Download Skin Pigmentation and Telangiectasia Article

Skin Pigmentation and Telangiectasia
Article contributed by: Dr Tan Hiok Hee, Dermatologist of
Thomson Specialist Skin Centre
Freckles
 Light brown small flat spots that appear on areas of sun exposed skin
 Commonly areas affected - cheeks and nose
 Usually present in childhood, patients often notice an increase in freckles a few
days after sun exposure; this can also increase with ageing. Conversely, some
freckles may also fade when the person stays away from sun exposure for a
period of time
 Freckles can be reduced and lightened by avoiding sun exposure and with the
regular use of sunscreens and skin lightening creams
 Can be safely removed with intense pulsed light therapy or pigment laser
treatment; usually two to three sessions are required
Solar Lentigines (Age Spots)
 Discrete brownish spots and small patches of pigmentation that occur on the face,
arms, legs and other sun-exposed skin as a result of chronic sun exposure
 Tend to appear after the age of 30
 Can progressively increase and is more visible with age
 Some areas can become slightly thickened with time, developing into a lesion
called a seborrheic keratosis
 Solar lentigines are harmless and do not turn cancerous
 Prevention is with regular use of sunscreen and sun avoidance
 Solar lentigines can be treated with lightening creams, as well as topical tretinoin
(e.g. Retin A)
 It can also be treated with intense pulsed light therapy (IPL) or pigment laser
treatment; again, several sessions may be required
 Topical anaesthesia is used
 With laser treatment, the patient may feel a mild snapping sensation on the skin
 For IPL treatment, a bright flash of light is sensed (patient will wear protective
goggles during treatment)
Melasma
 Tends to affect Asian skin
 Appears as brownish patches over the cheeks. The forehead, temples, nasal
bridge, upper lips and jawline may be affected as well
 This pigmentation is more diffused and not as well demarcated as compared to
solar lentigines or freckles.
 Melasma is due to a combination of genetic and hormonal factors, as well as sun
exposure
 Women are more commonly affected compared to men
 Melasma is often worsened after sun exposure, pregnancy and the use of oral
contraceptives
 More challenging to treat as recurrence after initial successful treatment is high
 Best controlled with the regular use of sunscreens, sun avoidance and lightening
creams
 Other treatments include chemical peeling, intense pulsed light therapy and
certain forms of laser therapy
Hori’s naevus
 A particular pigmentary disorder that affects mainly Asian women between the
age of 30-50 years
 Appears as discrete brown to greyish spots over the upper cheeks and nasal
bridge
 This pigment is darker than the pigmentation seen in melasma
 Genetic and hormonal factors play a role
 Pigmentation is located deeper within the skin, thus treatment with creams is
usually ineffective
 Hori’s naevus can be effectively lightened with the pigment laser although multiple
treatment sessions (about 7 to 10) are required
Telangiectasia
 Small dilated blood vessels near the surface of the skin, measuring between 0.5
to 1mm
 Most commonly found on the face (the cheeks nose and chin), as well as on the
thighs and legs
 Might be due to genetic factors, but can also occur in association with conditions
such as rosacea, excessive topical steroid use, following excessive sun or cold
exposure, and after radiation and chemotherapy treatments for cancer
 Very superficial vessels can be treated with the long pulsed Nd-Yag laser;
treatment is painless and does not require anaesthesia. One to two sessions may
be needed
 Thicker vessels may require sclerotherapy – where a chemical is injected into the
vessel to seal it
Common Treatments
Sunscreens
 A broad spectrum sunblock is recommended; it should protect against both UVA
and UVB.
 General recommendations - one with an SPF of 30 and above
 Sunscreens are creams, lotions or oils that protect the skin from the damaging
effects of ultraviolet radiation of the sun by providing a chemical or physical barrier
to sunlight.
 Chemical sunscreens absorb ultraviolet radiation, ensuring that ultraviolet light
reaches only the superficial layers of the skin.
 Physical sunscreens reflect and scatter light, thus preventing the ultraviolet
radiation from penetrating the skin.
Lightening creams
 They contain substances such as hydroquinone and arbutin. Some creams
combine hydroquinone with tretinoin and a steroid. Some may also contain alpha
hydroxy acids
IPL
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IPL uses light to treat pigmentary disorders. The light device is not a laser but a
broad band light source with a range of wavelengths, which can target different
skin lesions at the same time. The improvement is more gradual and subtle than
compared to laser therapy.
How many treatments are required? To achieve significant noticeable results,
multiple treatments are necessary. The skin should be treated at intervals of 4 – 6
weeks for 4 – 6 times
Is it painful? An anaesthetic cream is applied one hour before the treatment to
minimise discomfort. A mild burning sensation may still be felt for some people.
Most of the time, it is very well tolerated.
What are the possible side effects?The overall risk of side effects is low. The
treatment is associated with very little downtime and the patient can resume daily
activities almost immediately. Following the IPL treatment, there is usually mild
skin redness which lasts one to several hours.
Lasers
Q-switched Nd-Yag laser
 When the laser hits the skin, you may feel a pricking pain, somewhat like a rubber
band snapping on the skin. The pain is usually bearable and short-lived. An icepack can be used to minimize the pain immediately after the procedure.
 Pigment laser treatment often causes mild damage to the superficial layer of the
skin (epidermis). This appears as redness and swelling soon after the laser
procedure and lasts for several hours
 Over the next few days, superficial scabs which form over the treated areas will
fall off.
 If the laser is used to treat a deeper pigmentation using a deeper penetrating
laser wavelength, superficial pin-point bleeding on the surface of the skin may
result instead of superficial scabs. This will take 3-5 days to heal.
Gentlemax® (Alexandrite and Long pulsed Nd-Yag laser)
 Used for photorejuvenation and skin tightening, as well as to treat freckles,
lentigines and telangiectasia
 Mild scabbing can occur when removing freckles and lentigines
 Usually very mild and well tolerated