This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. Hyperpigmentation can affect the skin color of people of any race.

Changes in skin color can result from outside causes. For example, skin diseases such as acne and eczema may leave dark spots after the condition clears. Other causes of dark spots are injuries to the skin, including some surgeries. Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic. Age spots are a common form of hyperpigmentation. They occur due to sun damage, and are referred to by doctors as solar lentigines. These small, darkened patches are usually found on the hands and face or other areas frequently exposed to the sun. Freckles, age spots, and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun.

Here are some Lifestyle readers' questions regarding hyperpigmentation, and an explanation of some of the treatment options currently available.

I have a lot of darkened spots, scars, marks and breakout on my face due to acne. How am I going to have these removed totally and have clear skin again?

Acne breakouts are usually on parts of the body where there is a high concentration of pores that contain oil-producing glands. When these oil glands become clogged and inflamed, blackheads and whiteheads develop. If a whitehead or blackhead ruptures, its infected contents come into contact with the skin and the infection spreads, producing what is classically referred to as a pimple. If the pimple becomes badly infected it turns into a cyst that is located deep in the skin. If left untreated, these painful lesions can lead to an acne scar and leave hyper-pigmented marks on the skin.

Hyper-pigmentation due to acne can be treated with a chemical peel, laser and regular usage of pigment treatment gel containing Hydroquinone (a skin bleaching agent). These procedures stimulate the production of healthy new skin cells to replace the damaged, pigmented cells on the skin surface. Generally, good results can be seen after two to three treatment sessions over a three-month period.

However, before you consider having the existing pigmentation treated, it is important to first control the acne breakout and pimple formation resulting in the pigmentation problem. Treatment options currently available for treatment of oily and acne-prone skin will be discussed in the next issue.

I have eczema dermatitis that has left dark pigmentation on both my hands. I have tried almost everything, and even gone to the skin clinic but my skin is still dark and patchy. Currently, I am using a moisturizer which helps a little to lighten the pigmentation. Is there any remedy?

Pigmentation due to eczema and dermatitis requires careful management. People with this condition have highly sensitive skin and certain skin products and treatments may be too harsh and may actually worsen the condition. Avoid pigment control products that contain AHA (Alpha Hydroxy Acids) and Hydroquinone, which may irritate sensitive skin. A good alternative would be to apply Hydroquinone-free pigment gel, vitamin C serum and vitamin E cream, which help to lighten skin pigmentation and moisturize at the same time. Laser treatment can be highly effective to treat pigmentation but it must be performed with caution by a qualified doctor. Also use a gentle exfoliant twice a week to remove hyper-pigmented dead skin cells and use a sunblock daily.

I have dark circles under my eyes that seem to be gradually getting worse. I have tried various cosmetic products and eye creams, but they are not effective at all. Can you recommend any treatment procedures or products to treat dark circles?

Dark eye circles are caused by deposits of pigment such as melanin and haemosiderin in the lower eye lids. This is believed to be caused by thinning of the skin below the eyelid area and microscopic damage to small blood vessels in this area. Causes of this include nose and eye sensitivity due to allergies and irritation, sinusitis, lack of sleep and smoking. Cosmetic and over-the-counter products have so far not proven to be very effective. Medical treatment of dark circles currently available involves the application of a combination of high-potency vitamin K and Retinoic Acid to the lower eyelids. This is a procedure done once a week by a trained doctor, followed by application of vitamin K cream and moisturizing eye cream daily. This treatment has shown promising results. Any underlying conditions, such as allergic nose and eye sensitivity, and sinus problems must be treated at the same time.

Dr. Ram Nath is a General Practitioner with a special interest in aesthetics. He practices at Peace Family Clinic & Surgery (Blk 452 Ang Mo Kio Ave 10). If you have any queries, you can reach him by email at drkramnath@peace-medical.com or at the following postal address:

Robinson Road Post Office
P.O. Box 189 Singapore 900339

Email to sensasia@singnet.com.sg or mail (to the address above) questions concerning oily and pimply skin. If your question is selected for publication, you will be entitled to a free skin consultation worth $50. Remember to include your name, address, contact numbers, gender and age.

Closing date: Nov 8, 2004