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 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….

About Acne….

Acne is an inflammatory disease of the skin affecting the skin structures consisting of a hair follicle and its associated sebaceous gland. The most common inflammatory manifestations of acne are pimples.

Acne usually develops in puberty due to the surge of testosterone, which is a necessary (but not sufficient) causative factor in acne. In many people, acne disappears by early to mid twenties. Others continue to experience it throughout adult life, even though adult acne tends to be milder. Acne is very common.

Signs and Symptoms: Acne is of several types

• Comedone / Microcomedone: Comedone is enlarged hair follicle plugged with oil and bacteria. This is the first and smallest type of lesion. It is often called microcomendone because it cannot be seen by the naked eye.
• Open comedone / blackhead: Open comedone / blackhead is a plugged follicle that reaches the surface of the skin. Although dark in appearance, blackheads do not indicate the presence of dirt. The dark color comes from chemically altered oils and bacteria.
• Closed comedone / whitehead: Closed comedone / whitehead is a clogged follicle that stays beneath the skin. Whiteheads usually appear on the skin as round, white bumps 1-2 mm wide.
• Papules: Papules are inflamed lesions that appear as small, pink bumps on the skin. They do not contain any visible puss.
• Pustules / pimples: Pustules or pimples are inflamed pus-filled lesions red at the base
• Cysts and nodules: These are large, inflamed, pus-filled lesions that are lodged deep and can drain, causing pain and scarring.
• Scars: As they heal, acne lesions, particularly cysts and nodules and, less frequently, pistules may cause scars of various shape and size.

How acne lesions develop: Excessive secretion of oils from the sebaceous glands combines with naturally occurring dead skin cells to block the hair follicles. Sometimes, excessive or altered keratinization (hardening and death of epithelial cells) leads to abnormal shedding of the skin lining of the pores. Oil secretions build up beneath the blocked pore, forming a comedone, which is a perfect anaerobic environment for the growth of the skin bacterium Propionibacterium acnes. Bacterial growth triggers inflammatory response, producing an inflamed lesion, such as a pustule or a nodule. After an inflamed lesion heals, a scar may develop.

Causes of acne: Development of acne requires a combination of several factors, which are influenced mainly by heredity, age and gender. Lifestyle factors, such as diet or grooming habits appear to play a minimal role. Some of the factors contribute to the development of acne are:

• Hormonal levels: Certain hormones, particularly androgens, such as testosterone and dihydrotestosterone (DHT), promote acne. Of importance are not only absolute levels of these hormones but also the levels relative to other hormones, such as estrogens and progestins. Acne tends to flare up when levels of androgens increase either absolutely or relatively to other hormones. This is one of the main reasons why acne flare-ups are linked to puberty and menstrual cycles.
• Excessive sebum production: Excess sebum from overactive sebaceous glands is an important factor in acne. Excess sebum is most often caused by increase in absolute or relative levels of androgenic hormones. Sebum production may also be increased by stress and heat.
• Stress: There is some preliminary evidence that stress may exacerbate acne. The proposed mechanisms of this effect include altered hormonal levels and suppression of immune system linked to stress.
• Accumulation of dead skin cells: Excessive shedding of dead skin cells can plug the pore, creating a nutrient-rich anaerobic (oxygen-free) environment conducive to overgrowth of acne-causing bacteria.
• Bacteria: Propionibacterium acnes (P. acnes) is the species of bacteria most commonly associated with acne. However, other species may have a role as well. The factors contributing to the overgrowth of P. acnes include, excess sebum, accumulation of dead cell plugging the pore, suppression of immune system and others. Some people become allergic to P. acnes and may develop inflammatory acne lesions even when bacterial overgrowth is minimal.
• Skin irritation: Skin irritation does not generally cause acne by itself, but may induce a flare-up or exacerbate existing lesions.
• Drugs, pollutants: Certain drugs and environmental pollutants have been linked to acne with varying degree of certainty. Some examples include anabolic steroids, lithium, and barbiturates. Exposure to high levels of chlorine compounds, such as chlorinated dioxins, can cause severe, long-lasting acne, known as Chloracne.

Treatment: There is no cure for acne. However, there are a wide variety of treatments designed to keep acne under control - each addressing one or more factors contributing to the development of acne lesions

Next Article: Acne and skin aging………….

Basic steps of facial skin care routine: Cleansing & Toning

The purpose of washing/cleansing is to remove dirt, makeup, grime, contaminants and so forth from the surface of the skin. Proper cleansing not only removes impurities but also clears the way for the penetration of active ingredients you may want to apply afterwards. Cleansing may be beneficial or damaging, depending on how you do it.

Most people should cleanse their face twice a day, usually in the morning and before going to bed at night. It is best to use warm (lukewarm) water and a mild cleanser (free of harsh detergents, soaps, alcohol or other irritants). Here is the key steps and recommendations to follow:

• Gently run cleanser all over your face with your fingertips for about 20-25 seconds
• Splash running warm water in your face several times to rinse off the cleanser until there is no more residue on your skin. Do not direct the stream of water onto your face.
• Take a clean towel and gently pat your face. Make sure it remains moist.
• Apply a moisturizer or an active skin care product of choice onto clean, moist skin. Massage product into your face by gently tapping with your fingers until it is absorbed. No pulling or tugging.

Cleansers vary by the amount and types of detergents, moisturizers, emollients and other ingredients. Selecting the right cleanser depends on your skin type. But whatever your skin type may be, avoid cleansers with harsh detergents (such as sodium lauryl sulfate and its analogs), soap and alcohol (except perhaps for extremely oily skin).

Toning

Toning is often touted as an essential step in a skin care routine. Most toners contain alcohol and/or witch hazel. Both are drying and irritating, especially if you have dry or sensitive skin. So always, use a soothing toner free of alcohol or witch hazel, such as alcohol-free toner with Chamomile or Aloe Vera extract.

You do not want to strip every last molecule of oil from your skin. Only grime, makeup and excess oil on the surface needs to be removed. The underlying thin coat of fresh sebum is best left undisturbed. Toners, especially alcohol-based ones, tend to strip everything off, leaving the skin dry and/or irritated.

Some experts say that toners help close pores and tighten cell gaps after cleansing, thus reducing the penetration of impurities and environmental contaminants into the skin. You can tone after cleansing by wiping your face with a chip of frozen green tea. The cold from the ice helps close your pores; the caffeine and tannins in the tea help tighten skin and reduce puffiness; and green tea polyphenols may provide antioxidant benefits. But don't overuse the cold - frequent excessive cooling may increase the risk of developing stubborn skin redness.

Next Article: Basic steps of facial skin care routine: Moisturizing….