Archive for the ‘Skin Discoloration / Hyperpigmentation’ Category
There are countless skin care products available to treat skin discolorations known as “hyperpigmentation”, such as brown spots and melasma. There is also just as much confusion and misinformation, surrounding topical Hydroquinone and Non- Hydroquinone products. The fact is they are both necessary, as each have a place in correcting and maintaing pigment irregularities.
I am a proponent for Hydroquinone and for good reason, when used correctly it is arguably the most effective topical for treating hyperpigmentation. I am also a proponent for Non-Hydroquinone skin brighteners, because I do not support using Hydroquinone indefinitely without pulsing on and off.
If you understand how hyper pigmentation occurs, you are better able to understand how to treat it. The process of producing pigment (melanogenesis) is complex, with many process, so I am giving the short version. When the skin has hyperpigmentation, it means that, there are melanocytes that are over producing melanin (pigment) AND that those pigment cells are not being evenly distributed to the skin cells called keratinocytes.
Something must first, trigger the increase of tyrosinase activity, this can be sun exposure, hormones or inflammation. Tyrosinase is an enzyme in the skin that controls the production of melanin. One of the main goals in treating hyperpigmentation is to inhibit the tyrosinase, so that it will not trigger the overproduction of melanin (pigment). Products that aim to do this use ingredients that we call “tyrosinase inhibitors”. Hydroquinone is a strong tyrosinase inhibitor, however there are also non-hydroqinone tyrosinase inhibitors that are effective.
Hydroquinone is a strong tyrosinase inhibitors and very effective at treating hyper pigmentation. There is concern, however that with extended use the skin may become resistant to the effects. This is why it is important to use hydroquinone under professional guidance. The general idea is to maximize correction, before you build resistance. Many dermatologists and skincare professionals are now recommending pulsing on and off hydroquinone. If you are using or plan on using hydroquionone products, I recommend you read “Hydroquinone: What you need to know, to maximize it’s benefits and prevent resistance”.
When you are pulsing off hydroquinone, you may want to use a non-hydroquinone skin brighter. Look for a brightener with tyrosinase inhibitors. Ideally, non-hydroquinone skin brighteners should be formulated with a combination of ingredients that will have an effect on the various stages of melanogensis (the formation of pigments). Antioxidants and exfoliants play a role in melanogensis and should be part of a skin care regimen, along with a tyrosinase inhibitor. I am including a short list of some commonly used ingredients in Non-hydroquinone brighteners.
Non-Hydroquinone Lighting/ Brighting Ingredients
Arbutin (Bearberry Extract)
Licorice Root Extract
Hydroxyphenoxy Propionic Acid
For best results begin by preparing your skin to best absorb the topical products you are using, this is done by properly cleansing and toning skin. Topical antioxidants and a broad spectrum SPF, are a MUST, because they help block the effects of “triggers”. We also recommend some type of chemical exfoliant, such as glycolic or lactic acid. These help by exfoliating melanin filled skin cells from the surface, which accumulate and cause pigment to be more dense, making it look darker. Retinoids such as tretinoin (Retina-A) work by inhibiting the transfer of pigment to skin cells, this blends pigment for even skin tone. Retinoids also work as a tyrosinase inhibitor. Finally, if you are not seeing the results you want with topical products alone, consult with a skin care provider to discuss which treatment options are best for you. Typically, we recommend chemical peels or PhotoFacials (IPL or BBL), depending on skin type and conditions being treated.
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I can not tell you how many times I have been in the mall or a beauty store and heard a sales person give a shopper horrible advice on skin care. To the defense of the sales person, they probably are unaware they are giving poor advice, they are likely not trained skin professionals. Often the product they recommend cost just as much, if not more than the more effective cosmeceutical products used by skin professionals.
An in-depth consultation with an licensed Esthetician should be your first step to addressing aesthetic skin concerns such as aging. Even if you are just looking for professional advise on appropriate skin care to maintain your skin, a skin consultation is needed. Standing in the front office and talking to the office staff or even an Esthetician between appointments, does not cut it. Not everyone is qualified to give skin care advice, even the Esthetician can not give you the attention you need in 5 minutes. A full consultation is always the best way to go. We have put together a list of tips to help you get the most out of your skin consultation.
Select your Esthetician
An Esthetician is a skin care specialist, that has been educated and trained on skin health and beauty. They do not diagnose or treat medical skin conditions such as eczema, psoriasis, allergies or skin cancers. An Esthetician may work in a day spa, salon, med-spa or within a medical practice such as dermatology or plastic surgery. When selecting an Esthetician, be sure to ask about experience and training. Some Estheticians may have additional training or certifications to work in medical aesthetics. You should look for an Esthetician that fits your personal goals.
Be Prepared to Discuss Your Concerns
If you can help your Esthetician understand what you see, and what concerns you most, then they can better help you. We recommend you make a list of concerns and what you hope to improve. It may help to look in a mirror while creating your list. If you simply want to maintain your skin, we can help with that too. The more clear you are about your concerns, the more likely they will be addressed. You may have skin issues or signs of aging that do not bother you, your Esthetician does not want to offend you by suggesting that you improve something that you are content with. Estheticians understands that most people have a budget and we want to respect your money, so be sure to communicate the priority of your concerns.
What to consider:
Pigmentation Concerns Is your skin color even or do you notice irregular pigmentation such as Melasma, dark patches, freckles, age-spots, sun spots or pigmented scars.
Acne / clogged pores Do you have any cysts, pimples, black heads, white heads or clogged pores. Do breakouts correlate with menstral cyle or hair removal. How often do you break out.
Texture Is your skin smooth and even or does it feel rough or flakey. Does your skin look creapy, have fine lines or scars that are raised or depressed.
Vascular Issues Do you have Rosacea, broken capillaries, diffused redness or red spots. Do you flush easily?
Oil and Moisture Is your skin normal, oily, shiny, dry, tight and dry?
Aging concerns Do you have any lines, wrinkles, folds? Is your skin that lax or thinning. Is your facial volume plump and cohesive or do you see separation of the fat pads, hollowness of the face or under eyes, flat cheeks, or jowls? Do you have droopy or hooded brows?
