PIGMENTS- freckles, sunspots, melasma, hori’s, cafe au lait, post inflammatory hyperpigmentatn. PIH | MOLES | DARK EYE CIRCLES. Rosacea | Korean Aesthetic Clinic

This segment will cover 

1) Pigments

2) Dark eye circles

3) Red, sensitive skin 

Under Pigments, I will discuss the common pigmentary woes affecting Asian skin.

Freckles

Melasma

Sunspots

Hori’s Nevus

PIH (Post inflammatory hyperpigmentation)

Pigments in the Asian Skin:

Dark spots, red spots, brown spots, blue spots, gray spots, what are they? I have had many patients asking me about those spots on their faces. So to help you learn more about your skin, and understand those spots you see when you look into the mirror, I have decided to walk you through some of the common pigmentary conditions.Allow me to first start with freckles, those brown spots that you get for working out in the sun since your schooldays.

Freckles: 

What are they?

– Freckles are spots which commonly appear with sun exposure and are found on the cheeks and nose. They increase with age and darken with sun exposure. They lighten with sun protection.

How can we treat it? 

– In my opinion, treatment includes strictly avoiding the sun, using sun protection, using skin lightening cream and laser

therapy.Here is an example of freckles.

   

FRECKLES

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Melasma. 

So what causes Melasma?

-Melasma is very common with the Asian skin. It is multifactorial, with a strong genetic and hormonal component. It is worsened with sun exposure, OCPs and pregnancy. It tends to be distributed either over the cheeks or a central distribution from the forehead down to the chin.

How can we treat it? 

-There are many treatment regimens for melasma. Personally, I would suggest an advanced treatment which consists of priming the skin with lightening agents for a month, +/- oral medication followed by careful chemical peels and lasers.

MELASMA

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Solar Lentigines/ Age spots

What are they? – These are discrete lesions which progress with age. Prevention is the key with sun protection and sun avoidance.

How can we treat it? – They may be lightened with bleaching creams and pigment lasers. (sunspots, solar lentigo)

Solar lentigo 

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Hori’s Nevus

What are they?This is a pigmentary condition characterized by multiple dark blue gray spots, commonly found bilaterally in the cheeks. They darken with sun exposure and childbirth.

How can we treat it? IMHO, they can be lightened with a careful combination of sun avoidance, skincare and lasers.

HORI’S NEVUS

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Cafe Au lait spots

These are light brown macules that can be found over jawline, neck, face. 

Effectively treated with pigment lasers, but they can recur.

Post inflammatory hyperpigmentation

As the name suggests, these are pigmentation that form after an injury, be it picking a pimple, derma-roller performed on a skin, injury to the face etc… It can happen anywhere. Treatment entails careful use of laser toning with lightening agents and strict sun protection. They take 3 months to improve. 

 (courtesy of skinperfectbrothers.com)

PIH can happen anywhere on the body

PIH

What is it?

It is an area of localised hyperpigmentation, as a result of damage to the skin. It can range from light brown to black. It is temporary.

How can we treat it?

1. Sun block
2. Exfoliation
3. Antioxidant

What are the causes?

1. Sun
2. Injury. This can be as a result of over zealous chemical peel, laser, or other energy based devices.
3. Heat

Moles:

Everyone has moles. The question is whether it is visible or not.

Junctional nevus (flat moles) 

Compound – dermal and junctional component. (Mixed)

Dermal nevus (raised moles)

Note of caution. Moles can turn cancerous. And this is a problem that does not affect caucasians only. So if your mole has the following characteristics, it is best not to remove them but to investigate further.

• It has ABCD characteristics (Asymmetry, Border irregularity, Colour variation, Diameter > 6 mm)
• It is bleeding, crusted or itchy

Treatment:

Options include lightening creams, IPL, pigment lasers

Pigment laser treatments involve a light laser that generates heat and penetrates into the deep layers of your skin to stimulate collagen production without damaging the dermis. 1064 laser is a highly advanced laser that can deliver highly controlled energy into the skin. It is able to combine high peak power and short pulse width, to target and get rid of pigments without allowing the heat produced to damage the surrounding tissue.

It is an effective treatment for skin conditions such as pigmented lesions, melasma, skin redness, scars, and even tattoo removal, with minimal downtime.

