Melasma and Skin Pigmentation



Melasma is the presence of brown or greyish brown patches, usually on the face and occasionally on the arms. It is caused by an excessive production of melanin, the pigment that causes skin to tan. On the face the pigmentation is usually symmetrical on both sides of the cheeks, the upper lips, nose forehead and the chin. Melasma is a very common pigmentation seen in Asians affecting mainly women and occasionally men. There is a genetic predisposition for melasma, where in some families every generation will have melasma.

Melasma usually starts in the mid 30 ‘s old and continues throughout middle age. It may start for the first time during pregnancy ( the “mask of pregnancy) or during the use of oral contraceptives. It is estimated that up to 70% of pregnant women and up to 35% of women on oral contraceptives are affected by melasma. After childbirth or after stopping the oral contraceptives, melasma may improve but it never goes away completely.

There are some factors that make melasma worse and of these sunexposure is the most common factor. Other factors include age, hormones and heat.

The main stay for treatment of melasma is sun-protection using a broad spectrum sunblock and wearing hats, shades and sunglasses when outdoors. Prescription creams, oral medication, chemical peels, light or laser treatments are used to treat melasma. There is no cure for melasma and you may have to be on treatment for many years. If you have melasma and desire treatment, ask Dr Joyce Lim, a dermatologist, to tailor a treatment plan for you.

Other Skin Pigmentation


Freckles are small brown spots seen on sun-exposed skin like on the face, neck and arms. Freckles are first noticed during childhood and are commonly seen in fair skinned individuals. It is common to see freckles among members of the same family. On sun exposure, more freckles are seen and they also increase in size and get darker.

Freckles are harmless and can be left alone.

Treatment includes chemical peels and light or laser treatments. Recurrences are common and sun protection is vital to prevent recurrences.


Hori’s macules, also called acquired bilateral naevus of Ota like macules are dark brown spots often seen on both cheeks of individuals with melasma. They are common among Asians and are due to the presence of pigment producing cells inside the dermis. Hori’s macules are often misdiagnosed as melasma. It is important to make the correct diagnosis as Hori’s macules do not respond to creams. Only laser treatments can clear the macules.


Post – inflammatory hyperpigmentation (PIH) is skin pigmentation that is left after injury to the skin. It is commonly seen in individuals with dark skin tone as any slightest injury will trigger the numerous pigment producing cells in the skin to produce even more pigments. In dark skin persons, the colour may be more intense and lasts for a longer period of time.

This pigmentation is commonly seen after any injury or irritation to the skin, after an underlying skin diseases have healed and after aesthetic procedures like laser treatments, chemical peels or skin surgery. Some medications can also cause post-inflammatory hyperpigmentation

The pigmentation is confined to the areas of injury. While it is easy to make the diagnosis, treatment is often difficult and includes prescription creams and laser treatments. Care must be taken to prevent further injury to the skin eg avoid frequent rubbing or scratching and sunexposure. If you are prone to post injury pigmentation, or PIH, let your dermatologist know before you undertake any aesthetic skin procedures.


Dark eye rings are due to a combination of factors. Among them are congestion of vessels below the skin, pigmentation in the skin, post eczema, hollowness due to aging and a genetic predisposition. As you grow older the eye socket gets larger and the lower eyelid skin sags and this accentuates the dark rings. In Asians dark eye rings may be genetic appearing at an earlier age and they get darker with age

Treatment depends on the various causes and includes prescription creams and laser/light treatment. Sometimes dermal fillers will improve the sunken eyelids and as light reflects from the skin the dark eye rings appears lighter