Hair Even if you are only seeking skin treatments, let your Esthetician know if you experience unwanted hair, specifically facial hair and how you address it. Hair growth and hair removal methods may provide clues to skin issues. ( This applies to men and women) Some hair removal methods my be contraindicated to potential treatments or products. Estheticians specialize in hair removal methods, so they can provide you with or suggest the most appropriate hair removal methods.
Tell us what products you are using
Be prepared to talk to your Esthetician about the skin care products you have used in the past and are currently using. When filling out your consultation form, it is not enough to list a brand name or only including a couple products. We need a detailed list of the products you are using and it is even better if you bring the products in with you, so that we can read the ingredient list.
Not all skin care products or ingredients play well together, for example products with Benzoyl Peroxide can oxidize your topical antioxidants. Acne and anti-aging products usually active ingredients and if we mix too many, the skin may become very irritated. You may already be using something similar to what we would recommend and we do not want you to purchase something, if you already have it or something like it. Your Esthetician will try to work with your current products, when possible. Sometimes, however it may be necessary to start from scratch.
Tell us what you have done already
Think back to any cosmetic procedures or skin care treatments you may have had and make a list. Your Esthetician will need to know what procedures / treatments you have done. Some things should not be repeated too soon, while others my be contraindicated to each other. For example if you have had deep (full coverage) resurfacing procedures, your Esthetician will want to know because they can not be repeated too frequently. If you have recently had certain injectables, you may need to wait before having some procedures. If you have ever had any silicone injections or have you been on accutane, you need to alert your Esthetician.
Tell your Esthetician what you liked or did not like about the things that you have already done. If you had a good experience with something, that will provides a clue to how you respond to treatment. If you feel something did not work or you had a bad experience, we do not want to repeat that for you. Sometimes, your Esthetician may want to spend some time educating you on why you had that experience. Never assume anything is irrelevant.
Tell us a little more about you
Your Esthetician will want to know a little about your medical background and medications. Some medications may increase chance of bruising or cause photosensitivity. Do not forget to list any supplements or herbal treatments you may use. Remember to list any allergies, including food allergies, as some skin care products contain natural ingredients like pumpkin, papaya and pineapple. Medical conditions can effect how your bodies wound healing ability and how your skin responds to treatment. When listing medical conditions be sure to include any hormone therapy.
Your lifestyle and habits are important too. How do you exercise, are you on a restrictive diet, do you smoke, drink or use any other substance. We are not here to judge you, we need to take into consideration the variables that may influence how you will respond to treatment. If you have any special scheduling concerns, be sure to discuss them during your consultation.
Be clear on expectations
As you are discussing treatment options, be sure to clarify what you should expect. Often clients do not understand that they should expect some reaction with treatment or even some skin care products. Be sure you have an idea of what is normal and when you should be concerned. If you are having a treatment that involves any “down time”, your Esthetician will give you an idea of how long it will take to recover. Keep in mind, that this is just an estimated time frame. There are far too many variables that effect healing, it is impossible to predict exactly. It is also relative to what you consider to be “down time” and when it comes to your appearance being acceptable to return to work or social activities, everyone has different standards.
Before scheduling treatments, be sure you understand what typical results are. Often clients hear what they want to believe, expecting too much. Its tempting to hope that even if your Esthetician recommends a series of treatments, that you will be the exception. Sometimes we convince ourself that a non-surgical treatment will deliver a surgical result. We want to believe that one treatment can replace the need for others or that what we do at home isn’t that important. Try to keep your expectations realistic.
Be sure to find out about your consultation fee, often the consultation fee may be credited toward your first treatment. As a courtesy, many Estheticians offer a free consultation. This likely means they are not getting paid, so if you can not make your appointment, call to cancel or reschedule as soon as possible. A minimum of 48 hours prior to scheduled appointment is standard, this allows time to fill the space.
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In the world of medical aesthetics, hydroquinone is often a necessary part of skin care. It is the gold standard for treating dark skin irregularities known as hyperpigmentation. As effective as it is, there is a rising concern regarding the number of people who are using hydroquinone incorrectly, without on going professional guidance. Many of those who are using hydroquinone do not understand the risk of hydroquinone resistance or how to properly use it, as to enhance efficacy. It is important to use hydroquinone in a way to maximize it’s benefit, before the skin builds a resistance and how to properly transition off, to reduce incidence of rebound hyper pigmentation. Always seek a professional guidance before starting or continuing hydroquinone use. It should be used only under the strict supervision of a professional.
Why do we need Hydroquinone?
Hydroquinone is the single most effective topical ingredient for treating skin discolorations. Skin discolorations can include sun spots, Melasma and Post Inflammatory Hyperpigmentation (PIH), pigmented acne scars. When the skin is inflamed it can respond by over producing melanin, this inflammation can come from acne, injury, surgery or aesthetic procedures such as laser or chemical peels. UV exposure and hormones can also induce skin discolorations. In the world of medical aesthetics we are really dependent on the ability of hydroquinone to quickly correct hyper pigmentation. There are non-hydroquinone skin brighteners that are very good products, however they are not as effective as hydroquinone. That does not mean that botanical lighteners do not have a place, as you will learn, both hydroquinone and non-hydroquinone brighteners are important.
Resistance to Hydroquinone
Hydroquinone works by inhibiting tyrosinase, which is necessary for melanin production. It is believed that with extended hydroquinone use, the skin will compensate by increasing tyrosinase. This would causes the skin to become resistant to the effects of hydroquinone. When the skin becomes resistant to the effects of hydroquinone it will quit improving the hyper pigmentation. To prevent building resistance, it is not recommended to continue use for extended periods of time with out cycling off. It is usually recommended to cycle off hydroquinone after about 4-6 months. If needed, hydroquinone may be resumed after about 2 months. If you stop hydroquinone “cold turkey”, there is a risk of rebound pigmentation. To prevent rebound pigmentation, it is generally recommended to transition your skin off. While transitioning off and breaking from hydroquinone, continued stimulation with a retinoid is beneficial. When it is time to transition off your hydroquinone, you may begin to incorporate a non-hydroquinone skin brightener. There are several professional products that may be recommended. Exact regimens will vary individually, depending on skin condition and any skin treatments, such as laser treatments or chemical peels, that are planned. Do not attempt to cycle off hydroquinone without professional guidance!
