Hyperpigmentation

Hyperpigmentation is the most common and distressing condition afflicting people in Western countries.  Hyperpigmentation is defined as the darkening of skin or nails caused by an increase in melanin production, the substance in the body that is responsible for color or pigment.  The major cause of hyperpigmentation is exposure to the sun, but other conditions may cause an increase in melanin production such as pregnancy and Addison's disease (decreased function of the adrenal gland).  Certain drugs may cause an increase in melanin production such as antibiotics, antiarrythmics, and antimalarial medications, and others. 

One example of hyperpigmentation is called melasma, also known as chloasma, which is characterized by brown patches usually occuring on the forehead, temples, and cheeks.  Melasma can occur in pregnant women and in women who are taking oral contraceptives and is sometimes called the "mask of pregnancy", but it can occur in men as well.  Melasma is more common and lasts longer in people with dark skin.  Another example of hyperpigmentation is lentigines which are also called "liver spots" and they typically occur on the face and back of the hands.   Lentigines are flat brown spots that are oval in shape.  Chronic sun exposure is the major cause of solar lentigines.  Middle age is typically the first time lentigines are noticed and they increase in number with age.  Lentigines are an independent risk factor for melanoma even though a progression from lentigines to melanoma has not been established. 

The topical treatments for hyperpigmentation consist mostly of chemicals that inhibit the enzyme tyrosinase, which forms pigment.  Some of these chemicals used to treat hyperpigmentation are hydroquinone, kojic acid, vitamin C, azelaic acid, and arbutin.  Hydroquinone has been under scrutiny for its mutagenic effect and its ability to darken the skin after prolonged use.  It is banned in Japan and the European Union.  Kojic acid was discovered by accident when scientists in Japan were fermenting malted rice to make sake and kojic acid was a by-product.  Azelaic acid which is found in wheat and barley is a weak inhibitor of tyrosinase so a high concentration, such as 15%, is needed to produce lightening.  Arbutin is purified from mulberry or bearberry extract and is almost chemically identical to hydroquinone with the addition of a sugar molecule. Once it comes in contact with the skin the sugar is cleaved and hydroquinone is slowly released.  Arbutin takes a few weeks longer to work than hydroquinone, but it causes less irritation.  Vitamin A derivatives such as retinol, alpha hydroxy acids, and beta hydroxy acids are often used in conjunction with lighteners because they increase skin cell turnover which in turn speeds the removal of pigment granules. Niacinamide is also an effective skin lightener.  Its mechanism of action is unrelated to the enzyme tyrosinase.  Niacinamide prohibits the transfer of melanosomes (the pigment containing organelle) to skin cells inhibiting the production of discolored cells.

All of these treatments require two to three months before results can be seen so patience is needed.  Your expectations should be reasonable since these products will lighten but not erase the spots.  They are most effective in light skinned people.  Lighteners can make the skin more sensitive to the sun so a sunscreen is required while using skin lightening products.   Sunscreens are the first defense against skin aging in general, but particularly to prevent hyperpigmentation so start using sunscreens today to protect your skin for tomorrow.

The Science of Aging Skin

Aging begins at the moment of birth, but that fact is far removed from our conscience during our younger years. Biologically the skin changes as we age beginning as early as our twenties. The average skin cell takes about 28 days to reach the surface of the skin to be sloughed off, but as we age this process begins to slow down which in turn decreases collagen and elastin production producing skin that is loose and saggy. This decline in cell turnover also creates rough skin with an uneven appearance and dry texture. The true struggle for aging skin typically begins in the 40's with the onset of menopause for women. The lack of estrogen within the skin causes both a decrease in suppleness and thickness of the skin, but perhaps the most profound effect of decreased estrogen is the increase in unopposed action of testosterone. This increased action of testosterone creates an increase in facial hair and larger pores. The sebaceous gland secretion is controlled by estrogen so without it secretion is increased resulting in the return of acne. Hormone replacement therapy has a positive effect on the skin even for women whose loss of collagen is only slight.  A physician skilled in hormone replacement therapy can best determine whether hormone replacement therapy is correct for you.

Lifestyle choices are an area that we can control and these choices have a major impact on how we age. Sun tanning hastens the breakdown of collagen and elastin leading to thinner skin and the formation of wrinkles. Smoking is another lifestyle choice that accelerates the aging of skin. Smoking restricts blood flow so vitamins and oxygen are not delivered to the skin. Our skin is protected by the supply of vitamin A and the absorption of vitamin C, but smoking reduces these processes. Smoking increases the production of enzymes that breakdown collagen thus decreasing skin's firmness. Smoking is a leading cause of skin aging as evidenced by the wrinkles surrounding a smoker's mouth. Lack of sleep slows down the repair process that naturally occurs as we sleep leaving our skin dry and wrinkled. Improper skin care using soaps that leave the skin feeling tight and dry ages the skin as well. The proper cleanser should be at a pH around 5.5 to closely mimic the skin's natural balance. Proper skin care treatments include moisturizing products that contain proper nutrition for the skin. Finally, eating a healthy, balanced diet filled with vitamins, minerals, and antioxidants protects the skin and enables it to repair and maintain itself.

Using products that contain the most effective ingredients such as glycolic acid, retinol, peptides, and vitamin c among others is the best tool in fighting the aging process. Combining effective products with professional facial care will generate the best benefits for your skin as you age. It is never too late to start a skin care program, but the earlier you start the better your skin will age. Start today making favorable lifestyle choices combined with high quality products and your skin will benefit.

Cellulite

Cellulite ... known as orange peel skin, cottage cheese, or dimples, cellulite does not single out any one body type, skin tone or texture. Cellulite is seen in 80-90% of women where as men rarely have cellulite. Researching the 10-20% of women who are cellulite free will no doubt elicit tremendous understanding for the prevention and cure of cellulite. Surprisingly to many weight is not a factor in the development of cellulite. Cellulite is an extremely misunderstood condition with many myths surrounding its prevention and treatment. Females are plagued with cellulite much more than men due to higher estrogen levels. A basic biological function of cellulite is to breakdown collagen or the component of the skin that provides strength. Fat distribution in women is seen in the thighs, buttocks, and hips where cellulite is commonly seen. Although, cellulite is not considered a medical condition, many women are uncomfortable with its appearance.

The skin is connected to the underlying muscle by fibrous cords. These cords connect the skin to deeper structures with the fat cells lying in between . The cords pull the skin down, but as the fat cells accumulate they push up against the skin creating the dimpling effect seen as cellulite. It is commonly seen in families so a strong genetic component is definitely a contributing factor for developing cellulite. Even though weight is not necessarily a factor in cellulite development, maintaining a normal weight will decrease the appearance of cellulite. Also, increasing muscle tone will lessen the appearance of cellulite as well. Liposuction is not an alternative for cellulite treatment and may actually increase its appearance. According to a study recently published in the Aesthetic Surgery Journal, cellulite may be improved with a combination of laser treatment and fat transplantation. Laser treatment on the affected area proved to tighten the skin by stimulating collagen production and on a deeper level the laser proved to reduce fatty tissue. The fat from the patient was transplanted by injection into the dimpled areas to plump the skin. This was a small study, but had promising results. More research will be performed to obtain final conclusions. Unfortunately, there are not really any effective topical treatments for reducing cellulite. The best treatments contain collagen building ingredients such as Retinol and Vitamin C, but it takes several weeks to see any benefit from these products. Much research is being done in the cellulite fight so keep informed for the latest innovations. Since the public is clamoring for an effective cellulite treatment, researchers are bound to find something to alleviate this unsightly condition.