a brief review of hyperpigmentation treatment strategy in cosmetic field dr. mohammad baghaei

:a brief review of

Hyperpigmentation treatment strategy in cosmetic field

by :

Dr Mohammad Baghaei COSMETIC SCIENTIST

MECSCC PRESIDENT OF

1

Hyperpigmentation occurs when melanin is overproduced in certain spots on the

skin. Hyperpigmentation results in flat, darkened patches of skin that are light

brown to black in colour, and can vary in size and shape.

2


By Dr. Mohammad Baghaei

3

Hyperpigmentation in endocrine disorders

Generalised increased skin pigmentation is most intense on light exposed areas, in

flexures, at sites of friction and pressure, in the creases of the palms and soles,

and on all mucous membranes. The pattern is not specific and the possibility of

Addison’s disease should be considered in any case of increased pigmentation. In

autoimmune Addisons disease, patches of nonpigmented skin ie vitiligo may also be

present.

1. adrenal failure

2. acromegaly

3. Cushing’s syndrome

4. hyperthyroidism

5. phaeochromocytoma

6. carcinoid syndrome

7. high dose ACTH therapy


4

Pigmentation associated with nutritional deficiencies

1. deficiencies of any of vitamins A, C, niacin, folate or B12

2. malabsorption syndromes

3. "Vagabonds" disease? post-inflammatory pigmentation

Pigmentation associated with drugs

1. anti malarials

2. arsenic

3. chlorpomazine and related phenothiazines

4. phenytoin (appears like chloasma)


5

Hyperpigmentation in malignant disease

1. diffuse pigmentation in cachexia

2. diffuse slaty-blue colour due to melanoma

3. acanthosis nigricans (localised to the flexures). mild cases are frequently

seen in subjects with insulin resistance eg polycystic ovary syndrome,

acromegaly and unexplained cases.


6



There are three main types of hyperpigmentation, each of

which is categorized by their cause.

Post-inflammatory hyperpigmentation (PIH):

This occurs following skin injury from acne lesions, psoriasis, burns, friction and

even certain professional skin care treatments. It begins to fade as the skin

regenerates itself—a process that can take months or more. On the positive side,

PIH generally responds well to treatment.

Lentigines, Age Spot:

These are commonly known as age spots. Although they do become more

prevalent with age—they are found on 90% of light-skinned individuals over the age

of 60—they are not directly caused by the aging process. Rather, lentigines are

related to UV exposure. they appear mainly on body parts that are frequently

exposed, such as the face, hands and arms. They tend to be small, darkened

patches of skin

Melasma:

Melasma or chloasma , is often referred to as “the mask of pregnancy”, as it

affects 90% of pregnant women. It occurs as a result of hormonal influences such

as pregnancy and birth control pills, and causes dark and irregularly shaped areas

on the face or arms that can be quite large.It affects an estimated five to six

million women in the United States alone and can often be difficult to treat.

7

Things that can cause post-inflammatory pigmentation:

cystic acne or healing pimple

cosmetic procedures – lasers, IPL, microdermabrasion

deep chemical peels

chemical exfoliants – AHA’s and other acids

overuse of certain ingredients (e.g. Benzoyl Peroxide)

mechanical trauma – a wound that leads to a scar or discoloration

anything that causes excessive irritation



8


Hyperpigmentation treatment strategy (due to melanin), various ways:

1. Inhibit melanin production or deposits to prevent pigmentation from forming in the first place. Brightening ingredients work by blocking different steps of the melanin production pathway.

2. Remove melanin deposits by chemical means – exfoliating with AHA’s, getting chemical peels By increasing of cell turnover, which help move the melanin out of skin faster, using retinoids like Tretinoin or Retinol, brightening ingredients like Vitamin C, or a lightening agent like Hydroquinone.

3. Remove melanin deposits by mechanical means – ablative lasers which remove layers of skin, IPL (intense pulsed light) which shatters melanin pigment granules. Lasers are the best method for removing dermal pigment because they can penetrate all the way into the dermis. (Only By Dermatologist)

4. Slow down melanin production with injections (key ingredient is glutathione). (Only By Dermatologist)


9

Legal Lightening Agent (in the U.S.):

Hydroquinone (less than 2% for non-prescription, more than 2% must be acquired

by prescription in the U.S.)

Similar to Hydroquinone:

Kojic Acid (similar in structure to Hydroquinone, found in some mushrooms)

Arbutin (glycosylated form of Hydroquinone, gentler, found in Bearberry, Paper

Mulberry, Blueberry, Cranberry)

Mequinol (ether of Hydroquinone, used with Tretinoin, by Rx only)


10

Some of Other Plant-Derived Brighteners:

Licorice Root (botanical Latin name: Glycyrrhiza Glabra, may see this as Glycyrrhizate on an

ingredient list)

Glabridin (main oil-soluble compound found in licorice root)

Pine Bark (botanical Latin name: Pinus Pinaster)

Pycnogenol (main compound found in pine bark)

Indian Gooseberry (botanical Latin name: Phyllanthus emblica)

Willow Herb (botanical Latin name: Epilobium angustifolium, one of the sources of Salicylic Acid)

Cucumber


11

Some of Exfoliating Ingredients:

Azelaic Acid

Lactic Acid

Phytic Acid

Glycolic Acid

Salicylic Acid

Trichloroacetic (TCA)

Enzymes (e.g. papain, bromelain)



12

Some of Other Chemicals:

Retinoids (e.g. Retinol, Tretinoin)

Vitamin C

Niacinamide

Glucosamine

Soy (fractionated, without the estrogenic fractions, estrogen worsens melasma)

Resorcinol



13

Which Ingredients Are Effective? • There are no definitive answers on which

ingredients are most effective. But one thing is clear. To treat hyperpigmentation effectively, a blend of brightening ingredients are needed.

• The pigmentation process is a long sequence of steps. Brightening ingredients work by blocking different steps. The more steps that are blocked, the better. And the earlier the steps are blocked, the better.


14

Hydroquinone – most effective for lightening but controversial .

Kojic Acid – effective but controversial, has anti-bacterial properties

Licorice – strong tyrosinase inhibitor, 25x better than Kojic Acid, also anti-

inflammatory and antioxidant

Paper Mulberry – not a strong tyrosinase inhibitor compared with other

ingredients but has low risk for irritation and is anti-inflammatory

Azelaic acid – inhibits the growth of melanocytes (the cells that produce

pigment), a tyrosinase inhibitor, mild exfoliant, anti-bacterial

Lactic acid – a tyrosinase inhibitor, also hydrating, exfoliating, and anti-bacterial

AHA’s & Enzymes – only exfoliate skin, increasing cell turnover and ‘washing’

melanin out of skin faster, but do not target root cause of pigmentation

Vitamin C (L-Ascorbic acid) – good for providing overall radiance and brightening

Phytic Acid – works by blocking oxidation in the melanogenesis process

Retinoids – suppress melanosome transfer during the pigmentation process,

increases cell turnover and exfoliates skin so that melanin is removed from skin

faster



15

a brief review of hyperpigmentation treatment strategy in cosmetic field dr. mohammad baghaei

Education