Maximize Hydroquinone Effectiveness
When using hydroquinone to treat hyper pigmentation, the goal is to correct the condition before the skin builds resistance. In order to maximize effectiveness, we need to use a high quality hydroquinone product in the appropriate dosage, along with products that optimize penetration, assist in correction and protect from exacerbating factors.
We want to use enough of hydroquinone to reach correction, so a skin care professional needs to show you how to measure your hydroquinone and give you a time frame that you should expect to run out of product. Using hydroquinone every morning and night is a common protocol for treating facial skin.
We want the hydroquinone to have optimal ability to penetrate and work. Prepare the skin by cleansing with an appropriate cleanser. This would exclude anything that does not sufficiently clean the skin or leaves any occlusive film, this could inhibit product penetration. For this reason, I generally do not recommend cleansers like CeraVe or Cetaphil. Anything that is too harsh or active, should also be avoided, as we do not want to induce any unnecessary inflammation or irritation. After cleansing, an appropriate toner should be used, this will restore the skins PH balance after cleansing, preparing it for corrective skin care products. (astringent is not toner). Hydroquinone should be applied after toner, unless you have been instructed to use a Vitamin-C serum or other corrective serums. Always, confirm with your Esthetician or provider, the order your products should be applied.
When Hydroquinone is used with a mild exfoliant and Tretinoin (Retin-A), the pigment will be more evenly distributed. The goal is not just to suppress the production melanin (pigment), it is to have even distribution of the pigment. When the skin has hyper pigmentation, the melanocytes are not functioning properly. Not only is there an over production of melanin, but the pigment is not being evenly distributed to skin cells called keratinocytes. When Hydroquinone is used with Tretinoin, it works to evenly distribute the pigment. A mild chemical exfoliant will enhance the process by increasing the skin cell turnover. It is important that the exfoliant be appropriate to your skin type and personal skin care regimen, to reduce risk of any unnecessary inflammation. Here is the icing on the cake, tretinoin will also treat acne, increase collagen production in the dermis, as well as glycosaminoglycans such as Hyaluronic acid that bind to water and improve skin moisture. There is also evidence that tretinoin may positively effect gene expression in the skin. – Yes, please! I want all of that.
Sun protection is important for several reasons. 1) UV exposure stimulates the production of melanin, while hydroquinone is working to suppress it. It literally, defeats the purpose of using hydroquinone, if you do not have proper sun protection. 2) Hydroquinone, tretinoin and exfoliants can all cause photosensitivity of the skin. 3) Heat, including heat from the sun dilates capillaries in the skin and induces inflammation, which can exacerbated pigmentation problems. 4) UV exposure causes skin discolorations, free radical damage and breaks down collagen and elastin.5) UV rays damage DNA and causes skin cancer, and melanoma can be life threatening.
Your sunscreen should be an SPF 30 or higher and should have zinc oxide. Zinc Oxide can help by blocking some of the UV induced heat, that contributes to inflammation and exacerbates hyper pigmentation. Zinc also provides broad spectrum protection from UVA/UVB rays without the irritation occasionally seen with chemical sunscreens. Professional zinc products are more elegant and will look better on the skin. Using a moisturizer, BB Cream or cosmetic with an added SPF, is not enough. It is important to have an actual sunscreen, with high broad spectrum coverage. Sunscreen should go on after any moisturizer, it is the last thing you put on, but before makeup. Sunscreen needs to be used EVERY day!
Topical antioxidants are useful for many reasons, but in regards to skin discolorations we especially like topical Vitamin-C. First, Vitamin-C reduces oxidized dopaquinone, which helps further brighten the skin. Perhaps, more importantly, Vitamin C helps to reduce inflammation in the skin that can cause or exacerbate hyper pigmentation. Some antioxidants, including Vitamin-C also have photo-protectant ability, enhancing the effectiveness of sunscreen. They works by neutralizing the UV rays, rather than reflecting or absorbing UV rays like a sunscreen, so use them together to maximize your protection. We recommend using an l-ascorbic acid form of vitamin c, in serum form. A quality l-ascorbic acid, needs to be packaged in a glass bottle with a glass dropper, the bottle should be dark to reduce oxidation of the product.
Not all skin care products play well together and there are some skin care products that may be contraindicated to your personal skin care regimen. For example, you should not use any product that contains benzoyal peroxide with products that can oxidize, such as Hydroquinone and Vitamin-C Serums. Always inform your Esthetician or skin care provider of the products you are using, and do not add anything new without having it approved first.
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Décolletage is what we call the neckline, or more specifically the area made up of the neck, chest and cleavage. If we neglect this area between our face and breasts, it is sure to age us. Although we can cover up our décolletage, we would certainly be limiting our style and where is the fun in that.
The décolletage is a special concern, because it tends to suffer more sun damage than other areas and women also tend to develop lines between the breast while sleeping on their side. Luckily, there are plenty of options to improve this area, but we have to be patient as correction for non-facial skin is much slower than it is when treating the face. When we treat the décolletage or any non-facial area, we need to treat more conservatively and thus, more often. The skin cell turn over for non-facial skin tends to be slower, so this means the recovery process will take longer, which will require more time spaced between treatments. When treating the décolletage you should treat early and often. Slow and steady wins the race.
When it comes to skin care and anti-aging, the best approach is a comprehensive one. One treatment does not necessarily replace the other. Your skincare provider should work to help you understand which treatments are best for you and the time line that treatments may be done. When budget is a concern, you will need to decide which concerns are a priority for you.
