Pigmentation, LHE and combination treatment

Kuala Lumpur, 20 Sept 2012

In Southeast Asia, having a brilliant fair is the in thing. 4 out of 5 skincare service providers surveyed said that evening out their customer’s skin tone us the top request with whiten the dark pigmentation a close second. Let us first understand pigmentation which is close related to the two popular treatments.

What is pigmentation / hyperpigmentation: Pigmentation / Hyperpigmentation is a common skin condition, where some areas or patches of skin turn darker in colour. It is usually a harmless condition, caused when there is too much of the pigment, melanin, on the surface of the skin. This condition can affect people of all races.

Pigmentation has 2 main forms, hyperpigmentation and hypopigmentation which both have several symptoms. They are both common and usually harmless, but can often be embarrassing. Hyperpigmentation

Hyperpigmentation is where patches of skin become darker in colour than normal, healthy skin. This darkening often occurs because there is an excess of melanin, which forms deposits in the skin. Melanin is the brown pigment that produces our normal skin colour. Hyperpigmentation can affect the skin colour of people of any race. Here at the Pigmentation Clinic, we have years of experience treating clients of all ages and races, achieving successful results. In Asia, this is the biggest business driver for the skin care business.

Hypopigmentation

Hypogigmentation is caused by the reverse process of hyperpigmentation. Hypopigmentation is the result of a reduction in melanin production, causing patches of skin to become lighter than the surrounding skin. 3 common types of hypopigmentation and pigment loss are sun damage, vitiligo and albinism. If you’ve had a skin infection, blister, burn, or other trauma to your skin, you might have a loss of pigmentation, in the affected area. The good news with this type of pigment loss is that it’s frequently of a temporary nature, but it might take a long time to re-pigment. Vitiligo causes smooth, white patches on the skin. In some people, these patches can appear all over the body. It is an autoimmune disorder in which the pigment-producing cells are damaged. There is no cure for vitiligo, but there are several treatments, including cosmetic cover-ups, corticosteroid creams, or light treatments. Albinism is an inherited disorder caused by the absence of melanin. This results in a complete lack of pigmentation in skin, hair, or eyes. People with albinism have an abnormal gene that restricts the body from producing melanin. There is no cure for albinism. People with albinism should use a sunscreen at all times because they are much more likely to get sun damage and skin cancer. This disorder can occur in any race, but is most common among Caucasians.

The different types of pigmentation:

Melasma
Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip. Melasma usually occurs in women, with only 10% of men being affected. Often women who take birth control pills or have an IUD fitted, develop this type of pigmentation. It can become more prominent if the skin is exposed to sunlight and often worsens during the summer months. Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip. Melasma usually occurs in women and women who take birth control pills often develop this type of pigmentation. Only 10% of those affected are men. The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.

Chloasma
Some pregnant women overproduce melanin and develop a condition called Chloasma or the "mask of pregnancy", on their faces or occasionally on their abdomens. Again this can cover a relatively large area and may worsen after sun exposure. Some pregnant women overproduce melanin and develop a condition called Chloasma or the "mask of pregnancy", on their faces or abdomens. This can cover a relatively large area and may worsen after sun exposure.

Solar Lentigines (Sun Damage).
Age spots, sometimes called 'liver spots', are a form of pigmentation. They usually occur as a result of damage to the skin, from the suns rays. These are often referred to as solar lentigines. The small, dark spots are generally found on the hands and face, but any area exposed to the sun, can be affected. Age spots, sometimes called liver spots, are a form of pigmentation. They usually occur as a result of damage to the skin, from the suns rays. These are often referred to as solar lentigines. The small, dark spots are found generally on the hands and face, but any area exposed to the sun, can be affected. Exposure to the sun’s rays and a daily onslaught of environmental elements such as air pollution and the toxins in our food, all wreak havoc on our skin, damaging cell walls and connective tissue. This results in the visible signs of aging we see in our skin. Skin can look dull and lack lustre, pigmentation and age spots start to appear and wrinkles become more prevalent. The way our skin responds to UVA and UVB damage, is partly due to our genetic make-up but is also greatly influenced by the way we have treated our skin over the years. Excessive sunbathing or sunbed use can have a dramatic effect on the way we age.

Ephelides (Freckles)
Freckles are also common and usually a hereditary skin blemish. Though freckles are often thought of as attractive, some people do seek out treatment to reduce them.

PIH
PIH or post inflammatory hyperpigmentation. This type of pigmentation usually occurs after some type of injury to the skin. It can commonly occur after acne spots or other skin lesions, after traumatic skin treatments, such as inappropriate or overly aggressive laser or after over use of some skin products. PIH or post inflammatory hyperpigmentation. This type of pigmentation usually occurs after some type of injury to the skin. It can commonly occur after acne spots or other skin lesions, after traumatic skin treatments, such as inappropriate or overly aggressive laser or after over use of some skin products.

Dark Eye Cirlces:
There are two types of pigmentation that occur around the eyes.

