Pigmentary Disorders
Uneven skin tone is one of the most common reasons patients seek dermatological care in Singapore. Accurate diagnosis matters more here than almost anywhere else — because treatments suited to fair skin can worsen pigmentation in richly pigmented skin.
At a glance
- What they are
- Conditions in which skin pigment is increased (hyperpigmentation) or lost (hypopigmentation).
- Common types
- Melasma, post-inflammatory hyperpigmentation, solar lentigines, freckles, Hori's nevus and vitiligo.
- Why here
- Melanocytes in Asian skin types respond readily to ultraviolet light, heat and inflammation — and Singapore's equatorial position means year-round high ultraviolet exposure.
- Key principle
- Diagnosis first. Different pigmentary conditions look similar but respond very differently, and some are aggravated by the wrong treatment.
- Foundation of care
- Consistent broad-spectrum sun protection, without which other treatments underperform.
Pigmentation in Asian skin
All skin contains a similar number of pigment-producing cells, called melanocytes. What differs between individuals is how much pigment those cells make and how readily they are provoked into making it.
In the skin types common across Singapore, melanocytes are more easily activated. Ultraviolet light, heat, and above all inflammation prompt a brisk pigment response. This is a protective mechanism, but it means that any insult to the skin — a spot, a scratch, a rash, an overly aggressive cosmetic treatment — can leave a mark that outlasts the original problem by many months.
Three practical consequences follow, and they shape everything on this page:
- Controlling inflammation early prevents more pigmentation than any treatment applied afterwards
- Sun protection is not optional — it underpins every other treatment
- Aggressive procedures carry real risk, because treatments that suit fair skin may cause rebound darkening here
Common pigmentary conditions
These often occur together, and distinguishing between them is the first step in treatment.
Melasma
Symmetrical brown or grey-brown patches, most often on the face.
- Typically cheeks, forehead, upper lip and jawline
- Strongly influenced by hormones — pregnancy, oral contraceptives
- Aggravated by ultraviolet light, visible light and heat
- Tends to recur, so long-term management is the realistic aim
Post-inflammatory hyperpigmentation
Marks left where inflammation or injury occurred.
- Follows acne, eczema, a scratch, an insect bite or a procedure
- Takes the shape of whatever caused it
- Flat — a change in colour, not texture
- Usually fades over months, faster with sun protection
Solar lentigines & freckles
Sun-related brown spots.
- Lentigines (age spots) are well-defined and appear with cumulative sun exposure
- Freckles are genetic, appear earlier, and darken with sun
- Most common on the face, forearms and backs of hands
- Largely preventable with consistent sun protection
Hori's nevus & nevus of Ota
Deeper, blue-grey pigmentation.
- Hori's nevus typically appears over both cheekbones in adulthood
- Blue-grey or slate-coloured rather than brown
- Pigment sits deeper in the skin than melasma
- Frequently mistaken for melasma, but managed differently
Vitiligo
Loss of pigment producing well-defined pale patches.
- An autoimmune condition in which pigment cells are lost
- Sharply demarcated white or pale patches
- Sometimes associated with thyroid and other autoimmune disease
- Not contagious; treatment options exist and work better started early
Other hypopigmentation
Pale marks with other causes.
- Post-inflammatory hypopigmentation after a rash has settled
- Pale patches in children that can follow eczema
- Some fungal infections cause uneven pale patches
- Assessment distinguishes these from vitiligo
How pigmentary disorders are treated
Treatment begins with establishing which condition is present — and often more than one is. Examination determines the type of pigment, how deep it sits, and whether inflammation is still active. Only then does a treatment plan make sense.
Sun protection — the foundation
Broad-spectrum sunscreen used daily and consistently is the single most important element. Ultraviolet exposure drives pigment production directly and undermines every other treatment. For melasma, tinted formulations containing iron oxides are often preferred because they also screen visible light, which contributes to pigmentation in deeper skin tones. Hats and shade matter too.
Topical treatment
A range of topical agents can reduce pigment production or accelerate its clearance, including depigmenting agents, retinoids and azelaic acid. These are prescribed according to the condition and the skin type, and generally require months rather than weeks of consistent use.
Procedures
Chemical peels and, for selected conditions, laser treatment may be used as adjuncts. The choice is deliberate and conservative: the aim is enough to clear pigment without provoking the inflammation that would create more. For some conditions — deeper dermal pigment such as Hori's nevus — laser plays a central role. For others, notably melasma, it must be approached with caution.
Treating the cause
Where pigmentation follows inflammation, controlling the underlying condition comes first. Treating post-acne marks while acne remains active is working against the tide.
What helps, and what makes pigmentation worse
These measures support medical treatment and are often what determines whether results hold.
Helpful
- Apply broad-spectrum sunscreen every morning, and reapply during the day
- Consider a tinted sunscreen if you have melasma
- Use hats and seek shade, particularly around midday
- Treat acne and eczema promptly to prevent new marks
- Be patient — pigment treatments work over months
- Introduce active ingredients gradually to avoid irritation
Unhelpful
- Picking or squeezing spots, which deepens the resulting mark
- Scrubs and harsh exfoliation, which provoke inflammation
- Unsupervised strong bleaching creams from informal sources
- Aggressive laser or peel treatments without proper assessment
- Stopping sunscreen once things improve
- Assuming all pigmentation is the same and can be treated the same way
When to see a dermatologist
Consider a specialist assessment if:
- You are unsure which type of pigmentation you have
- Over-the-counter products have not helped after a reasonable trial
- Pigmentation is worsening despite treatment, or returned after a previous procedure
- You are considering laser or peel treatment and want to know whether it is suitable for your skin
- Pale patches are spreading or appearing at new sites
- The appearance is affecting your confidence or daily life
Dr Chen Qiping
Consultant Dermatologist · MBBS, MRCP (UK), M.Sc, FAMS (Dermatology)
Pigmentary disorders are one of Dr Chen's two subspecialty interests, alongside skin cancer. Consultations are available in English and Mandarin.
Pigmentary disorders — frequently asked questions
Why is pigmentation such a common concern in Singapore?
What is the difference between melasma and post-inflammatory hyperpigmentation?
Will laser treatment fix my pigmentation?
Do dark marks from acne eventually fade?
Is vitiligo related to any other medical condition?
Does sunscreen really make a difference?
References
- DermNet. Melasma, Postinflammatory hyperpigmentation and Vitiligo. dermnetnz.org
- Thawabteh AM, Jibreen A, Karaman D, et al. Skin Pigmentation Types, Causes and Treatment — A Review. Molecules. 2023;28(12):4839. ncbi.nlm.nih.gov
- Kaufman BP, Alexis AF. Psoriasis and pigmentary considerations in skin of colour. Am J Clin Dermatol.
Page last reviewed: 28 July 2026.
Concerned about uneven skin tone?
Arrange a consultation with Dr Chen Qiping, whose subspecialty interests include pigmentary disorders, at our Collyer Quay clinic — two minutes' walk from Raffles Place MRT.