Topical Skin Care
The first step is to use effective skin care products on your neck and chest, every morning and every night, just as you would your face. Most of the skin care products that are used on the face, can also be used on the chest. Some topicals, such as hydroquinone and retinoids need to be used less frequently on non-facial skin to avoid irritation. Some products should be used daily, such as topical antioxidants and an SPF 30 or higher. There are some great products formulated specifically for the neck and chest. Revision skin care formulated Nectifirm for firming the neck and décolletage. NIA 24 Sun Damage Repair for Décolletage and Hands, is formulated with patented Pro-Niacin to repair damaged skin. Consult with your Esthetician, to determine the appropriate protocol for you.
Treatments that use Intense Pulsed Light work to treat brown spots and redness. There is also research to suggest that ongoing treatments will positively effected gene expression in the skin to mimic that of a younger person. Generally a series of 3-5 treatments are recommended, scheduled 3-4 weeks apart. For enhanced results Levulan may be applied prior, this is known as PhotoDynamic Therapy.
Medium depth chemical peels that reach the papillary dermis or upper reticular dermis, such as the Obagi Blue Peel or ZO controlled depth peel will improve skin discolorations, improve texture, laxity, lines and stretchable wrinkles. A medium depth peel on the chest, may take up to 14 days for peeling to be complete. On the up side, peels on the face generally do not look bad during the peeling phase and are easy to tolerate. These peels can be done as often as 4 times a year, however I find that once a year is optimal when combined with other treatments.
Ultherapy is the treatment of choice for the lines that develop between the breasts. Ultherapy works at a deeper level than any other non-surgical treatment, to lift and tighten skin. Ultherapy uses focused ultrasound to target deep into the dermis and even the top of the muscle. Like many other aesthetic treatments, Ultherapy works by creating a wound healing response, but because the targeted areas are at a deeper level we see more tightening and lifting. The increased collagen production in the treated area, can be seen a year post treatment. Most people should plan on repeating this treatment once a year, although younger patients may be able to stretch it out to every two years. Those with advanced photo damage, or who desire more improvement may choose to repeat the treatment in six months. Pain medication may be prescribed, in which case you will need to arrange for someone to bring you in to your appointment and take you home.
Non facial skin does not respond well to “full coverage” ablative laser resurfacing. Non-ablative or sublative fractional resurfacing treatments, such as E-Matrix or Fraxel are more appropriate for treating non-facial skin. These treatments reduce lines, wrinkles and smooth skin texture. Like many other aesthetic treatments, fractional lasers work by creating a wound healing response in the skin, that stimulates the fibroblast in the skin to up regulate the production of collagen. Because laser treatments create heat, we appreciate a different type of wound healing response than we do with other treatments such as chemical peels, micro needling, which is why we see the up regulation of collagen for longer periods of time post treatment.
Fractional lasers generally work in the deeper layers of the skins dermis, an area which is not effected by chemical peels or IPL treatments. The frequency and number of treatments will depend on the level of treatment performed, level of correction desired and condition of skin.
Micro-Needling Collagen Induction Therapy
Aesthetic professionals use micro-needling pens such as the Eclipse or Dermapen, to deliver tiny needles into the epidermal and dermal layers of the skin creating micro-injuries. This begins a natural wound healing or renewal process that will stimulate collagen production in the treated area. There is little to no down-time, and it is surprisingly comfortable. Although, micro needling treatments do not deliver the same level of correction to skin texture as fractional lasers, they are the treatment of choice for scars and stretch marks. Micro-needling is also a good option for early intervention or in between other aesthetic treatments.
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Hydroquinone has been the gold standard for treating hyperpigmentation for over 50 years, but some confusion about hydroquinone has developed over the past few years. Common rumors include, hydroquinone has been banned or that it causes cancer. A lot of information found on the internet misrepresents hydroquinone by omitting some of the facts related to Hydroquinone studies and the FDA’s proposed rule.
I personally use hydroquinone on my skin to treat melasma and hyperpigmentation. I love what hydroquinone does for my skin and I have not been able to duplicate the results with other skin lighteners, however health is always going to outweigh the benefit of beautiful skin. I certainly would not want to use anything that is unsafe, furthermore I consider my self an advocate for my clients. It is important that my clients feel confidant in my knowledge of skin care and even more important that they trust that I always have their best interest in mind. I have spent a lot of time educating my self on hydroquinone and I aim to clarify some of the confusion.
What is Hydroquinone
Hydroquinone is an active ingredient used in topical creams and cosmetics as a depigmenting agent to treat skin discoloration such as melasma. Topical skin lightening creams containing Hydroquinone first became available in the United States in 1955. Hydroquinone has been described as a ubiquitous chemical, meaning it is something that we are exposed to as part of our daily life. Hydroquinone occurs in some plants as free hydroquinone or as arbutin. Arbutin (glucosylated hydroquinone) is found in the leaves and fruits of many plants that are used for food and bacteria in the intestines can transform it into hydroquinone. Hydroquinone and Arbutin can be found in foods such as cranberries, blueberries, pears, beans, broccoli, onions tea, coffee, beer, red wine, all-wheat bread and cereals (concentration may exceed 1%). Hydroquinone also has a number of other uses, it is used as an antioxidant for rubber, a reducing agent for photographic developing solutions, a stabalizer in paints and varnishes. It is also found in hair dyes and nail polish. The list goes on and on.
Does Hydroquinone Cause Cancer
Hydroquinone has been available as active ingredient for over 50 years and there have not been any reported cases of hydroquinone induced cancer in humans. There is also no evidence in human clinical studies to suggest that Hydroquinone could cause cancer in humans. It is suggested that additional studies are needed.
What about the Rats? I have heard and read many times that hydroquinone causes cancer in rats, so I decided to read the study and reviews myself. The 2 year gavage study with hydroquinone, showed some Rats with end stage CPN developed cancer. The problem is that you need to read the full report and it’s reviews before you develop a conclusion. CPN is a renal disease that affects various strain of rats, but has no counterpart in humans. In a 2007 review, McGregor concluded that hydroquinone is carcinogenic only in the context of end-stage CPN, which is not relevant in humans. There is some debate over using rats in carcinogenicity studies, as test results may not be relevant to humans. It should be noted that certain strain of rats are prone to spontaneously develop tumors.
