Pigmentation Disorders

Skin pigmentation disorders and irregularities are common. Hyperpigmentation problems are particularly prevalent and many are associated with aging. While the triggers may vary, hyperpigmentation occurs when pigment-producing cells (melanocytes) become more active than normal, which leads to the production and deposition of more pigment (melanin). Conversely, hypopigmentation occurs when melanocytes are destroyed or silenced. Following are the most common pigmentation problems.

Hyperpigmentation Disorders

Age spots / sun spots (solar lentigines): Age spots/sun spots (solar lentigines) are pigmented skin blemishes associated with aging, sun damage and, to a lesser degree, other forms of skin damage. Age spots range in color from light brown to black and are predominantly located in areas exposed to the sun, such as hands, face, and arms. It is not entirely clear how sun damage triggers age spots: most likely, UV radiation produces mutations, local inflammation and other changes that increase local proliferation of melanocytes and/or activate melanin-producing genes. Sun/Age spots are harmless but may be cosmetically frustrating.

Freckles : Freckles are small, pigmented spots containing more melanin than the surrounding skin. Freckles are not caused by aging and/or sun damage. As opposed to age spots, freckles tend to fade with age. Sun exposure, while not a cause of freckles, typically makes freckles much more prominent. Freckles are found mainly in fair skinned people and tend to run in families. The cause of freckles appears to be largely genetic. Freckles are not considered a skin disorder and are harmless. Some consider them a cosmetic nuisance.

Melasma / Chloasma: Melasma is a condition characterized by increased tan-like skin pigmentation typically having uneven, patchy distribution. Chloasma is a variant of melasma occurring mainly in women and associated with increased levels of certain hormones. Chloasma may be triggered by pregnancy, oral contraceptives and occasionally other hormonal imbalances.

While hormonal changes seem to be the most common cause of melasma / cholasma, other factors may have a role. In particular, a combination of sun damage and certain ingredients found in deodorants, toiletry and other personal care products may result in melasma - apparently due to local sensitization of melanocytes.

In some cases, melasma resolves on its own if the underlying hormonal imbalance is removed (e.g. when hormonal contraceptives are replaced by a non-hormonal method or after childbirth). If the cause is non-hormonal, avoiding sun exposure and reducing/eliminating suspect skin/body care products may improve melasma. In persistent cases, various methods of skin lightening may be used.

Hypopigmentation disorders: Hypopigmentation is far less common that hyperpigmentation. Hypopigmentation occurs when pigment-producing cells (melanocytes) are either destroyed or stunned into inactivity. This generally occurs either due to serious skin damage (e.g. a burn) or due to an autoimmune disease where the immune system erroneously attacks melanocytes

Prevention of pigmentation disorders: Most hyperpigmentation problems are either caused or exacerbated by sun exposure. Hence sun protection is important for preventing hyperpigmentation. Other measures of skin protection should also help. Women with history of chloasma may be able to prevent recurrence by using non-hormonal birth control methods. However, such step should be discussed with a physician and balanced against the disadvantages of the non-hormonal alternatives.

Treatment of pigmentation disorders: Hyperpigmentation problems may be improved or eliminated by a variety of treatments, including topical lightening agents, laser / intense pulsed light, cryotherapy and chemical peels.

Treating hypopigmentation may be a greater challenge. Hypopigmentation after a burn or similar skin injury may resolve itself over time as melanocytes migrate to the damaged area. Current treatments for vitiligo are of limited effectiveness. For many people, camouflaging hypopigmentaed areas with sunless tanning products represents a viable alternative

Next Article: About Cellulite………….

Acne Treatments

There is no cure for acne. However, there are a wide variety of treatments designed to keep acne under control. The main reason why so many diverse acne treatments exist is that acne is caused and/or exacerbated by several different factors. Each acne treatment targets one or several of these factors. Another reason for the wide variety of acne treatment is that due to the complexity of acne causes no acne treatment appears to work for everyone. On the other hand, most people eventually find an effective treatment or a combination of treatments to control their symptoms.

Both prescription and over-the-counter acne treatments are available.

Exfoliation with AHA and BHA

Exfoliation is a common component of acne treatment programs. It is rarely effective on its own, but may be modestly useful in conjunction with other treatments. Since exfoliation removes dead, hardened outer skin cells, it improves the penetration of subsequently applied topical treatments. Whether exfoliation helps clear dead cells from deep inside the pores is debatable, but if it does, that would be helpful too. Common exfoliating agents used in acne include alpha-hydroxy acids (AHA) and beta-hydroxy acids (BHA). Overall, BHA, particularly salicylic acid, appears to be more useful because they also reduce sebum production.

