Posts Tagged ‘melasma’

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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 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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Q&A2Question: I am a 45 year old South Asian women. I now live near Chicago  and the weather is  usually  grey and very cold.  My cousin says I still need to use a sunscreen and I think its unnecesary  at this time of year.  Who is right?

Answer: Umm, I tend to stay out of family arguments, but  in this case I have to say your cousin is right.  The UV rays are  hitting our skin all year  round.  While  your melanin rich complexion  provides protection from sun aging and skin cancers,  even weak UV rays  can  provoke  unwanted patches of darker pigmentation known as hyperpigmentation or melasma.    Brown spots and splotches  are an increasing problem  for  skin  of color.  Rather than spend a good part of your beauty dollar on  products that promise to  brighten and even out the skin tones,  prevent hyperpigmentation by investing   in a sunscreen with at least a 30SPF.  In summer a 50SPF is  even better.

Virtually every dermatologist  I  speak to makes sun protection for everyone  their main focus– and they dream of the day when its as automatic  as brushing  your teeth.  Because its so essential for skin health and beauty, its key is choosing the right sunscreen for your skin.  If you have dry skin, a good sunscreen can   boost  hydration.  However if you have oily  or acne prone skin,   the wrong sunscreen can increase  skin problems.  For  best results,  look for  oil free forumulation that provide physical sun protection with zinc oxide or titanium dioxide.  The chemical sunscreens like avobenzone and Mexoryl are effective  but can be irritating– and this irritation can provoke moremelasma and hyperpigmentation  in women of color.  Not what you are looking for.

Use the sunscreen every day  on your face, neck and hands.    There has been  alot of discussion about how much  goo you should put on.  I’ve tried out the   often quoted recommendation of one tablespoon  per face and the results were both funny and disturbing.    To keep up sun protection during the day, use a mineral based powder  like Brush on Block ( $30, free shipping)or Colorerscience ( $50, free shipping).

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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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Tri-luma was a popular combination of tretinoin ( the generic name for Retin-A), hydroquinone  to lighten the skin and a medium strength steroid  by the name of flucinolone. The tretinoin  would hasten skin growth and exfoliation to shed darkened skin; the hydroquinone would  decease melanin production and the steroid would avoid redness and swelling from the other two turbo driven ingredients. It worked  well  for my under eye shadows and was the go to-product for brown patches  known as melasma.

It would take  at least three weeks  to see results  for Tri-luma, but when it worked, it WORKED.  You had to be complusive about sunscreen using at least a 30SPF during and after Tri-luma  since  the ingredients increased sun sensitivity to the sun.Then one  day Tri-luma seemed to disappear from pharmacy shelves.    THere was no FDA recall, no  clear statement from the manufacturer.  Nothing.

Then I started hearing rumors  on the web  that specialty  pharmacists could compound it individually for their customers who brought in a  prescription from their dermatologist. I asked my go-to dermatologist Dr Albert Lefkovits  about the idea and he was wonderfully supportive.  It turns out that the   Tri-luma formula was actually  developed by Albert Kligman, considered  by many  to be the father of cosmetic dermatology.

Dr Lefkovits made a slight change  in the Kligman formula substituting a  milder steroid called desononide.  One of the concerns about Tri-luma was  the strong steroid could cause  thinning of the skin and lead  to the development of rosecea.  Using desonide takes down the risk of these problems.

I never had a personally compounded product before  and I was excited to pick it up at Caligor pharmacy in NYC near Bloomingdales.   The small elegant store  had  it ready for me.  Rahter than a tube, the custom compound was in a small jar.  The pharmacist suggested that I keep it in the frig  to maintain potency.  What a good idea. I had noticed that my $300 tube of Tei-luma soon turned yellow and started to small like rotten eggs. 

The strange smell  was due to the deterioration of the sulfite preservative  and was so aunappealing I stopped using  the tube when it was still half full.  Refrigeration will stabilize  the formula so I’m hoping to be able to use it to the last drop.  Oh, and the best part?  My own personal Tri-luma like cream was more than $100 less than  the brand name product. Let the bleaching games begin.

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Question:  I have heard so  many horror stories about IPL, but you had great results.  Can you tell me what machine was used and at what settings?

Answer:  I had IPL with Dr Ellen Marmur of Mount Sinai School of Medicine, so I  asked  her to answer this question.  Dr Marmur used the Luminis IPL with two handpieces– the 560nm and the 590nm.   “Both  of them focus on red spots, blood vessels and brown freckles”  she explained.  “The treatment settings vary from patient to patient based on skin color and the amount of the target to be removed.  For example, I use  lower settings for freckles to avoid over-heating the skin.’    Dr Marmur also warned against getting IPL when tanned ”   You need to avoid the sun for at least wo weeks prior to IPL treament ” she warned.

IPL Road Rules

IPL or Intense Pulsed Light is a form of light that is related to laser technology, but  far less invasive.  It operates in the top layers of the skin and can remove unwanted hair, small red lines and spots as well as freckles,brown spots,  and dark patches.    It is practically painless, and leaves the skin a bit red rather than burned and oozy like true lasers.

But there are reports of problems with IPL.  Because the light focuses on pigments in melanin,  women  with darker complexions are most at risk of developing irregular pigmentation.  Even  dark olive complexions  should  proceed cautiously with IPL. 

Choosing  the right setting, device and timing of applications is a learned skill.  I met Dr Marmur though a smart, well-connected  friend  and I have found this type of one to one reccomendation is a great  way to getting  someone  you can trust.  I would also check out  a doctors credentials  to be certain that they have the training they need  to  give you healthy,  beautiful results. For more info on IPL you can also check out an earlier post IPL- Five Top Questions.

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