Posts Tagged ‘hyperpigmentation’

FrecklesIts back on shelves!  Tri-luma, the turbo powered skin lightener is now available after a more than an 18 month disappearance.  There was no FDA recall or explanation from the company.  Nothing.   I discovered that compounding pharmacies could make it up for individual prescriptions, but that option  was just not widely  available.  Then,  without fanfare  or explanation,  Tri-luma  was back– and I’m delighted. 

 How Tri-luma Works

This prescription- only skin lightener  contains three active ingredients:

1.  Tretinoin ( aka Retin A) is famous for its ability to speed up cell growth and exfoliate darkened areas.

2. Hydroquinone which prevents melanin production and is considered one of the most effective  weapons in the  anti- hyperpigmentation tool  kit

3.  Mild corticosteroid to keep  things calm.  Both Retin A and  hydroquinone can be irritating.  Enter  a  mild steroid.  It allows the skin brighteners to do their job  while keeping the skin calm and comfortable

While Tri-luma can be used over the entire face, I needed it mainly  to lighten my dark under eye shadows.   Plain Retin A  is too irritating to be used on delicate under eye areas but mixed with a steroid it can  address  skin darkness without causing more  problems.

Tri-luma was one of the first anti-aging tools I used and I loved the way it lightened  my long standing  dark shadows.  However while plain RetinA can be used continuously for years, most  doctors recommend using  Tri-luma  only for three montha at a time.   The treatment period  should be followed by a three month  Tri-luma holiday and then the  product can be used again for another three months.  To keep it fresh and effective, pharmacists recommend keeping it in the refrigerator.

There is a whole buffet  of skin lighteners including kojic acid, arbutin and soy extract, but Tri-luma  is often the product of choice.   It represents the new thinking about  medical treatment.  Rather than a single  solution to a problem , researchers are looking at different targets  for treatment.  In the case of  hyperpigmentation,  some skin lighteners like retin A a can help the skin shed darkened skin cells while  while ingredients like hydroquinone  can break up existing  melanin.  Combining them in one product can be much more effective than used spearately.  Since Kojic acid seems to prevent melanin production, I would love to see a  product  that combines all four ingredients.  There are so many me-too  products, it would wonderful to see a formulation that uses all of the science  we  now have about treatmenting dark patches and spots.


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QandA3Question: My chest does not match my face. It’s  discolored with brown, white  and red patches.  I’ve tried moisturizers with vitamin C, skin brighteners with Kojic acid and even broke down and bought  hydroquinone to lighten the skin.  Nothing worked.  Do you have any suggestions?

Answer: I have received  several very similar questions and I  finally  have a good answer.  The Woman’s Dermatology Society arranged for me to  interview  Dr Tina Alster,  the internationally  acknowledged expert in laser dermatology to discuss the best way to deal  with  a discolored  chest or decollete.    According  to Dr Alster, the technical term  for the problem is poiklioderma.  Caused by unprotected sun exposure, its a mash-up of  hyperpigmentation ( brown spots),  hypopigmentation ( white areas), swollen blood vessels ( reddened skin tones), and damaged collagen ( wrinkles).  The UV rays  can lead to this permanent bronzing.While a standard vacation  suntan usually fades by the time you have unpacked,  thus type of hyperpigmentation stays darkened throughout the year. 

If the discolorations are fairly  mild (  often seen under age 30), they may respond to  a series of  office based glycolic peels.  This is not the milder 10% peels that you can buy at the cosmetics counter.  These are the 50- 70% peels that are available in a doctor’s office.  They are adminstered by a  nurse and physician.  This  strong  glycolic  solution is  dabbed on the  chest and allowed to reamin for 5-10  minute. Then a neutralizer is applied to restore normal PH to the skin.

