Did you know that compared to Caucasians, Asians have a higher SPF of about 3 to 5, or twice the level of natural UV protection from the sun? Ethnic groups with darker skin may have an even higher level of SPF protection ranging from 9 to 13.5. What this means is Asians and other ethnic skin types are at a much lower risk of getting sunburnt and skin cancer — all thanks to greater melanin production. 

Unfortunately, this enhanced melanin production can create many pigmentary issues for us especially as we enter our mid 30s. Yes, I’m referring to freckles, Melasma, moles… the list goes on. For some women, pigmentation may occur earlier during pregnancy due to hormonal changes, causing the melanocytes to produce more melanin. I’ve met patients who also experienced pigmentation due to oral contraceptives.

Pigmentation problems in Singapore

In Singapore, our chances of getting pigmentation are way higher due to our year round sunny weather. Many also head out without adequate sun protection, but what they don’t realise is that repeated exposure to harmful UV rays actually sensitises our melanocytes to produce more melanin, leading to more dark spots and pigmentation. For some, this can appear in the form of blotchy-looking pigmentation or what we term as melasma, occupying an entire area on the cheeks, chin, forehead or nose. 

Melasma is often seen in pregnant women and can continue to persist or become worse depending on how much unprotected sunlight they have been exposed to during their pregnancy. 

I would like to add that certain drugs are also an often ignored cause of pigmentation; they play a 10-20% role in hyperpigmentation. While it’s not the drugs per se that cause pigmentation, the drugs increase your skin’s sensitivity to the sun. These include certain antibiotics, NSAIDs, antidepressants and antihistamines. If you are on any medication, please voice them out to your doctor.

Why are Asians more prone to pigmentation issues?

An interesting thing to note is that all humans generally contain the amount of melanocytes in our body. What’s different is how our ethnicity and genetic makeup determine how much melanosomes (cells responsible for colour and photoprotection) are distributed into our skin cells and how much melanin is produced. I’ve previously written an article on how genetics affect the way we form pigmentation, but the general idea is that many Asians with Fitzpatrick 3 skin type tend to tan more than burn after repeated exposure to UV rays. 

While this appears like good news, it isn’t really — due to sensitised melanocytes, Fitzpatrick 3 skin types or Asian skin is one of the most trickiest and difficult to treat for pigmentation issues. Unfortunately, many resort to seeking treatment with lasers without understanding the nature of their pigmentation, or fall for marketing tactics that sell certain skincare or laser procedures. As with all skin conditions like acne, there is no one size fits all solution for pigmentation as every case is unique. Some may require just topical creams, while others require lasers for optimal results.

When done incorrectly, sub-optimal lasers can potentially cause more irritation and create even more pigmentation issues. I will discuss some of the best techniques to treat pigmentation on Asian skin, but so far I’ve found any laser with pico technology has produced positive and realistic results for Asian skin.

Treating pigmentation in Asian skin: My approach

When it comes to treating pigmentation, I favour lasers. While it’s possible to lighten pigmentation without lasers, most pigmentation medications work by slowing down pigmentation production and encouraging the skin to self-remove the pigmentation. This takes a very long time. Lasers, on the other hand, directly destroy built up pigmentation in a specific manner, proving to be very fast and safe. I use the Discovery Pico Plus and Fractional Thulium Laser for treating pigmentation on Asian skin and have found results to be very encouraging so far. 

However, in order to manage patient expectations, I must add that currently there is no laser or pigmentation treatment that can get rid of conditions like melasma forever. To treat melasma, a combination of lasers and medication are required to significantly lighten or clear the melasma — medication to suppress melanin activity, lasers to lighten the pigmentation. 

Pigmentation is a tricky condition to tackle especially on Asian skin. But it is not impossible — especially in the hands of an experienced doctor. 

Wishing everyone great skin!

References

  1. Chan, I. L., Cohen, S., da Cunha, M. G., & Maluf, L. C. (2019). Characteristics and management of Asian skin. International journal of dermatology, 58(2), 131–143. https://doi.org/10.1111/ijd.14153
  2. Kang H. Y. (2012). Melasma and aspects of pigmentary disorders in Asians. Annales de dermatologie et de venereologie, 139 Suppl 4, S144–S147. https://doi.org/10.1016/S0151-9638(12)70126-6