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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.

More Health

More articles by Shashi Gossain B.Sc (Hons), MRPS, Member

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