Freckles

These are light brown small flat spots that appear on areas of sun exposed skin such as the cheeks and nose. They are usually present when young and get more with ageing.

Freckles can be reduced and lightened by avoiding sun exposure, use of broad spectrum sunscreen with re-application when outdoors and skin lightening creams. If creams and sun avoidance still do not give satisfactory results, they can be safely removed with intense pulsed light therapy or pigment laser treatment. However, chance of recurrence is high with sun exposure.

Solar lentigines (age spots)

These are brownish discrete pigmentation that occur on the face, arms, legs and other sun-exposed skin as a result of chronic sun exposure causing extrinsic skin ageing.

They are usually first noted in the 30’s-40’s and get progressively more with age. Some lesions can become slightly thickened with time. Solar lentigines are harmless and do not turn cancerous. However, some skin cancers mimic them and should be examined by a dermatologist for confirmation of diagnosis. They can be left alone or can be removed for cosmetic reasons. 

Prevention is with regular use of a broad spectrum sunscreen with reapplication when outdoors and sun avoidance. Solar lentigines may be lightened with bleaching creams, intense pulsed light therapy or pigment laser treatment. However, chance of recurrence is high with sun exposure.

Melasma

Melasma is a common pigmentary problem affecting the Asian skin. It usually appears as brownish patches over the cheeks although the forehead, temples, nasal bridge, upper lips and jawline may be affected as well. Melasma results from the interplay of genetic, hormonal and UV factors. Women are more commonly affected compared to men. Worsening is often reported after sun exposure, pregnancy and the use of oral contraceptives.

Melasma is challenging to treat as recurrence after initial successful treatment is high. Melasma is best controlled with the regular use of broad spectrum sunscreens, sun avoidance and lightening creams. For difficult cases, chemical peeling and intense pulsed light therapy may offer additional benefits but the results are variable. Pigment laser may be used for melasma as a last resort but should be used with caution as they can potentially worsen melasma.

Hori’s Naevus

This is a peculiar pigmentary disorder affecting mainly Asian women in their 30’s-50’s. It appears as discrete brown to greyish spots over the upper cheeks and nasal bridge. Genetic and hormonal factors are likely to play a role. The pigmentation is relatively deep within the skin, therefore 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.