Everyone has to age. No ethnic group is spared! However, what are the unique characteristics of aging Asian skin? Dr Tan Hiok Hee of Thomson Specialist Skin Centre in Singapore gives the facts.
1. Asian skin and sun exposure
Intrinsic aging and photo-aging are two processes contributing to skin aging. Most Asians have Fitzpatrick phototypes III to V. The high melanin content in Asian skin confers better photo-protection than Caucasians, resulting in a lower risk of certain skin cancers. However, photo-damage in the form of pigmentary disorders and skin discolouration is more common in Asian skin. Wrinkling patterns have been observed to differ between Asian and Caucasian skin, but excessive UV exposure and smoking accelerate these changes in both groups.
2. Common skin pigmentation problems in Asian skin
Melasma is a common problem affecting Asian skin. The age of onset is between mid- 20s and late 30s. It affects more women than men and usually presents symmetrically on the cheeks as brown patches. The nasal bridge, forehead and temples can sometimes be affected as well. Risk factors include sun exposure, hormonal changes, genetic predisposition, pregnancy and the use of oral contraceptives.
Melasma can be of great cosmetic concern. Sun protection and topical agents remain the first line of treatment. Chemical peels, and certain laser modalities may provide additional help in lightening melasma.
- Solar lentigines
Lentigines, also known as age or sun spots, occur on skin with chronic sun exposure. Although these are also known as liver spots, there is no association with liver or other internal disease. The age of onset is mostly in the 30s and 40s and may be more common in fair Asian skin. Lentigines appear as well-demarcated brown spots which may coalesce into a bigger patch over time. Common lentigines demonstrate no gender differences. Laser therapy and intense pulsed light have shown to be effective in lightening these spots.
- Hori’s naevus
This condition is also known as acquired dermal melanocytosis (ADM). It is mostly confined to Chinese women, with onset in the 30s and 40s. It presents as grey-brown spots on the upper cheeks and nasal bridge. There may be a positive family history among female members of the family. Multiple sessions with laser therapy are usually required to lighten these spots as the pigmentation is deeper in the skin than in lentigines. Topical lightening agents are often ineffective. Melasma and Hori’s naevus may occur concurrently.
- Post-inflammatory hyperpigmentation
Post-inflammatory hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of colour. This can occur after any form of injury or inflammation to the skin, such as a pimple, an abrasion, scald, etc. The affected area of skin becomes hyperpigmented after the inflammation or injury resolves, and can remain so for many months. This is particularly so in Asian skin because of the increased melanin content within the skin.
PIH has no gender predilection and can occur in any age. PIH can be a source of stress and great concern when it occurs on the face, such as in individuals with significant acne. Many topical lightening agents have been tried with varying success in PIH, and the best modality is probably to leave the pigmentation to fade gradually, and treat any underlying inflammatory skin disorder to prevent further PIH. Appropriate camouflage cosmetics may also be advised.
3. Can such facial pigment problems be prevented? How so?
Acquired pigmentary lesions that are primarily the result of long-term excessive sun exposure such as lentigines can be prevented by practicing good sun protection from a young age. Some other conditions with a genetic predisposition such as freckles in early childhood may not be preventable, but adequate sun protection can delay or prevent increasing numbers of these lesions, and also help avoid the development of malignant changes.
4. Why should I have pigmentation
Professional medical assessment is essential even when the lesions are perceived as just due to sun exposure or aging. This is because cancerous skin lesions can be mistaken as moles or other benign growths and spots. For example, pigmented basal cell carcinomas and melanomas can resemble dark moles, and can enlarge only very slowly over years.
Another reason for seeking professional advice is that the diagnosis of the pigmentary skin problem is not always straight forward, and there are subtle differences between the various types of lesions. An accurate diagnosis is important as treatment modalities differ, and what works for one type of disorder may not be effective for the other.
5. What are some Asian skincare treatments that can help?
Remedies include the use of topical agents, chemical peels, light and laser therapy, as well as the use of camouflage if the pigmentation cannot be substantially cleared. Topical lightening agents include hydroquinone and arbutin. These agents are commonly combined with other prescription-only agents such topical retinoids (vitamin A derivatives) and occasionally with corticosteroids. Very rarely, prolonged application of topical hydroquinone in high concentrations over years may lead to a condition known as exogenous ochronosis, presenting as blue-black pigmentation on affected skin.
The Thomson Specialist Skin Centre offers laser treatment for acquired pigmentary disorders such as lentigines, freckles and Hori’s naevus using either the Q-switched Nd:YAG (532nm and 1064nm) or long-pulse Alexandrite (755nm) laser systems. Many pigmented lesions can be removed within one or two treatments but some will require multiple treatments. The number of sessions required depends on the condition being treated.
To reduce the risk of recurrence of pigmented lesions following treatment, appropriate preventive measures such as sun avoidance, adequate use of sunscreens and sun protection need to be adopted.
6. What habits can hasten skin aging?
Locally, excessive sun exposure between 10am and 4pm without any sun protection does increase the risk of acquiring a pigmentary disorder. Sun protection includes the generous application of water-resistant sunscreens which offer broad-spectrum coverage (UVB and UVA) , keeping out of the sun if possible, covering up with a hat, long-sleeves and sunglasses where appropriate.
7. Are Singaporeans proactive about getting the right skincare and skin treatment?
There is much publicity generated through media and word-of-mouth that skin problems should not and need not be brushed aside. Singaporeans are approaching dermatologists for assessment of both medical and aesthetic dermatological issues. The growing awareness particularly for medical skin problems is encouraging, indicating that people are now aware that there are effective methods of controlling and treating acute and chronic skin ailments, improving quality of life.
Concerned about pigmentation and aging skin? Find qualified, experienced and licensed Singapore dermatologists at the Thomson Specialist Skin Centre. Get skincare tips and proper treatment for wrinkles, spots, and other early signs of skin aging.