So I hope this mini segment on pigmentary woes in the Asian skin has been useful. Remember, stay bold and beautiful. Dr Daniel Chang

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DARK EYE CIRCLES

Dark eye circles, puffy eyes, the BANE of our Asian work etc.Busy, busy, busy. You are working your socks off, drinking more coffee and sleeping less. You have not had time to pamper yourself, and you are looking into the mirror one day and wondering when in the world did you starting getting panda eyes.Welcome to the rat race.

So what are dark eye circles?

Its largely 2 issues, the discolouration and the puffiness.

(courtesy of darkcirclesresearch.com)

Dark eye circles (discolouration) form as a result of vascular changes, shadowing, and pigments.

1. Vacular changes – which can be purple, blue, pink depending on the oxygenation in the blood
2. Shadowing – which is a direct result of ageing, where the skin develops fines lines and wrinkles and sags, and you lose volume in the cheeks
3. Pigments – which is the stimulation of your melanin cells, commonly as a result of sun exposure.

(soyouwanna)

Puffiness is commonly a result of fluid retention. So here are some home remedies.

1. Cut down on salt please. This helps the puffiness, and your health.
2. Apply cold cucumber to your under eye area.
3. Apply caffeinated green tea bags, straight from the fridge.

So what causes dark eye circles?

The reasons can be divided into 3 aspects.

1. Ageing – Mainfested by volume loss in the cheeks, undereye skin thinning, undereye fat bulging (the eyebags).
2. Genetics and allergies-> notably history of allergic rhinitis, atopic eczema.
3. Lifestyle -> for example poor or lack of sleep, taking too much coffee and alcohol, smoking, sun exposure etc, which leads to venous pooling and vascular changes.

(A patient with heavy eyebags)

drnaomi.com.au

So how can we treat dark eye circles?

Treatment is customised and related to your underlying cause.

For example, in Asians, vascular changes is a common cause. So for females, the dark eye circles may vary in intensity with your monthly menstrual cycle and sleep patterns.

Let me share with you the various ways of treatment, from the simple  to the more invasive.

vivawoman

Treating the cause:

Conservative measures include lifestyle changes.

1. Adequate sleep and taking less coffee and alcohol,
2. Not rubbing the area around the eyes,
3. Cut down on smoking, and sun exposure.

More active measures for removal include

1. Sunprotection – Here I cant stress enough the T.C.S principle. Time, cover and shade. Time: The sun is strongest between 10am to 4pm so please use stay indoors if you can. Cover: Use your brolly, sunglasses whenever you head out for lunch. Sunscreen: Generous use of sunscreen will complete the picture.
2. Use of lightening products that contain hydroquinone and Vit C. Hydroquinone is the gold standard for lightening, and found in medical grade clinics only.
3. Dermatological procedures for example chemical peels, pigment lasers and undereye fillers, depending on the cause.

aaronstonemd-plasticsurgery.blogspot.com

Fillers can be used to volumize the cheeks and tear trough, hence reducing the shadow effect. So looking at the diagram above, your dermatologist can fill the grooves under the eye to correct the defect and improve the reflection of light.

It’s important to find one who isnt just fixed on filling the defects, but one with an artistic eye to correct and enhance your best features.

Aggressive measures would include

1. Fat grafting- which works on the same principle as fillers, which is to volumise defects.
2. Eyelid surgery – bleopharoplasty
3. Surgical cheeklift    So I hope this has been helpful. Have a Happy and  prosperous New Year.

Dr Daniel Chang

Red face, red nose, red eyes… No we are not talking about Rudolf here.
And no, we are not talking about allergies here.And we are certainly not talking about CNY.We are talking about ROSACEA.Commonly known as the English Rose in the West, this condition is known to affect Caucasians.I have seen quite a number of Singaporeans with this condition, hence I wish to share some information about this, in the hope that you can learn to identify, and manage it.So what is Rosacea?Rosacea consists of a set of primary and secondary features. If you have any of the primary features, you may very well have rosacea. Speak to your Dermatologist for further information.

Primary features

1. Easy Flushing
   Intermittent and easy blushing and flushing is often an early sign of rosacea.
2. Persistent Redness
   Persistent facial redness is a strong indicator.
3. Papules, bumps, pimples
   These bumps on the face resemble acne, but the distinguishing feature is the absence of blackheads and whiteheads,
4. Telangiectasia – Visible Blood Vessels
   In many people with rosacea, visible capillaries are seen, on the nose, cheeks, etc.