Does Hydroquinone Cause Ochronosis
There are two types of ochronosis, endogenous and exogenous. It is only exogenous ochronosis which can be induced by the topical application of compounds including hydroquinone as well as antimalarias, mercury, resorcinol and phenol. Exogenous ochronosis is a fairly rare type of dermatitis that needs to be diagnosed by a dermatologist. It is not known exactly how hydroquinone induces ochronosis but suggested factors include: sun exposre, long term use of hydroquinone, high concentrations of hydroquinone, other active derivatives and penetrating vehicles such as t-butyl alcohol, mercuric compounds, resorcinol and hydroalcoholic lotion. Exogenous ochronosis is believed to be a progressive disorder that likely develops over several years.
Was Hydroquinone Banned
No, hydroquinone was not “banned” in the US. Hydroquinone is available in concentrations of 2% or less over the counter (OTC), and concentrations over 2% (typically 4%) are available in prescription strength in the United States.
To simply say Hydroquinone has been “banned” in other countries is something of a misrepresentation. First, we need to acknowledge that hydroquinone is an active ingredient available in prescription strength and over the counter (OTC) strength. I am not aware of any ban or proposed ban on prescription strength hydroquinone in any country. The confusion seems to come from the change in availability of over the counter (OTC) hydroquinone. In Japan and Australia hydroquinone is no longer available in cosmetics OTC (over the counter), it is only available as a prescription based ingredient.
As part of a review of OTC products, the FDA published a proposed rule in 2006 to consider the withdraw of the 1982 rule that recommended hydroquinone be GRASE, because of evidence indicating that hydroquinone may act as a carcinogen in rats and mice after oral administration. It is argued that this is not relevant in humans, so the proposed rule recommended additional studies should be conducted to determine if there is a risk to humans. The FDA has yet to make a final ruling, but until then it’s still believed that hydroquinone should remain available as an OTC (over the counter) drug product.
I have considered the facts, studies, reviews and opinions of medical professionals and have concluded that I will continue to use hydroquinone. I would not be concerned if my mom, best friend, husband or children were using hydroquinone. I feel very confidant in the efficacy and safety of hydroquinone. I will continue review and consider any new information and I will modify this post if my opinion changes.
I have read hundreds of pages of studies, reviews, letters and other published literature on the subject of hydroquinone. I am not able to share everything I have learned, but I focused on some of the main points. I have included links to resources that are available on line, I encourage anyone who is concerned about hydroquinone to do thier own homework. I also recommend consulting with your doctor.
If you are using hydroquinone, be sure to use a broad spectrum sunblock and give your skin a resting period from hydroquinone. For example: 3 months on and 3 months off.
There have been reports of counterfeit beauty products and illegally imported skin care products containing mercury. I strongly discourage purchasing skin bleaching creams on-line.
Nomination Profile /Hydroquinone [CAS 123-31-9] Supporting Information for Toxicological Evaluation by the National Toxicology Program /21 May 2009 / Prepared by U.S. Food & Drug Administration Department of Health and Human Services
Hydroquinone: An Evaluation of the Human Risks from its Carcinogenic and Mutagenic Properties / Critical Reviews in Toxicology 2007, Vol. 37, No. 10 , Pages 887-914 / Douglas McGregor /Toxicity Evaluation Consultants, Aberdour, Scotland, United Kingdom / Toxicity Evaluation Consultants, 38 Shore Road, Aberdour, KY30TU, Scotland, UK
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Imagine a skin treatment that has the ability to treat sun damage, rough skin, freckles, skin discolorations, redness, broken blood vessels, rosacea, acne, kill acne causing bacteria, reduce oil glands, minimize pore size, improve appearance of some acne scars and treat precancerous Actinic Keratose. Believe it or not, such a treatment does exist! The skin treatment I am referring to is PhotoDynamic Therapy (PDT). PhotoDynamic therapy is a non-invasive, non-ablative treatment with little to no down time.
PhotoDynamic Therapy (PDT) is a 2 part skin treatment that uses the light activated drug therapy, Levulan (aminolevulinic acid) also known as ALA. Levulan is a topical agent that is used to photosensitize the skin prior to light based treatments such as IPL (photofacial) and blue light acne treatments.
Adding Levulan (ALA) to a photofacial IPL treatment, is a bit like putting your photofacial on steroids. The Levulan photosensitizes the skin, allowing the IPL energy to be better absorbed by the targeted pigmented and vascular chromophores. This results in a higher level of correction of freckles, sunspots, skin discolorations, broken blood vessels and redness compared to photofacial alone. Although, Levulan in it’s self does not penetrate to dermal layers of the skin, the heat and inflammatory response caused by PhotoDynamic Therapy does reach the Papillary dermis. This heat stimulates the fibroblast to produce collagen.
PhotoDynamic Therapy is unique because Levulan is absorbed by abnormal cells, such as those of Actinic keratosis (AK’s). Aminolevulinic acid is also absorbed into the oil glands and hair follicles. When the Levulan is activated by the appropriate light or laser it damages the oil glands and reduces P. acne bacteria. Acne can be affectively treated by using Levulan to pretreat the skin before IPL (photofacial) or Blue light treatments.
How is the treatment done?
First your skin is pretreated with an acetone scrub, to remove oil from the skin’s surface. Sometimes microdermabrasion is also preformed before the Levulan is applied. Microdermabrasion will remove dead skin cells and cause blood vessels to dilate, which will result in a more effective treatment with IPL. After the skin is prepped the Levulan Kerastick is cracked open and applied to the skin. Aminolevulinic acid (ALA) doesn’t sting or burn like acids used in chemical peels. The ALA is left on the skin to “incubate”. The incubation time can be anywhere from 1-8 hours, a longer incubation time can cause more reaction as well as more correction. Non-facial skin generally requires a longer incubation time. Once the Levulan is applied, you must avoid sun exposure for 40 hours. Topical anesthetic may also be used. After the Levulan has been on for the determined amount of time, the skin is then treated with IPL and/or Blue Light. The light will activate the ALA. Blue Light is used specifically to treat acne and can be done alone or with IPL.
