Types of Pigmentation in Asian Skin: How Each Looks and What Fits
Medical Director Dr Sin Yong explains the six common types of pigmentation in Asian skin, how deep each sits, which can darken after laser, and the approach that usually fits each one.
WhatsApp to Enquire →Key facts ↓The main types of pigmentation in Asian skin are melasma, freckles, solar lentigines (sun spots), Hori’s naevus (also called ABNOM), post-inflammatory hyperpigmentation and naevus of Ota. They differ in pattern, depth and cause. Surface spots often respond to spot laser, melasma is controlled rather than removed, and deep grey-brown pigment needs a spaced laser course.
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- Hori’s naevus profile: in 497 Chinese patients with Hori’s naevus, 486 were women, over 70 in 100 were aged 21 to 30, and the cheekbone area was involved in 496 [1].
- Melasma is not only surface pigment: reviews describe changes in the dermis, including more blood vessels, more mast cells and sun damage to elastic tissue [2], and propose melasma as a photoageing disorder [3].
- Acne marks are common: post-inflammatory pigmentation was present in 188 of 324 acne patients across seven Asian countries [5].
- Pico laser in Asian skin: a meta-analysis of 200 Asian patients treated with picosecond laser for pigmentary disorders rated clearance excellent in about 56 in 100 at three months [7].
- Settings change darkening risk: after fractional resurfacing in 37 Chinese patients, generalised post-inflammatory pigmentation rates were 7.1 in 100 at one setting and 12.4 in 100 at another [8].
What are the main types of pigmentation in Asian skin?
Six types account for most facial pigmentation seen in Asian skin: melasma, freckles, solar lentigines, Hori’s naevus, post-inflammatory hyperpigmentation and naevus of Ota.
| Type | How it usually looks | Who and when | Depth | Main driver | What usually fits |
|---|---|---|---|---|---|
| Melasma | Symmetrical, blurred-edged brown patches on cheeks, forehead, upper lip | Mostly women, 20s to 50s; worse with pregnancy, hormones, sun | Mostly surface; often dermal changes too | UV and visible light, heat, hormones, genes | Control: sun and heat protection, medical care, gentle low-energy toning |
| Freckles (ephelides) | Small, light brown dots across the nose and cheeks | From childhood; darken with sun | Surface | Genes plus sun | Spot pico or Q-switched laser, then sun protection |
| Solar lentigines (sun spots, age spots) | Flat, sharp-edged brown spots, larger than freckles, on cheeks, temples, hands | From the 30s onwards; accumulate | Surface | Cumulative sun exposure | Spot pico or Q-switched laser |
| Hori’s naevus (ABNOM) | Grey-brown or blue-brown speckles on both cheekbones, sometimes temples, lower eyelids, nose | Mostly women; appears in late teens to 30s | Dermal (deep) | Pigment cells in the dermis; family tendency | A spaced course of pico or Q-switched laser |
| Post-inflammatory hyperpigmentation (PIH) | Flat brown or grey marks where a spot, rash, burn or procedure was | Any age; more in skin that tans readily | Surface, sometimes deeper | Inflammation | Treat the cause; creams and sun protection; gentle laser if it persists |
| Naevus of Ota | Blue-grey patch, usually on one side of the face, sometimes the white of the eye | Present at birth or from adolescence | Dermal (deep) | Dermal pigment cells | A long, spaced course of Q-switched or pico laser; eye involvement checked |
Asian skin tends to make pigment readily and to react to inflammation with pigment, so these types are common and often appear together [9]. The first step is never the device; it is working out which types are present, how deep each sits, and what is driving it. The type-by-type treatment comparison, with costs and timelines, is in pigmentation removal in Singapore.
Why does the depth of pigmentation matter?
Depth decides what can reach the pigment. Surface pigment responds to creams, peels and spot laser; pigment in the dermis needs laser energy that penetrates deeper, over more sessions.
Colour is the first clue. Pigment near the surface looks brown. Pigment deeper in the dermis looks grey, slate or blue-brown, because light scattered back from deep pigment shifts towards blue. That is why a grey-brown patch that has not responded to lightening cream for years is often not melasma at all, and why an even brown patch is rarely Hori’s naevus.
| Depth | Typical colour | Examples | What can reach it |
|---|---|---|---|
| Epidermal (surface) | Light to dark brown, sharp or blurred edge | Freckles, solar lentigines, most PIH, much of melasma | Sun protection, topical agents, superficial peels, spot laser |
| Dermal (deep) | Grey, slate, blue-brown | Hori’s naevus, naevus of Ota, some long-standing PIH | Pico or Q-switched laser in a spaced course; creams change little |
| Mixed | Brown with grey areas | Melasma with dermal change; melasma overlying Hori’s naevus | Staged plan: calm the surface type first |
At examination, depth is judged by colour, pattern and dermoscopy. In melasma the picture is more complicated, because even when the pigment is mostly in the surface, the dermis below shows extra blood vessels, mast cells and sun damage, which helps explain why melasma returns after it has been lightened [2].
What does melasma look like, and what fits it?