Lasers to the Rescue

   More  pronounced poiklioderma mottling responds beautifully  to a series of Fraxel or IPL laser treatments. Because  chest bronzing is made  up of four different problems, Dr Alster uses the Fraxel Dual in two different wavelengths to treat both white and dark patches as well  as encourage new collagen growth.  To  deal with the redness, Dr Alster may also use  pulsed dye laser or  IPL.     Fraxel will leave the skin bright red and a little sore for 48 hours.  Use a mild cleanser like Cetaphil and moisturizer  like CeraVe   to reduce discomfort and  peeling.   If the skin seems  super dry   you can dab on  a light  layer of Aquaphor.  If the sorenss persists for more than 2  days,   Alster may recommend a mild steroid cream to reduce inflammation.  Whatever therapy is used,  it must be accompanied by an iron bound committment to use a 50SPF sunscreen such as SkinCeuticals Physical Defense SPF50  for both the  chest  and neck.    Freckles and dark spots  have a powerful memory  and unprotected sun exposure will trigger their return.

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 QandA3-smQuestion:   I’ve tried just about   everything for acne.  I wanted  to try Retin A but   my  doctor  gave me a prescription for Azelaic acid.  Do you think it could help or should I  go to a doctor to give me what I want?

Answer:   Azelaic is one of the newer  acne fighters.   It is found  on a yeast that lives on our skin and  is a natural  anti-inflammatory compound.    It is a triple threat against acne– kills bacteria that provoke  breakouts, decreases the growth of  pore clogging keratin and reduces irritation.   But wait there’s more.  Azelaic acid is effective for  lightening  dark  spots and melasma because it inhibits  the production of melanin.  It  is especially  effective for  darker skin  tones because it avoids  the  problems of irritation  of Retin A and Benzoyl Peroxide.   Azelaic is also  prescribed  for   types of  rosacea breakouts that  resemble  acne eruptions.  Finacea is a 15% Azelaic gel that has been a pproved   for both  mild to moderate acne  and rosacea.

You can also find azelaic acid in over the counter products, but usually the concentration is not listed on the label.  One excellent  example where the this info is  available  is  Acne Gel from PCA Skin that contains 5% Azelaic Acid and 2% salicylic  acid ( Its available online from The Derm Store).  You can also try  to get the  azelaic acid levels in a product by writing to the manufacturer.

One final thought:  Azelaic acid  works for  less severe acne.  If you have  cystic and/or  hormonal acne, Azeleic alone will not get the job done.

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QandA3Question:   Can  Arbutin  help my  acne?

Answer:  Found in both the mulberry and  bearberry  plants, arbutin  is known not  for acne care  but for its ability to lighten skin discolorations.   Arbutin acts by inhibiting production of tyrosinase , the enzyme that promotes  melanin.  In short, less tyrosinease, less melanin.  Keep in mind that Arbutin  converts to hydroquinone in the body, so if you wish to avoid hydroquinone, arbutin is not the lightener  you want.

Arbutin does not directly deal with  the forces behind acne.  However, it may be useful to lighten  darkening or hyperpigmentation that can develop after breakouts.   While laboratory studies  indicate that  arbutin can reduce melanin production it is   often not possible to determine how much  arbutin  is used  in a commerical, non-prescription  products.  With active ingredients like zinc oxide  or salicylic acid, the concentration is listed on the label.  Without this information, you cannot  judge how strong or how weak  an arbutin product is  before you buy it.  With arbutin, this info is just not provided on the package.   Arbutin is often called mulberry extract and the amount of this ingredient is also  not stated on the label.  Like most skin lightening formulations, arbutin is usually combined with other skin brighteners including Kojic acid and even hydroquinone.  

Like most lightening  ingredients, arbutin  has to be used for at least six weeks to see a difference.  Most  work by inhibiting new melanin production so you need to slough off the old darkened  cells before the slow down of melanin will make a visable difference. And whenyou use a lightening agent,  its absolutely imperative to use an effective SPF50 sunscreen to prevent new melanin production.

And to get back to  your original acne problem. You need to look for products that contain proven, measured anti-acne ingredients eg salicylic acid and benzoyl peroxide. You also want to avoid products with  acne triggers such as mineral oil, shea butter, beeswax and lanolin


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While I cover many anti-aging tools, I get so  many questions about Retin A,  I decided to do  a post  covering  the Five Top Questions.  This actually increased the number of questions  that I posted a free, four page  PDF  guide to Retin A.    Retin A Road Rules covers  the basic issues such as  how it works and  who should use it.  The  guide continues with  a step by step program  for  incororating  Retin A into a daily skin care.  For example  to avoid  irritation and flaking you need to wait at least 20 minutes between the time you wash your face and when you apply Retin A before bedtime.  Road Rules also includes a complete  review of the six different types of Retin A , including the pros and cons of each and  how to choose the right one for your type of skin.