Topical Antibacterials

Since bacterial growth (particularly of P. acnes) in pores is a factor in the developments of acne, topical bactericidal agents have been used as a treatment. The most common such agent is benzoyl peroxide, which is a strong oxidizer that kills bacteria by generating oxygen free radicals. The strong suite of benzoyl peroxide is that bacteria do not develop resistance to oxygen. Hence, if benzoyl peroxide works for you, it is likely to continue working as long as you use it. The downside is that free radicals are damaging not only to bacteria but to your skin as well: they cause irritation, dryness, cell damage and accelerate the rate of skin aging. Unfortunately, for many people, benzoyl peroxide is only effective topical treatment. In that case, it is prudent to find the lowest possible effective concentration. Concentrations of benzoyl peroxide as low as 2.5% may be effective, especially if combined with other treatments.

Other topical antibacterials that have been used for acne include triclosan, chlorhexidine gluconate, colloidal silver and tea tree oil.

Topical antibiotics

Topical antibiotics have an important advantage over benzoyl peroxide in that they kill acne-causing bacteria in a more targeted way, causing minimal collateral damage to the skin. Antibiotics most commonly used for topical acne treatment include erythromycin, clindamycin and tetracycline. Topical antibiotics are about as effective as oral ones but with far fewer side effects. However, if acne is present over large areas of the body, oral antibiotics may be easier to use. Antibiotic treatment for acne may not be sustainable over the long term because bacterial resistance may develop to any and all of these drugs.

Oral antibiotics

Oral antibiotics used to treat acne include erythromycin, tetracycline or their analogs (oxytetracycline, doxycycline, minocycline or lymecycline). Oral antibiotic appear to be about as effective as topical antibiotics but produce a variety of side effects, such as diarrhea, dysbacteriosis, colitis and others. The advantage of oral antibiotics over topicals is the ease of use, especially when acne affects large areas of the body. Also, occasional cases unresponsive to topical antibiotics would respond to oral administration. Antibiotic treatment for acne may not be sustainable over the long term because bacterial resistance may develop to any and all of these drugs.

Next Article: Continuation of Acne treatments….

Acne treatments 2

Hormonal treatments

Androgens are a major factor in acne and reducing the levels and/or blocking/counterbalancing their action would generally improve acne. However, such treatments are inappropriate in men due to sexual and other side effects. In women, some estrogen/progestin contraceptive combinations were shown to reduce acne. Antiandrogens, such as cyproterone, alone or in combination with estrogens are even more effective. However, antiandrogens may sometimes affect sex drive and produce other side effect even in females. There is some evidence that topical antiandrogens (such as 5% topical spironolactone) may be modestly effective in acne.

Topical retinoid

Retinoid are active metabolites of vitamin A and their analogs. They improve acne by reducing sebum production an altering the lifecycle of epithelial skin cells. Treatment with topical retinoid often causes temporary increase in acne outbreaks during the first several weeks of treatment. Retinoid may also cause skin irritation, dryness and flaking. Also, retinoid cause sensitivity to UV light and should not be used without a thorough sun protection.

Oral retinoid

Oral retinoid, such as isotretinoin (Accutane), are among the most effective acne treatments. They work by reducing production of sebum, altering the lifecycle of epithelial skin cells and possibly modifying other acne-causing factors as well. Isotretinoin has been shown to be highly effective in severe acne and can either improve or clear over 80% of patients. A course of treatment usually takes 4-6 month and, just like topical retinoid, may cause an initial flareup. As opposed to virtually all other acne treatments, isotretinoin often leads to long-term remission of acne. In those who relapse, recurrences tend to be milder.

Despite high effectiveness and durability of improvements, oral retinoid are infrequently used and are the treatment of last resort. Common side effects include dry skin and nosebleeds (due to dry mucosa). Less frequent side effects include liver damage, permanent skin texture changes, and elevated blood triglycerides. The drugs have been linked to cased of depression and psychosis. Oral retinoid should never be used in women who are or may become pregnant due to the high risk of birth defects.

Other treatments

Topical azelaic acid: Azelaic acid (Azelex, Finevin, Skinoren) reduces sebum production possibly by partly blocking the effects of androgens. It inhibits the formation of comedones and may help in mild comedonal acne.

Topical tea tree oil: The oil of tea tree (Melaleuca) has both antibacterial and anti-inflammatory effects and in further studies was shown to be as effective as topical antibiotics with no side effects reported till date.

Topical Niacin amide: In a few small studies, 4% niacin amide gel was shown to be equally or more effective than topical antibiotics. Niacin amide is a form of (Vitamin B3). The effects are said to be due to the anti-inflammatory action of topical niacin amide.

Heat therapy: Directed targeted heat (Zeno device) delivered to the area where an acne lesion is just beginning to form appears to make lesions milder and shorter-lived. The method does not seem to work on cystic acne.

Oral Vitamin B5: Oral Vitamin B5 (Pantothenic Acid) taken orally in large doses as calcium pantothenate has been claimed to improve acne. This has not been rigorously studied, however.

Tomorrows Article: Pigmentation disorders……….