Melasma is symmetrical, blurred-edged brown patching on the cheeks, forehead, upper lip or jaw. It is managed and controlled over time rather than removed in one course.
Hormones and genes set the stage, but UV, visible light and heat drive it, and recent research frames melasma as a photoageing disorder of predisposed skin [3]. That is why melasma darkens after a holiday, a hot yoga class or an aggressive laser setting, and why high-energy spot laser is the wrong tool: the heat can inflame it and make it rebound.
What fits is a combination: daily broad-spectrum sun protection with a tinted product that blocks visible light, avoiding heat, medical treatment chosen after screening, and, where suitable, gentle low-energy laser toning on the DEKA TORO spaced weeks apart. The full plan, including who should not take oral treatment, is on melasma treatment in Singapore.
What is the difference between freckles and solar lentigines?
Freckles are small, genetically determined dots that darken with sun from childhood; solar lentigines are larger, sharper spots that build up with years of sun exposure.
Both are surface pigment, and both are driven by sunlight: freckles largely by genes switched on by sun, lentigines by accumulated sun damage [4]. In temperate climates freckles fade in winter; in Singapore there is no winter, so they stay. Lentigines do not fade and tend to multiply on the cheeks, temples and backs of the hands.
Because both sit near the surface, they usually respond to spot treatment with pico or Q-switched laser: the spot darkens, crusts finely and lifts over about a week. New ones appear without sun protection. Details by type are in freckles removal and age spot removal, and the three-way comparison with melasma is in age spots vs freckles vs melasma.
What is Hori’s naevus (ABNOM)?
Hori’s naevus, also called ABNOM (acquired bilateral naevus of Ota-like macules), is grey-brown speckled pigment from pigment cells in the dermis, usually on both cheekbones.
ABNOM and Hori’s naevus are two names for the same condition. It is common in East Asian women and is often treated as melasma for years before it is recognised. In a series of 497 Chinese patients, almost all were women, most were aged 21 to 30, about one in five had a family history, and the cheekbone area was involved in 496 of 497; lesions were yellow-brown in 44 in 100, blue-brown in 21 in 100 and slate-grey in 35 in 100, and slate-grey became more common the longer the condition had been present [1].
Because the pigment is deep, creams and peels change it very little. It needs pico or Q-switched energy that reaches the dermis, in sessions spaced weeks to months apart, and temporary darkening after early sessions is common in Asian skin and planned for. Where melasma overlies it, the melasma is usually calmed first, because settings that reach Hori’s naevus can inflame melasma.
Naevus of Ota is the condition ABNOM is named after, and it differs: it is usually on one side of the face, appears at birth or in adolescence, and can involve the white of the eye. It also needs a long, spaced course of laser.
“Brown on the surface and grey in the depth are different problems that can sit on the same cheek. Treat them as one, and you usually make one of them worse.”
What is post-inflammatory hyperpigmentation?
Post-inflammatory hyperpigmentation is a flat brown or grey mark left where the skin was inflamed or injured: after acne, eczema, insect bites, burns, waxing or a procedure.
It is more frequent and more severe in darker skin types [6], and in Asia it is often the main concern of people with acne: in one multinational study, 188 of 324 acne patients had it, and picking or scratching was commonly reported [5]. Most surface PIH fades over months once the inflammation has stopped, faster with sun protection and a topical lightening routine.
The order matters: treat the cause first, because new spots make new marks. Persistent marks can be helped by gentle laser toning or peels, kept mild so that the treatment itself does not inflame the skin. Red marks after acne are a different problem (post-inflammatory erythema) and respond to different treatment; both are covered in acne marks and post-inflammatory pigmentation.
Which pigmentation types are most likely to darken after laser?
Melasma and still-inflamed skin darken most easily, and any type can develop post-inflammatory pigmentation if laser energy is too high for skin that tans readily.
Most people in Singapore have Fitzpatrick skin types III to V, whose pigment cells react strongly to heat and injury. Settings make a measurable difference: after fractional resurfacing in Chinese patients, generalised post-inflammatory pigmentation rates were 7.1 in 100 with one combination of energy and density and 12.4 in 100 with another, and localised darkening around the mouth occurred without air cooling [8].
Picosecond pulses fragment pigment with more of a pressure effect and less heat than nanosecond Q-switched pulses, and a meta-analysis of picosecond laser in Asian patients found most results rated good or excellent at three months [7]. Device choice between the Fotona StarWalker PQX and the DEKA TORO is explained under pico laser in Singapore.
| If you have | Usually treated first | Then |
|---|---|---|
| Melasma with sun spots | Melasma calmed with sun protection and medical care | Sun spots spot-treated once melasma is stable, at cautious settings |
| Melasma over Hori’s naevus | Melasma | Hori’s naevus in a spaced course |
| Active acne with PIH | Acne | PIH, once new spots have stopped |
| Freckles and lentigines only | Spot laser | Sun protection to slow new spots |
Which brown spots should be examined before any pigment treatment?
Any brown or black spot that is new, changing, irregular or unlike the others should be examined before laser, because laser destroys what the doctor needs to see.
