigmentation. Sometimes, more than one type may be present.

Freckles are caused by the sun and can be found in all ages. They tend to fluctuate with the amount of sun exposure. They are located mostly on the face and arms in the epidermis, the top layer of the skin.

Solar lentigenes, also known as “age spots or” sun spots”, are found in older people and are larger than freckles. These are often on the face, arms and legs. They are also located superficially in the epidermis.

Melasma is a diffuse patchy type of pigmentation found mostly in women in their 40s and 50s. It can be triggered by oral contraceptives, pregnancy and sun exposure. Areas involved are usually cheeks, forehead, jawline and upper lip. It is usually located in both the epidermis and dermis.

Hori’s naevus is a type of speckled pigmentation often found in Asian women on the cheek bones and sides of the forehead. This is genetic and hormonal in nature. It is located deeper in the dermis.

What is the treatment for facial pigmentation?

The treatment depends on the diagnosis. Pigmentation can be improved with certain lightening ingredients e.g. vitamin C,  glycolic acid, azelaic acid, tranexamic acid, hydroquinone, tretinoin, cysteamine, arbutin. Sunscreen is important for prevention of darkening of existing pigmentation and prevention of new ones.

Freckles and solar lentigenes are easier to treat as they are superficial. They can be treated with intense pulsed light (IPL) or pigment lasers (Q switched NdYAG laser, pico laser).

Melasma is more persistent and tends to recur as it is hormonally driven. First line treatment involves topical lightening creams. Some procedures like chemical peels, intense pulsed light and certain lasers (Q switched Nd YAG laser, pico laser, fractional carbon dioxide laser) have been used with varying degrees of success. Oral tranexamic acid and certain supplements may be beneficial in persistent cases.

Hori’s naevus can be treated with pigment laser. Several sessions are required at 6 to 8 week intervals.

It is best to have your dermatologist assess your type and depth of pigmentation, and discuss the various types of treatment options.