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Pigmentary changes often start around a person’s mid 20s and increases with age. It may be more common in women due to hormonal influences (child birth, oral contraceptive pills etc).
Freckles, melasma age spots and many other pigmentary changes are part of the aging process. As the normal mechanism for producing healthy cells slows down eventually, there will be more pigment cells that surfaces rather than healthy cells. Sun exposure, hormonal factors, genetic influences and certain drugs can augment this process and cause the effects to appear quicker.
CAUSES OF PIGMENTATION
There are various factors that catalyze the formation of melanocyte in the skin (melanocytes are cells that produce melanin).
The most common triggering factor is the ultraviolet A (UVA) and ultraviolet B (UVB) radiation from the sun. The UV radiation from the sun activates the tyrosinase enzyme, which promotes melanogenesis. Applying sun block will only help to minimize the harmful effects of sun but it does not confer full protection.
Pigmentary changes are part of an aging process, where melanocyte production increases with age. One theory suggests that the reaction that DNA suffers in aging skin triggers off the melanocyte formation.
Hormone changes during pregnancy, menopause or while on oral contraceptive pills, stimulates melanocyte formation by activating the tyrosinase enzyme.
Trauma to the skin following injuries, acne, burns, etc. stimulates melanocyte production and causes post inflammatory hyperpigmentation.
TYPES OF PIGMENTATION
There are different types of pigmentation. The choice of treatment depends on the type and severity of the pigmentation.
Melasma is one of the most common pigmentary conditions, especially among Asians. Melasma is commonly seen in middle aged individuals and also post pregnancy or as a result of the oral contraceptive pill. It presents as a large irregularly shaped patch that slowly gets larger and darker over time. The lesion is most often epidermal (superficial) and dermal (deeper) and requires a wider range of Laser wavelength treatment.
Solar lentigo is common among adults. It appears as a small well-defined patch on the skin. The lesion is most often epidermal (superficial) and responds very well to lower wavelength Laser treatment.
Freckles are common among teenagers and middle aged individuals. It appears as multiple small-discolored spots most often over the cheek and around the eye area. The lesion is most often epidermal (superficial) and responds very well to lower wavelength Laser treatment.
This is one of the most common pigmentary conditions among Caucasians. It is mainly seen in middle aged individuals who have subjected themselves to excessive sun exposure. It appears as large irregularly shaped dark patches, overlapped by sharply demarcated freckles that slowly get larger and darker over time. The lesion is most often epidermal (superficial) and dermal (deeper) and requires a wider range of Laser wavelength treatment.
Post inflammatory hyperpigmentation (PIH)
PIH is common after an inflammatory process such as acne, chemical or Laser burns, drug blisters (allergic reaction), trauma, etc. It appears as dark, well-defined patches. The lesion is most often epidermal (superficial) and dermal (deeper) and requires a wider range of Laser wavelength treatment.
Hori’s Nevus is a well-defined, dark and irregular shaped pigmentation that is very similar to freckles. Treatment for Hori’s Nevus is different and more difficult compared to freckles.
It is important for patients to realize that pigmentation can be treated and kept under control, but cannot be cured permanently. In addition to medical treatments, a healthy lifestyle and positive mind-set is equally crucial.
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