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June - July 2006
Health
The Perfect Skin Lightening Programme
by Shashi Gossain B.Sc (Hons), MRPS, Member
A flawless, fair and a radiant complexion has always been desirable amongst Asians for many centuries.
Hyper pigmentation
is a very common skin problem which is particularly prevalent amongst the
Asians. Dark patches and spots, called chloasma or melasma can be quite distressing
for some individuals, particularly in cultures where a fair complexion is
valued as a sign of health or beauty.
Hyper pigmentation may occur due to birth control pills, pregnancy, hormonal
imbalance or any other kind of trauma e.g. due to reaction from certain drugs
and skin injury. Exposure to UVB light of the sun leads to skin discolouration
called solar lentigenes, also known as sun or age spots.
The result of all the above leads to sight- specific increased production of
melanin. Melanin is a coloured pigment of the skin and is formed by melanocytes,
a process controlled by an enzyme called Tyrosinase. In order to select the
best treatment for this hyper pigmentation the extent and the depth of the
pigmentation should be studied.
If the hyper
pigmentation is in the epidermis, it can be helped with some skin lightening
products. If the pigment is deeper laser treatments and other combination
treatments should be considered. The treatment hyper pigmentation in Asian
skin is particularly challenging due to the inherent differences of the Asian
skin structure.
DIFFERENCES IN ASIAN SKIN
OBSERVATION OF THE ASIAN SKIN
ü Less wrinkling and sagging due to photo protection by melanin
ü Greater numbers of hyper pigmentory spots
ü Greater scarring of spots
SCIENCE
ü Asian skin has a more compact surface layer of skin, stratum corneum
ü Asian skin has higher levels of Protease Activated Receptor 2 (PAR2),
which signals the production of melanin in the melanocytes.
ü Asian skin has larger sized melanosomes which are melanin containing
packets made by melanocytes and taken up by the surface skin cells. The larger
size makes the degradation and dispersal much slower than the smaller melanosomes
found in the white skin.
ü Asian skin produces more melanin in response to UVB light than most
white skin
ü PAR2 is present on the surface of keratinocytes i.e. keratin containing
skin cells. PAR2 makes the keratinocytes engulf melanosomes produced by melanocytes
thereby giving colour to the skin cells.
SKIN LIGHTENING AGENTS
There are several de-pigmenting agents available but very little published
clinical evidence to support the effectiveness in most of them.
KOJIC ACID
Kojic acid is derived from various fungal species. It is a tyrosinase inhibitor
thus stops the production of melanin. Kojic acid can be used in concentrations
of up to five per cent twice daily as a safe skin lightener.
HYDROQUINONE
Although a good skin lightening agent, it can cause skin irritation and unpleasant
side effects. For this reason hydroquinone has not been licensed in the UK
unless under a supervision of a doctor.
SUN SCREEN
A daily use of a good sun screen of a SPF 25 should be used to allow some natural
repair to occur as well as a protection from further photo damage. Sun exposure
is one of the highest causes of hyper pigmentation and using any kind of skin
lightening or laser treatments without a sun screen are a total waste of time.
LASER TREATMENTS
Hyper pigmentation deep in the dermis cannot be treated by creams and more
drastic procedures e.g. chemical peals or laser treatments have to be carried
out. Laser treatments are not particularly suited to the darker skins and the
results are not consistent.
TRETINOIN
This is less effective than Kojic acid and can take far longer before an improvement
can be seen. However it improves the skin cell production, collagen production
and elasticity.
ALPHA HYDROXY ACIDS
Alpha hydroxy acid peals can remove some skin discolouration. It is quite a
lengthy and traumatic procedure and can only be performed by doctors who are
trained in this field.
AZELAIC ACID
This is particularly good for treating acne but has not shown a good result
in skin lightening.
ARBUTIN
This is derived from plants e.g. bearberry and is used in some; natural skin
lightening products but the results are very poor.
The best results for skin lightening amongst the Asians has been shown with
the use of 5% Kojic acid followed by an effective sun screen.