Posts Tagged ‘tretinoin’
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
Topical Products
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.
480 421-1701
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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.
Step #3 Clear AM/PM
A topical prescription treatment that includes 4% hydroquinone to correct hyperpigmentation (discoloration) and improve and even skin tone.
Step #4 Exfoderm or Exfoderm Forte AM
Exfoderm – For Normal/Dry Skin
A plant acid (3% phytic acid) that removes old skin cells while promoting new skin cells for a lighter, brighter complexion.
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.
Blender
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.
Reaction
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
Control Reaction
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
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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.
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Isotrex: This drug is NOT FDA APPROVED!
The FDA has sent out warning letters to company’s that are selling Isotretinoin drugs online.
Isotrex is a topical Isotretinoin drug used to treat acne. There are not any topical Isotretinoin drugs that are currently approved in the US. The only form of Isotretinoin that is FDA approved is Oral Isotretinoin (Accutane), and it is very regulated. Isotrex is a category X drug, in comparison to Percocet and Tretinoin ( Retin-A) that are category C drugs. Do not confuse Isotretinoin with Tretinoin, although they are both Vitamin A derivatives, Isotretinoin can have severe side effects and is a category X drug.
I worked for a doctor that prescribed Isotretinoin ( Accutane) and I was the i Pledge designee for the clinic. Every month I had to schedule patients for lab work, doctor’s visits, and register patients with i Pledge. I can tell you it is a lot of work. Special Prescribing Requirements for Isotretinoin Isotretinoin is only dispensed one month at a time, so every months patients will need to return to their doctor to have a pregnancy test, and blood work done before you physician can register you for that month. Patients must also go to the i Pledge website and answer a series of questions and reregister every month. After you have met all of the i Pledge requirements you have 7 days from the date on the prescription to get your prescription filled at an approved pharmacy. If you do not fill your prescription within 7 days you are not eligible for another month. You will repeat this entire process every month for up to five months. Many insurance company’s do not cover Isotretinoin, and the cost ranges from $500 – $900 a month depending on the brand. Patients may also be responsible for covering the costs of monthly lab work and doctor’s fees. You should check with your insurance company to see what they cover. With all that said: Brand names for oral Isotretinoin: Brand names for topical Isotretinoin : If you suffer from acne, call Paradise Valley Skin Klinic to schedule a free consultation. Shapiro Plastic Surgery, Paradise Valley Skin Klinic Thank you for visiting Best of Both Worlds Az.
Because of isotretinoin�s teratogenicity and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the Food and Drug Administration. This program is called iPLEDGE™. Isotretinoin must only be prescribed by prescribers who are registered and activated with the iPLEDGE program. Isotretinoin must only be dispensed by a pharmacy registered and activated with iPLEDGE, and must only be dispensed to patients who are registered and meet all the requirements of iPLEDGE.
I believe that Isotretinoin is a good idea for some patients. If someone is suffering from severe or cystic acne and has exhausted all other options, they may want to consider Isotretinoin. There are many acne treatments available, if you are compliant and patient they are very successful. You should discuss options with your doctor.
Accutane, Claravis, Amnesteem, Stret
Isotrex, Isotrexin ( not approved in US)
480 421-1701
www.shapiroplasticsurgery.com
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