Dr. Lena Fan: Underarm whitening: The most overlooked aesthetic procedure ever?
As we reach puberty and transition into adulthood, the number of melanocytes (cells that produce melanin) in our hair follicles increases as thick terminal hairs in the underarms start to develop. A variety of reasons cause our underarm skin to darken, such as sunlight exposure, lifestyle issues like friction from clothes, or even irritation from unsuitable products. In our quest to have hairless and smooth armpits through procedures such as shaving, waxing and IPL, side effects of post-inflammatory hyperpigmentation may develop over treated areas.
A medical condition called Acanthosis Nigricans (AN) also manifests as darkened and thickened skin over the underarm, neck and groin areas. AN is linked to obesity, pre-diabetes and diabetes, and should be assessed by a medical doctor for further management.
To lighten their underarms, it is not uncommon for ladies to turn to the use of over-the-counter topical creams or “natural remedies”. However, some treatments may not be effective, and some ladies’ underarms might even take a turn for the worse instead.
Will shaving my underarm hair cause darkening?
Shaving the underarms can be a quick fix to remove armpit hair, but doing it often may actually lead to underarm darkening, due to skin inflammation from repeated trauma and friction. When there is repetitive friction on the skin, the skin responds by becoming thicker and hyperpigmented. Second, shaving creams that contain ingredients like alcohol or fragrance can be extremely irritating to skin.
Is waxing a better option then? Not necessarily. In fact, ripping away hair with wax may actually be worse, especially if you’re prone to ingrown hair. Laser hair removal is a better option that addresses all these issues. This method of hair removal is a lot less traumatic, especially for individuals with darker skin. Hair that grows back after laser hair removal is also much finer, which means there’s a slimmer chance of growing ingrown hair and developing hyperpigmentation in the underarms.
Why are home remedies for underarm whitening so dangerous?
This is an actual screenshot from a health website on how to whiten one’s underarms naturally.
Here’s the truth – a good portion of “home remedies” are not backed by much scientific research. Beyond wasting your time and money, you might risk skin damage as many of these compounds are highly acidic in nature and can cause a variety of symptoms and skin reactions, especially if applied incorrectly in wrong amounts.
That’s not to say that all naturally occurring extracts are not useful in skin whitening. In this study(1), tyrosinase inhibitors extracted from natural sources, such as Cysteamine, have been shown to have effectiveness in underarm whitening.
There are effective underarm whitening procedures. They’re simply overlooked amongst the sea of misinformation out there.
As a doctor with special interests in feminine conditions, I’m writing this article to share with fellow ladies what safe and effective treatments are available for underarm whitening.
What treatments does Veritas offer for underarm whitening?
Like many other conditions, the doctors at Veritas believe that a combination approach is the best way forward. We use a combination of lasers to break down dark pigmentation as well as prescribe effective topical medication.
Some of the lasers we use in underarm whitening treatment to break down dark pigmentation include:
- Blend laser protocol: A selection of multiple lasers which effectively treats pigmentation with no down-time. Pico laser is commonly selected for it breaks down pigmentation quickly and effectively.
- PERFECT laser protocol: A combination of fractional lasers that resurfaces skin and improves darkened underarms with a short recovery period.
- Fotona v3 redness laser: A long-pulsed laser with 532 and 1064nm wavelengths that is well absorbed by haemoglobin, improving generalised skin redness and visible blood vessels.
Why the need for multiple lasers? It is important to keep in mind that pigmentation consists of various components that develop at different layers of the skin (epidermal, superficial dermal, deep dermal).
Therefore, using simply one laser to target all levels of pigmentation is going to be less effective compared to using a variety of lasers, each calibrated to target a component of pigmentation at a specific layer. Studies have shown that when a single laser treatment approach is overdone, there runs a greater risk of developing macular hypopigmentation as possible complications(2).
This selection of lasers we choose to treat underarm whitening may also be used to treat a variety of other pigmentations – albeit tuned to an appropriate setting for the individual’s underarm condition and skin type.
Won’t combination lasers require more sessions? Won’t that increase downtime?
Some patients are put off by procedures that are too time-consuming and overly complex, which is not the case at all with underarm whitening treatments. Most underarm whitening combination laser treatments can be completed within 15 to 20 minutes.
As combination laser treatments are more attuned to targeting pigmentation at specific layers of the skin, the overall downtime is actually less when compared to single laser treatment modality. This is because the unnecessary damage done to unaffected skin layers is kept to a minimum.
Here’s a quick rundown of the down-time expected for each treatment:
Blend laser: Pink or slightly reddened skin which should resolve within the day.
PERFECT skin resurfacing: Mild swelling, redness, sensitivity lasting 3-5 days.
Fotona v3 redness laser: Some redness of the skin post-treatment should subside within several hours.
Much like all other treatments, improvements seen from underarm whitening may vary. Factors that affect this include:
- Pigmentation depth and type
- Severity of pigmentation
- Individual’s skin type
For patients who have a moderate degree of underarm darkening, I would say that a realistic treatment duration to see notable improvement would be 3 to 4 months with regular treatments. Of course, a proper skincare regime, lifestyle changes and post-care will be imperative in attaining these results, but any patient that sticks to the plan is likely to get better results.
Are topical medications effective or should I avoid them?
As with most pigmentation-related conditions, combining topical creams for home application together with in-clinic laser treatment protocols maximises the lightening effect to underarms and minimises possible side effects of treatments, and is recommended for better results.
Some common active ingredients found in medical lightening creams that include
- Hydroquinone (HQ)
- Azelaic acid
Depending on your individual skin type, we might recommend different creams for you. It is important to note that even medical creams, when unsuitably prescribed, can irritate the skin resulting in discomfort, redness, or a rebound with worsening pigmentation. Hence, do avoid a self-prescription of whitening creams and apply those that have been prescribed by a doctor after proper consultation and assessment.
At Veritas, I prescribe a special gentle yet effective in-house lightening cream, Cell-Reve Serum, for people with sensitive skin that is suitable for application on sensitive areas such as the underarm.
Another topical cream that we prescribe for use in combination with laser treatments is Cysteamine. A novel non-hydroquinone lightening agent, Cysteamine is highly effective at regulating melanin production without the irritation commonly associated with hydroquinone and tretinoin.
If you are bothered by your dark underarms and yearn to wear sleeveless dresses or tank tops confidently in Singapore’s tropical heat, I hope my article has shown you the possibility of effective underarm whitening to set you on your path.
Do you have a question for me?
- Smit, N., Vicanova, J., & Pavel, S. (2009). The hunt for natural skin whitening agents. International journal of molecular sciences, 10(12), 5326–5349. https://doi.org/10.3390/ijms10125326
- Wong, Y., Lee, S. S., & Goh, C. L. (2015). Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments. Annals of dermatology, 27(6), 751–755. https://doi.org/10.5021/ad.2015.27.6.751