The degree of post treatment reaction will depend on the amount of skin damage and how aggressive the treatment is done. The Luvulan can be left to “incubate” longer, before it is activated for a more aggressive treatment. Those with a lot of sun damage or active acne can expect to have more reaction. Some people will experience little to no side effects. Similar to photofacial, pigmented spots will become temporarily darker, until they flake and peel off. The treated area will likely appear pink or red for the first few days and peeling may also occur and last for up to 7 days. Some may also experience mild swelling that lasts a couple days. It is important to avoid sun exposure for the first 40 hours post treatment, sun block will not protect skin against photosensitivity reactions caused by visible light. Sun exposure can cause stinging, burning, redness and swelling to the treated area.
How many treatments are needed?
The amount of treatments needed will depend on the skin condition and level of correction desired. There is significant improvement with each treatment. Some people may be satisfied with a single a treatment, however for optimal results a series of treatments are recommended. Treatments can be scheduled as soon as 3- 4 weeks apart.
Schedule a consultation to determine if you are a candidate for PhotoDynamic Therapy, and set up a treatment plan.
Melasma (chloasma) is hyperpigmentation or dark, irregular patches commonly found on the upper cheeks, nose, upper lip, and forehead. The patches can develop gradually over time or during pregnancy. Melasma can also develop when taking oral contraceptives or hormone replacement therapy medications. Melasma is thought to be stimulated by hormones, however exactly which hormones are involved has yet to be determined. The most important factor in the development of melasma is sun exposure,and without the strict avoidance of sun exposure, treatments for melasma are likely to be unsuccessful. Melasma can be permanent or disappear and reappear with each pregnancy.
Hyperpigmentation is the term used to describe any type of abnormal dark area of the skin, this includes melasma, freckles and sun spots. When we treat hyperpigmentation in the skin, it is important to understand that the melanocyte is not functioning properly, so it overproduces melanosomes and the excess melanin can not be evenly distributed among the keratinocytys. As the cells rise to the surface of the skin they cause over pigmented or dark spots. When the skin is exfoliated with AHA’s, chemical peels or microdermabrasion, the hyperpigmentation will appear lighter because some of the top layers of skin have been removed and the pigment is less dense (temporarily). The pigment is still there, it is just appears lighter and the melanocyte is still not functioning properlly, so in a few weeks as the top skin layers are replaced the pigment will appear dark again. Tanning will also further stimulate the melanocyte causing darker pigmentation to develop and Melasma will become worse. Hydroquinone works to suppress the melanocyte and is an excellent way to treat the pregnancy mask. For best results Hydroquinone can be used in conjunction with exfoliating treatments. I understand this description may be a little difficult to understand, so if I have lost you, you can come in for a consultation and I will use visual aids to better explain the cause and treatment for hyperpigmentation.
Melasma: My Personal Story
I have Melasma myself, on my upper cheeks and forehead. I first developed Melasma patches on my upper cheeks in my late twenties and later after giving birth to my second child I developed another large patch in the center of my forehead. I have successfully treated my Melasma, but I need to continue to maintain my skin so that it doesn’t come back. As a Medical Esthetician, I obviously have access to the best skin care products and treatments available. I can share both my professional and personal experience with treating Melasma. Using hydroquinone, and broad spectrum sunblock is absolutely necessary for treating and controlling Melasma. Even after successful correction of Melasma, the hyperpigmentation can reappear especially after sun exposure.
My Personal Skin Regimen
My personal skin regimen includes using the Obagi Nu-Derm system, with a 1/2 gram of Clear (4% hydroquinone) AM and PM. Initially I used a 1/2 gram of a .1% tretinoin ( Retin-A) every night, however I am now on a maintenance protocol and only use tretinoin occasionally. I also use a topical vitamin C and a broad spectrum sunblock containing Zinc oxide. I top it off with Jane Iredale mineral makeup SPF 20.
Professional Skin Treatments
I have had an Obagi Blue Peel, and Fraxel treatments. I personally felt I had better results with the Blue Peel. Fractional laser resurfacing and Blue Peels are ideal when treating deep or resistant Melasma.
Although I have corrected my Melasma, I still need to continue to maintain my skin to keep the Melasma under control. In addition to the topical products I previously mentioned, I try to have a light chemical peel every 4-6 weeks. The chemical peel I have found that gives me the best results treating pigmentation, is a custom chemical peel.
Obagi Nu-Derm System
This is correction after using the Obagi Nu-Derm System. This is a prescription strength skin system and is only available at medical skin clinics. Treatment protocols vary depending on skin type and condition.
Obagi Blue Peel
This is an example of deeply pigmented Melasma.
After treatment with Obagi Nu- Derm & Obagi Blue Peel
It is important to precondition with the Obagi Nu-Derm System and Retin-A before having a Blue Peel. I recommend preconditioning for a minimum of 6 weeks or longer depending on how aggressively Tretinoin is used. Patients that are better preconditioned get a better result. It is also necessary to continue to use the creams after peel to prevent Hyperpigmentation & to maintain healthy skin.
Custom Chemical Peel for Melasma
The Custom Chemical Peel I use is a light peel that can be repeated as often as every 4-6 weeks, compared to the Obagi Blue Peel which is a deeper peel necessary for treating deeper pigmentation. I have decided to not include details of my protocol for this custom peel. It is proprietary information that I don’t wish to share with others in the industry. If you would like to learn more, you can schedule a private consultation. I can tell you that with this peel, I will usually get light peeling for 2-3 days. The peeling is minimal and I would not consider there to be any “down-time”, you can still go about your regular routine. You just don’t want to schedule a peel less than a week before any major event like a wedding. I make it a point to work with my clients and their social calendar, so that they look their best for any events.
Get Professional Treatment For Melasma
If you have Melasma call to schedule a free consultation at
Paradise Valley Skin Klinic.
After Obagi Most Women Go Naked
The Obagi Nu-Derm® system is the world’s #1 professional skincare program, used by more than 11,000 physicians throughout the world. It is the most effective treatment for skin health restoration, correcting complex problems such as acne, melasma (brown spots), fine lines, wrinkles, and scars.