Acne and skin aging

The relationship between acne and aging has several facets. It is well known that acne typically starts at a certain age and tends to either resolve or diminish in early to mid twenties. (Some people continue having outbreaks as late as the middle age.) Less known is the fact that untreated acne contributes to the process of skin aging. Furthermore, some acne treatments, even when they are effective, also accelerate skin aging.

Acne is a chronic inflammatory disease. Acne prone skin spends significant time in the inflamed state. Inflammation is a well-known accelerator of aging. Inflammation generates free radicals, activates matrix metalloproteinases i.e enzymes that break down the skin's structural components like collagen and elastin, promotes excessive cell proliferation, etc., all of which contributes to skin aging. Treating your acne, at least to the degree of markedly reducing the number of inflamed lesions, can be the best skin anti-aging step you could make apart from sun protection.

How you treat your acne may have a major impact on the aging of your skin. As a general rule, any treatment that causes skin irritation and/or excessive skin dryness should be used cautiously. Irritation, by itself, promotes skin aging. Excessive dryness reduces the skin's ability to heal itself. Certain acne treatments should be used with a particular caution (as far as skin aging is concerned).

Benzoyl peroxide

Benzoyl peroxide is a strong oxidizer that kills bacteria by generating oxygen free radicals. Topical benzoyl peroxide is one of the most effective topical acne treatments. It is highly effective in killing against P. acnes (acne-causing bacteria). Furthermore, benzoyl peroxide has an advantage over antibiotics because bacteria do not develop resistance to it.

Unfortunately, oxygen free radicals generated by benzoyl peroxide are damaging not only to bacteria but to your skin as well. They cause irritation and dryness, damage skin cells and skin matrix, and otherwise accelerate the rate of skin aging. An occasional, short-term use of benozyl peroxide produces relatively small long-term skin damage. On the other hand, long-term use of benozyl peroxide, especially at high concentrations, is likely to age your skin prematurely. It is worth trying safer alternatives first. Unfortunately, for many people, benzoyl peroxide is only effective topical treatment. In that case, it is prudent to find the lowest possible effective concentration. Concentrations of benzoyl peroxide as low as 2.5% may be effective, especially if combined with other treatments.

Topical retinoid

Topical retinoid are one of the common prescription acne treatments. Possible side effects include skin irritation, dryness, and sensitivity to UV light. Over the long run, chronic skin irritation may accelerate skin aging. Neglecting meticulous sun protection when using retinoid is likely to accelerate skin aging as well.

However, the situation with topical retinoid and skin aging is more complicated. In fact, retinoid (Retin A), a widely used retinoid, is one of the very few drugs approved by the FDA as an anti-wrinkle agent. Indeed, when used prudently, retinoid actually reduce many signs of skin aging and may even inhibit some of the mechanisms of skin aging.

Some people with acne respond to the concentration of retinoid sufficiently low to avoid chronic, long-term skin irritation. In that case, one may get both anti-acne and anti-aging benefits. Others respond only to the formulations of retinoid strong enough to produce chronic irritation. In that case, other topical alternatives should be explored and/or steps be taken to reduce the irritation.

Exfoliation

Exfoliation with alpha or beta-hydroxy acids is a common component of acne treatment programs. Whether it is effective against acne and to what extend it debatable. Arguably, it may improve penetration of other treatments and, when done with salicylic acid, reduce the formation of comedones. Moderate exfoliation, especially with alpha-hydroxy acids, may also have some skin rejuvenation benefits. On the other hand, excessive exfoliation may lead to chronic irritation, skin dryness and sensitivity and actually contribute to the aging process.

Tomorrows Article: Acne treatments….

Sebum, Sweat, Skin pH and Acid Mantle

Sebum is an oily secretion produced by sebaceous glands, tiny ducts adjacent to hair follicles. Sebum is secreted into the follicle, from which it spreads over the hair and skin. The main role of sebum is to waterproof the skin and hair. Both excess and lack of sebum are undesirable. Excess sebum is associated with oily skin and acne. It is particularly common in adolescents as the increased levels of sex hormones stimulate sebum production. Lack of sebum, which is common in middle and older age, leads to skin dryness and accelerates wrinkle formation.

Sweat is a salty, watery solution produced by sweat glands, numerous microscopic channels opening onto the skin surface. As sebum and sweat mix up on the skin surface, they form a protective layer often referred to as the Acid Mantle (Acid Covering). Acid mantle has a particular level of acidity characterized by pH from about 4 to 5.5. A pH of 7 is considered neutral, above 7 is alkaline, and below is acidic. The pH of acid in the human stomach, for example, is usually from 1 to 2, which is highly acidic. The skin, on the other hand, is mildly acidic. In addition to helping protect skin from "the elements" (such as wind or pollutants), acid mantle also inhibits the growth of harmful bacteria and fungi. If acid mantle is disrupted or loses its acidity, the skin becomes more prone to damage and infection. The loss of acid mantle is one of the side-effects of washing the skin with soaps or detergents of moderate or high strength.

Tomorrows Article: Acne…………