Melanin basicsDark-skinned people have more melanin than light-skinned people. Melanin, which is produced by cells called melanocytes, is also your body’s natural sunscreen, protecting the skin from ultraviolet light. Suspect number one: the sun! You can’t feel it happening, but ultraviolet rays stimulate melanocytes to produce more melanin. As more melanin is produced, the skin gets darker (hence, you get tan). Hyperpigmentation occurs when the body produces too much melanin, causing dark spots and patches to pop up or making existing freckles and age spots look even more pronounced. Minimizing the chances and effects of hyperpigmentation means practicing smart sun safety: Limit the time you spend in the sun, wear protective clothing, including a wide-brim hat and sunglasses, and use a broad-spectrum, water-resistant sunscreen with a minimum SPF of 15 (though 30 or higher will offer better protection) year-round.

inflammation, which typically occurs when skin is injured by a cut, scrape, burn, or chemical exposure or by acne, eczema, or psoriasis. It’s not the wound itself that’s the problem but rather what happens during the healing process. As the wound closes, you may experience postinflammatory hyperpigmentation, in which the area around the injury turns dark, like a scar. This discoloration can last for months or years or may even be permanent. Early treatment of the original injury is the best method of prevention, but there are steps you can take later on to try to fade the spot, such as chemical peels, microdermabrasion, and skin lighteners. Keep in mind that postinflammatory hyperpigmentation is more likely to affect people with darker skin than those with fair skin and that sun exposure will likely make matters worse.  Hormones: any woman (and some men!) will tell you that hormones can cause all sorts of weird stuff to happen in your body. We’re particularly prone to hormonal fluctuations during pregnancy, when taking birth control pills or undergoing hormone therapy, or during certain illnesses. One such hormonally produced phenomenon is melasma, a common pigmentation disorder that typically occurs during pregnancy. Like postinflammatory hyperpigmentation, melasma (also known as the mask of pregnancy) is more likely to affect people with darker skin tones and tends to appear on the cheeks, nose, forehead, chin, and upper lip in brown or grayish-brown patches. Don’t panic if the mask pops up on you — melasma typically disappears after pregnancy (or the discontinuation of birth control pills). If it doesn’t, your dermatologist can treat it with topical steroid creams, skin lighteners, chemical peels, or laser treatments.  Illness and Medication is also another trigger that causes Hyperpigmentation. These are usually triggered by autoimmune and gastrointestinal diseases, as well as metabolic disorders and vitamin deficiencies. Plus, there are a number of medications known to cause hyperpigmentation, including certain hormone treatments, antibiotics, antimalarial drugs, antiseizure drugs, antiarrhythmics, and others. Talk to your doctor about the potential side effects of any drug you take, and be extra careful about sun exposure while taking medication.

Melanocytes are melanin-producing cells located in the bottom layer (the stratum basale) of the skin's epidermis. Melanin is the pigment primarily responsible for skin color.

Through a process called melanogenesis, these cells produce melanin, which is a pigment found in the skin, eyes, and hair. This melanogenesis leads to a long-lasting pigmentation, which is in contrast to the pigmentation that originates from oxidation of already-existing melanin. There are both basal and activated levels of melanogenesis; in general, lighter-skinned people have low basal levels of melanogenesis. Exposure to UV-B radiation causes an increased melanogenesis. The purpose of the melanogenesis is to protect the hypodermis, the layer under the skin, from the UV-B light that can damage it (DNA photodamage). The color of the melanin is dark and it absorbs all the UV-B light and it blocks it from passing the skin layer. Since the action spectrum of sunburn and melanogenesis are virtually identical, they are assumed to be induced by the same mechanism.[7] The agreement of the action spectrum with the absorption spectrum of DNA points towards the formation of cyclobutane pyrimidine dimers (CPDs) - direct DNA damage. Regulating melanongenesis is the key to treating pigmented lesions.

Treating Pigmented lesions.

Ablative treatment solutions include dermal abrasion, deep chemical peels and laser skin resurfacing. However, there is significant down time associated with these methods and the post treatment complications can make the cure worse than the disease. Non-ablative light based therapy methods are gaining increasing popularity as they are successful removal of pigmented lesions using either non-ablative Laser or Intense Pulsed Light (IPL) systems. Light emitted by these systems selectively targets melanin in pigmented lesions subsequently causing heating of the lesions to the coagulation point of 70-75 ºC causing their disappearance . Normal tissue contains much lower melanin concentration than the targeted lesions and is therefore not damaged. Most non-ablative Laser or IPL systems require large cooling devices to protect the epidermis from burn. This renders the systems too heavy to be portable. Additionally, the practitioner must be skilled in both operating the system and in use of the skin cooling device to ensure the treatment safety. Therefore,the development of compact systems that are simple too operate and safe was desired.

Light and Heat Energy (LHE) based technology joined the arena of non-ablative light based systems used for skin rejuvenation in 2000. The LHE family can roughly be divided into three classes mLHE (modified LHE), sLHE (specialized LHE) and xLHE (eXtended LHE for multiapplication). The sLHE  and xLHE were introduced for pigmented and superficial vascular lesions treatments. The LHE LUA (Light Unit Assembly) contains two tube of flash lamp that emits broad spectrum light of 400-1200 nm. In contrast to lasers and IPL systems that suppress the heat by using various cooling methods while LHE uses dual light to achieve similar penetration depth at lower fluency. LHE uses the same principle of selective photothermolysis to cause a thermal insult on the selected cell structure triggering the body’s wound healing mechanism. LHE also has a special property. The heat opens up the pores, allowing desired products to penetrate easily into the skin. This delivery mechanism reduces the need to use large quantity of products in order to penetrate the dermis. Clinical and field studies have shown that LHE when used together with cleansers, ampoules containing Vitamin C and Arbutin, is effective in lightening the lesion.