The Obagi Nu-Derm System contains prescription-strength formulations that can only be sold through a licensed physician, such as a dermatologist or plastic surgeon.
*Take a moment to watch the Obagi video at the end of this post.
The goal of the Obagi Nu-Derm system is to create soft, radiant- looking skin, increase skin tolerance and restore normal skin functions. The problem is, it only works if you use it. It works even better when you use it correctly. Dr Zein Obagi created the Obagi Nu-Derm as a skin health restoration system, and the products are designed to be used together. Each of the products are good individually, but if you don’t use the full system, you will not see the amazing results that Obagi is famous for.
- Increase smoothness
– Reduce pore size
– Improve elasticity
– Normalize oil production
– Increase skins own ability to hold moisture
– Increase skin tolerance to all external factors
– Generate a balanced, even skin tone
– Reduce hyperpigmentation ( freckles, age spots, melasma, Post inflammatory hyperpigmentation )
I have worked professionally with the Obagi products for over 10 years, and have had “literally” thousands of clients on the Nu -Derm system. The results shown in the before and after photo’s are typical and common. If you use the Obagi system correctly you will experience skin transformation. Using a specific dose and frequency that’s recommended specifically by your skin care professional for your skin condition, the prescription-strength system exfoliates old skin leaving healthy, new skin that looks and acts younger and healthier. The products in the Nu-Derm System are clinically proven, prescription-strength, ingredients that work to improve your skin cell function, compared to retail products that contain more cosmetic-based ingredients.
Obagi System: Steps 1-6
All of the products are labeled AM, PM or both AM/PM and numbered 1-6 in the order you would use them. The lines between the letters in the word OBAGI are designed as a tool to measure product. For example from the O-A = 1/2 gram ( thick like toothpaste).
Step #1 Cleanser AM/PM
Foaming Gel – For Normal/Oily Skin or Gentle Cleanser – For Normal/Dry Skin
Proper cleansing is necessary
Step #2 Toner AM/PM
Adjusts the pH of the skin for increased penetration of the system ingredients.
Exfoderm® Forte – For Normal/Oily Skin
An alpha hydroxy acid (6% glycolic acid, 4% lactic acid) that removes old skin cells while promoting new skin cells for a lighter, brighter, firmer complexion for skin that needs deeper exfoliation.
Step #5 Bleander & Tretinoin PM (mixed as prescribed)
This step restores damage to the deeper layers of the skin. It restores skin elasticity by enhancing the production of collagen and elastin.
A topical prescription treatment that contains 4% hydroquinone to target hyperpigmented (discolored) areas of the skin and increase the penetration of the active ingredients of the system.
Tretinoin Cream 0.025%, .05% , or.1% (as prescribed)
A topical prescription, use as directed. *Do not wax skin that is treated with tretinoin.
Step #6 Healthy Skin Protection SPF 35 AM
A sunscreen with 9% micronized zinc oxide and 7.5% octinoxate that helps to protect newly transformed, younger looking skin and prevents further sun damage. This is a physical/chemical sunscreen with UVA/UVB protection.
If you just want to FEEL good you should get a spa treatment. If you want to LOOK good, then follow the recommended Obagi Nu Derm protocol. Generally, with a more aggressive protocol you will have more reaction, however you will also have more stimulation, see correction faster and build up tolerance more quickly. That doesn’t mean everyone should start out aggressively, individual system protocol is determined by skin type.
Reaction Phase: Out with the Old
Inital correction and stimulation phase
This is the time in which the damaged top layer of skin is replaced by a new layer of healthier cells. It takes about six weeks for ” newborn” cell to reach the surface of the skin and exfoliate.
You WILL experience one or more of the following symptoms:
– Dryness – Itching
– Burning – Redness
– Sensitive skin
– Exfoliation ( flaking and peeling)
These reactions are a sign the skin restoration is in process. The Nu- Derm system is accelerating the skin cell turnover to alter the rough top layer of the skin.
Tolerance Phase: In with the New
Correction and stimulation continues
Your skin has built tolerance , skin improvement is viable. The skin increases the production of collagen and elastin, to diminish wrinkles and reduce pore size.
Correction Phase: Healthy Glow
Finally, your skin enters the last stage and you are ready for a maintenance protocol. Skin tolerance is now complete.
“Begin with the end in mind.” – The 7 Habits of Highly Effective People
Peeling is more severe in the center of the face and around mucus membranes (eyes, nose and mouth). You can try focusing product use on the forehead and cheeks and blending them in toward the center of the face. Most people notice that the peeling reaction peeks late afternoon-early evening. It is okay to cleanse your face later in the day ( at least 4 or 5 hours later) and reapply sunscreen and makeup. Cleansing the skin can help slough off some of the loose peeling skin. If you have an social event and need to stop reactions, discontinue step 5, four days before event. Obagi Action and Tolereen are “control” products that can be used as needed to relieve surface tightness, itching and dryness. Control products should only be used temporarily, as they slow the skin restoration process. Be sure to discuss options for controlling your reactions with your skin care professional.
Obagi Nu-Derm Action
A moisturizing cream to be used as needed to soothe areas of dry, flaky skin.
Obagi Nu-Derm Tolereen
Contains 0.5% hydrocortisone for the temporary relief of itching and burning associated with minor skin irritations.
Find Obagi neer you. www.obagi.com
Tretinoin ( retinoic acid) is the acid form of vitamin A and is available as a cream or gel (brand names Retin-A, Renova, Aberela, Airol, Atralin, Avita, or Stieva-A). Tretinoin was FDA approved as a topical medication in 1971. Tretinoin treats acne, minimizes pores and reduces oiliness. The anti-aging benefits of tretinoin include, reducing appearance of fine lines and skin discoloration.
Tretinoin promotes detachment of cornified cells and the enhanced shedding of corneocytes from the follicle. Tretinoin also increases the turnover rate of thin, loosely-adherent corneocytes. By making keratin softer and more gelatinous, the stratum corneum becomes soft and compact. Tretinoin suppresses the melanocytes, this is why it is often used when treating skin discoloration.
