Rethinking a common skin ailment

Pigmentation - it's probably the biggest beauty bane of an Asian woman in a society that prizes fair, even and clear skin.

Hormonally-caused Melasma is a common condition, and now, a Singapore-based doctor has identified a condition among Asian melasma-sufferers which wasn't thought to be prevalent before.

Melasma - a brown or grey-ish discolouration of the skin on the face - affects mostly women. It is often called the "pregnancy mask" or chloasma when it occurs during pregnancy, or sometimes when contraceptives are taken.

Besides that, UV damage to the skin is another factor. It affects more than 45 million people worldwide. Every year in Singapore, the National Skin Centre sees about 1,500 cases of women who suffer from the condition.

What's "new" is that treating melasma with hydroquinone can lead to a worse condition, called exogenous ochronosis (EO).

"It was long believed that Asians don't suffer from EO, but I have since found about 30 over cases among my patients," says SK Tan, a specialist in hyperpigmentation and the senior medical director of The DRx Clinic.

He had initially suspected some 140 patients of his to be afflicted with EO. Eventually 38 agreed to have a biopsy, and from that, 13 were confirmed EO cases. He later submitted an article about his treatment to the International Journal of Dermatology. Since then, he's treated more than 30 cases.

Skin-lightening products

He's the first doctor to report that EO can indeed happen among Asians. It was found that Dr Tan's EO patients had a history of using skin-lightening products for a minimum of two years. With EO, the melasma pigmentation gets more uneven, and tiny lumps may form on the surface, called the caviar effect.

"We don't know why some people with melasma develop EO and some don't, but it's strongly linked to hydroquinone. Hydroquinone is still the first line of skin-lightening treatments, however," says Dr Tan.

Dr Tan found that stopping hydroquinone treatment helps and laser treatment to be quite effective with EO-sufferers. He has treated six patients, out of the 38 he diagnosed with EO, with laser, with good results.

The main problem now with EO is that not many patients are willing to do a biopsy and that's the only way to diagnose it, he notes.

Giving a few patient examples, Dr Tan says that one of his patients is a woman in her 60s who had melasma for over 10 years, and when he saw her, her discolouration and texture were already quite bad. Another woman in her late 50s had been to several doctors for her melasma condition before she consulted Dr Tan. From her 6-7-year history of hydroquinone treatment, Dr Tan suspected EO, and a biopsy turned out positive. He stopped her hydroquinone treatment, and she has responded well to laser treatment.

"Using clinical-grade skincare is still the first-line treatment because even if laser treatment is successful, the patient would still need to continue with skincare to maintain the results," he adds.

Noting that he has a database of some 30,000 patients, 38 with EO isn't an alarming number. However, he suspects that the number could be actually higher. It's just that not many are willing to do a biopsy to confirm it.

"We can't treat EO unless it's confirmed, so we need to raise the awareness about this condition," he concludes.

uihoon@sph.com.sg

This article was first published in The Business Times.