Right now you can download the free guide by liking my Facebook Page.  At the start of 2013, I will replace  Retin A Road Rules with  The No-Nonsense Guide to Dark Spots and Splotches.  It  will  look at the causes of different types of hyperpigmentation, and explain  how to even  out skin tone.  The free four page PDF will explore different options including  lasers, IPL, hydroquinone,  Kojic Acid and licorice root.  And it will look at which popular  skin lighteners are  a waste of money  as well as those that can cause more discoloration and scarring.  

Questions  about hyperpigmentation are second only to interest in Retin A.  When I started my anti-aging  journey my first step was a date with a laser to remove larger age spots and freckles.  I’ve used IPL to erase small freckles and   Triluma to lighten under eye circles.  Next week I will be trying out a new type of low level  laser called Clear and Brilliant.  This  device   can be used on the body and is wonderful for dealing with hypigmentation  and sun damage on the chest.  It was featured on Dr Oz, but the show did not reveal before and after results.  I’ll be posting  photos of the entire process — the  good, the bad and hopefully the beautiful.

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This beautiful spring morning the host of Fashion  Flash is Jodell of Black Cat Plus.  Not only does Jodell discuss the  plus size fashion tips, she is now an e-tailer of some of the top clothing brands.   My cousin lives in an area where choices in plus size fashion is very limited.  She could  find the basics, but for  anything aboove that it was a struggle.  Now with Black Cat Plus she can find clothing  she loves, not something she has to settle for.

And when you’ve finished looking through  all the  dynamic Fashion Flash sites,  check out  Brown Skin by Susan Taylor MD.   A Harvard trained dermatologist, Dr Taylor provides a culturally sensitive, comprehensive  guide to  skin care for women of color.  African American, Hispanic and Asian skin has the ability to naturally resist aging, but is vulnerable to problems of too much  or too little  pigmentation.  This can cause different types of dark  or light patches such as hyperigmentation, melasma, and vertiligo.

I get  many questions from the Phillipines  asking about safety of Retin A  and IPl for darker skin tones.   Brown Skin   provides the best explanation of  what causes these skin  color changes and how to treat them.  For example for the first time I learned that  pigmentation can occur both  in the epidermis, the upper  layer of the skin and  in the dermis, the lower layer.  The brown pigments in the upper layer  can usually be treated successfully, but the black pigments deep in the dermis are much  more difficult to manage.  This is important because overly aggressive treatment can actually  make hyperpigmentation worse. For Dr Taylor all women of color MUST wear sunscreen, no so mucht to avoid aging, but to prevent dark spots and patches. 

Brown Skin also has great targeted advice on acne prevention and treatment.  And again its important to tailor  any acne program to avoid irritation which can produce darkened areas.  For example   one type of popular antibioitic, Minocycline, used for acne control can actually increase pigmentation.

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Kojic Acid  has been around for almost  100 years.  It was originally discovered by Japanese scientists  who were working on different fermenting methods  to turn malted rice into sake.  As the story goes, the scientists noticed that spots and freckles on their hands disappeared after working with Sake production.  Kojic Acid has been a popular Japanese beauty aid for generations.  In recent years we’ve learned that Kojic Acid acts somewhat  like hydroquinone by preventing melanin  formation.

Research has shown that Kojic Acid can be effective but it has its problems.  On the one  hand it tends to be unstable and high concentrations are often needed to be an  effective spot buster.  On the other hand, Kojic can be very irritating and is known  to cause allergic reactions.  Often the best solution is to combine lower concentrations of Kojic acid with other skin lighteners like soy or hydroquinone.

If you want to try Kojic acid skin lightening creams, make sure you do a little patch test on your arm before slathering it on your face.

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