Tretinoin stimulating fibroblast.
It is believed that tretinoin stimulates the fibroblast. Some studies suggest that tretinoin can help firm the skin by stimulating fibroblast activity. Fibroblasts produce collagen, elastic fibers, and the ground substance of the dermis. With age fibroblasts become smaller and less active.
Tretinoin enhances the skin healing process.
Studies show that topical use of tretinoin before chemical peels, enhanced healing. There is more epidermal regeneration and collagen regeneration appears to be faster when skin was pre treated with tretinoin.
Tretinoin makes my skin peel and it feels tight and dry.
Initially, tretinoin dehydrates the skin the outer surface of the skin ( stratum corneum ), causing a rapid exfoliation. The good news is, tretinoin repairs the damaged keratinocytes, increases mitosis, and restores proper hydration. With time your skin builds up tolerance and reactions subside.
Does tretinoin thin the skin?
I have heard people say, “don’t use tretinoin it thins the skin”. I think there is some confusion, about what part of the skin is thinning and if that is a good or bad thing.
Tretinoin works by thinning the outermost layer of the skin (stratum corneum), while cells in the epidermis are stimulated to produce a thicker epidermis layer. Collagen production and cellular growth in the dermis layer also increases. Although it is true that tretinoin does thin the stratum corneum, it actually makes other layers of the skin thicker. Thinning the stratum corneum isn’t exactly a bad thing. With age the statum corneum can become thick and dehydrated causing the appearance of fine lines and rough, sallow skin.
Epidermis Stratum corneum, outermost layer with dead keratinocytes being exfoliated off.
Is retinol the same as Retin-A ( tretinoin)?
Many people confuse retinol with Retin-A (tretinoin). Retinol and retinoic acid (tretinoin) are related but distinctly different. Retinol, retinal and retinyl palmitate, do not have the same effect on the skin as tretinoin/ retinoic acid. They first need to be converted by special enzymes into the active metabolite, retinoic acid. Unfortunately , the conversion rate is low and varies among individuals. The other problem is that when retinols are exposed to air, they can become oxidized and degraded. There are some companies that have produced retinol formulas that are more stabilized.
Tretinoin vs AHA’s
Tretinoin causes a rapid coarse exfoliation, which is the shedding of attached group of cells. AHA’s cause shedding of individual cells. The action of AHA’s is extracellular, compared to the intracellular action of tretinoin. The intracellular action of tretinoin works goes into the dermis and stimulates the fibroblast. The effects of tretinoin can last up to four months even after product has been discontinued, in contrast to the short lasting smoothing effects of AHAs.
Tretinoin is a drug.
Tretinoin is a drug and should be used only as prescribed. There are certain contraindications for using Tretinoin, including pregnancy and nursing. You should not wax skin that has been treated with tretinoin and some skin treatments are not recommended while using tretinoin. Be sure to discuss possible contraindications with your skin professional.
*You should never purchase Tretinoin or any other prescribed drug on line.
Skin Medica’s Vitalize Peel has been a popular skin treatment for many years, however you may not be familar with Skin Medica’s newer Illuminize and Rejuvenize Peels.
SkinMedica Rejuvenize Peel™ launched in October 2009.
Level of Skin Medica Chemical Peels
Illumenize Peel, Very Superfical with little to no peeling
Vitalize Peel, Superficial with 2-3 days peeling
Rejuvenize Peel, Superficial with 2-5 days peeling
Rejuvenize Peel™ is a blend of Salicylic Acid, Lactic Acid, Resorcinol, Panthenol and Isoceteth-20 with the addition of .3% Retinoic Acid. Deeper than SkinMedica Vitalize Peel®, Rejuvenize Peel™ produces a moderate amount of peeling for 2-5 days, and can be repeated every 4-6 weeks.
Rejuvenize Peel is an advanced formulation of peeling agents, with a built-in anti-irritant and penetration enhancer that provides controlled exfoliation of the uppermost damaged layers of the skin to reveal fresher and healthier skin. Provides predictable results with minimal down time.
Effective for use on skin with sun damage, melasma, pigmentary changes and acne scarring
Noticeable improvement with just one peel
Recommended for Skin types I-VI
Well tolerated with minimal “down time”
Isoceteth-20, creates more uniform peeling while controlling penetration of salicylic acid, and reduceing skin irritation associated with the stronger chemical peels without diminishing peeling effect
A recent clinical study of female subjects, aged 23-62 years, with mild to moderate facial photoaging, melasma, hyperpigmentation, or mild acne receiving three consecutive peels (once every four weeks) discovered the following results:
80% felt it improved evenness of skin tone and appearance of age spots and pigmentation
85% felt it made skin look healthier and more youthful
90% felt it improved smoothness of skin
90% felt it improved overall condition of skin
Blend of Salicyclic Acid, Resorcinol, Lactic Acid, Panthenol, Isoceteth-20 and Retinoic acid.
Addresses various skin conditions, such as acne, pigmentation abnormalities, post-inflammatory hyperpigmentation, melasma, and photodamage
Effective (achieve visible improvement after one treatment, significant results after a series of treatments)
Can be customized for the treatment of each specific condition
May be performed on Skin types I- VI
Little or no or down time
Peeling solution combined with Retinoic acid creates more exfoliation than other chemical peels same depth
Well tolerated (minimum or no burning)
This non-invasive very superficial chemical peel utilizes a novel approach to chemical peeling with a newer generation of alpha-hydroxy acids (mandelic acid and malic acid) in combination with phytic acid and commonly used peeling agents (salicylic acid and resorcinol) to maximize skin rejuvenating effects with low irritation.
Increase skin glow and radiance
Tightens the skin and restores a more youthful appearance
Improves clarity, color and skin texture
Patients achieve enhancement of skin appearance with minimal downtime and discomfort
Appropriate for first-time chemical peel patients or patients looking for a gentle, very superficial peel
May be performed on Skin types I- VI
Little or no visible peeling
Paradise Valley Skin Klinic offers all of the Skin Medica Peels as well as Skin Medica products.
Call to schedule a treatment or consultation. 480 421-1701
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