- A flat brown patch on the face that is slowly enlarging with an irregular edge or uneven colour.
- A spot that bleeds, crusts, itches or feels rough and does not heal.
- A dark streak in a nail, or a dark patch on a palm or sole.
- Pigment around or in the eye, or a blue-grey patch present since birth.
These are examined with a dermatoscope, and a spot with concerning features is referred rather than treated; the process is described in mole check before removal.
What Dr Sin Yong looks for
- The pattern: symmetrical blurred patches, scattered dots, sharp-edged spots or grey speckles on both cheekbones.
- The colour, brown or grey-blue, as a clue to depth, confirmed with dermoscopy.
- Whether more than one type is present, and which one should be treated first.
- Triggers: hormones, pregnancy plans, sun and heat at work or sport, and recent acne or procedures.
- Your skin type and history of darkening after spots, waxing or previous laser.
- Any single spot that is changing or irregular, which is examined before anything is treated.
General clinical observations used at consultation; they describe what is checked, not any individual result.
Frequently asked questions
What are the different types of pigmentation?
The common types on the face are melasma, freckles, solar lentigines (sun spots or age spots), Hori’s naevus (ABNOM), post-inflammatory hyperpigmentation and naevus of Ota. They differ in how they look, how deep they sit and what drives them, which is why each needs a different plan.
Is Hori’s naevus the same as melasma?
No. Melasma is mostly surface brown patching driven by light, heat and hormones; Hori’s naevus is deeper, grey-brown speckled pigment from cells in the dermis. They often appear together on the cheeks, which is why the type is confirmed at examination before any laser is chosen.
What does ABNOM stand for?
ABNOM stands for acquired bilateral naevus of Ota-like macules. It is the same condition as Hori’s naevus: grey-brown speckles, usually on both cheekbones, that appear in the late teens to thirties, mostly in East Asian women. It is treated with a spaced course of laser.
Which type of pigmentation is hardest to treat?
Melasma is usually the hardest to keep away, because it is driven by light, heat and hormones and tends to return; it is controlled rather than removed. Deep pigment such as Hori’s naevus and naevus of Ota responds to laser but needs more sessions spaced further apart.
Can pigmentation in Asian skin be removed completely?
Some types can clear well: freckles and sun spots often lighten markedly with spot laser, though new ones form without sun protection. Hori’s naevus can lighten substantially over a course. Melasma can be lightened and controlled but tends to recur, so results vary between people and are reviewed over months.
Why did my pigmentation get darker after laser?
Darkening after laser is usually post-inflammatory pigmentation, from energy that was too high for skin that tans readily, or melasma reacting to heat. It usually fades over weeks to months with sun protection and time. Choosing the type first and keeping settings cautious lowers the risk.
How can I tell if my pigmentation is deep?
Colour is the first clue: deep pigment looks grey, slate or blue-brown rather than brown, and it changes little with lightening creams. Dermoscopy at an examination helps confirm the depth. A brown, sharp-edged spot is usually surface pigment; grey speckles on both cheekbones suggest Hori’s naevus.
Does sunscreen help every type of pigmentation?
Yes, though in different ways. It slows new freckles and sun spots, is essential for controlling melasma, and helps post-inflammatory marks fade. It does not lighten deep dermal pigment such as Hori’s naevus, but it protects the skin during and after laser treatment, when darkening is more likely.
Book an assessment
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. At IN Eternity Clinic a consultation fee applies, and it is waived if you go ahead with any medical treatment; the fee is S$120.
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References
- Zhong Y, et al. Both age and disease duration are associated with clinical phenotype of Hori's nevus in Chinese: a retrospective analysis of 497 cases. Clin Cosmet Investig Dermatol 2021. doi:10.2147/CCID.S285935
- Kwon SH, Hwang YJ, Lee SK, Park KC. Heterogeneous pathology of melasma and its clinical implications. Int J Mol Sci 2016;17(6):824. doi:10.3390/ijms17060824
- Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell Melanoma Res 2018;31(4):461-465 (online 2017). doi:10.1111/pcmr.12684
- Praetorius C, Sturm RA, Steingrimsson E. Sun-induced freckling: ephelides and solar lentigines. Pigment Cell Melanoma Res 2014;27(3):339-350. doi:10.1111/pcmr.12232
- Abad-Casintahan F, Chow SKW, Goh CL, et al. Frequency and characteristics of acne-related post-inflammatory hyperpigmentation. J Dermatol 2016;43(7):826-828. doi:10.1111/1346-8138.13263
- Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol 2010;3(7):20-31. PMID 20725554. PMID 20725554
- Dong W, Wang N, Yuan X, Zhang W. Treatment of pigmentary disorders using picosecond laser in Asian patients: a meta-analysis and systematic review. Dermatol Ther 2021;34(1):e14709 (online 2020). doi:10.1111/dth.14709
- Chan HH, Manstein D, Yu CS, et al. The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med 2007;39(5):381-385. doi:10.1002/lsm.20512
- Ho SGY, Chan HHL. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol 2009;10(3):153-168. doi:10.2165/00128071-200910030-00002
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.