Secondary features

1. Eye Irritation
   Commonly, watery eyes, bloodshot eyes, can be indicative of ocular rosacea.
2. Stinging, burning or Itch
   When you notice your skin reacts quite easily to sunlight, and various cosmetic products.
3. Dry Appearance
   A dehydrated skin is common.

So what are the subtypes of Rosacea?

(from rosacea.org)

So what are the usual triggers?

I would like to divide the triggers into

1) Exercise and stress

2) Food, alcohol

3) Sunlight, the elements

So how can we manage Rosacea?

Most importantly, stay away from triggers.

Cleanse your skin gently with soap free cleansers. Minimise overuse of skincare products.

So how can we treat rosacea?

Here I shall outline the measures taken for erythema, telangiectasia, papulo-pustular and phymatous subtypes.

For the common garden condition of erythema and telangiectasia, there are some simple measures to utilise.

Erythema control can be achieved with the following.

1) Brimodinine topical gel ( an alpha agonist which induces vasoconstriction. They work within 30 min, and effects last for up to 12 hours. Clinical studies have shown that a once daily usage of this product can help with rosacea, and it has been safe to use it.)

2) Vit C, Aloe Vera, Licorice, metronidazole topical

3) IPL ( Intense Pulse light therapy, which under a doctor’s supervision, can achieve quite beautiful results)

Telangiectasia control can be achieved with the following.

1) Pulse Dye Laser

2) IPL ( Intense Pulse Light)

3) Long pulse ND Yag Laser ( This works for the deeper vessels)

Papulo-pustular variants (bumps)

These respond to oral antibiotics, tetracycline, well.

Skin thickening variants (commonly on the nose) will require a course of isotretinoin.

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So what happens if we dont treat Rosacea?

(from totalpict.com)

So if you have rosacea, or think you have it, please contact your dermatologist for a consult. 

For those of you who are interested, here is the study on brimodinine.

Improvement in Facial Erythema Within 30 Minutes of Initial Application of Brimonidine Tartrate in Patients With RosaceaMark Jackson MD,aJoseph Fowler MD,aAngela Moore MD,b Michael Jarratt MD,c Terry Jones MD,dKappa Meadows MD,e Martin Steinhoff MD,f Diane Rudisill BSc,g and Matthew Leoni MDgon behalf of the Brimonidine Phase III Study Group

aUniversity of Louisville, Louisville, KY
bArlington Center for Dermatology, Arlington, TX
cDermResearch, Inc, Austin, TX
dJ&S Studies, Inc, College Station, TX
eThe Education & Research Foundation, Inc, Lynchburg, VA
fUniversity of California, San Francisco, CA
gGalderma R&D, Princeton, NJ

ABSTRACT

BACKGROUND: Brimonidine tartrate (BT) 0.5% gel demonstrated significantly greater efficacy versus vehicle gel once-daily for the treatment of moderate to severe erythema of rosacea.
OBJECTIVES: To assess the 30-minute speed of onset of topical BT 0.5% gel in reducing facial erythema in Phase III studies as measured by subject and clinician assessments of erythema.
METHODS: Two Phase III, randomized, controlled studies with identical design in which subjects with moderate erythema of rosacea (study A: n=260; study B: n=293) were randomized 1:1 to apply topical BT 0.5% or vehicle gel once-daily for 4 weeks. Evaluations included severity of erythema based on Clinician’s Erythema Assessment (CEA) and Patient’s Self-Assessment (PSA) prior to study drug application and at 30 minutes after application on days 1, 15, and 29.
RESULTS: 97.7% and 96.6% of subjects reported normal study completion for studies A and B, respectively. The percentage of subjects achieving a 1-grade improvement in both CEA and PSA was significantly increased at 30 minutes post-dosing with BT 0.5% gel compared to vehicle gel on visit days (day 1: 27.9 vs 6.9%, P<0.001; day 15: 55.9 vs 21.1%, P<0.001; Day 29: 58.3 vs 32.0%, P<0.001 for BT 0.5% gel vs vehicle) in study A. Similar results were shown for study B.
CONCLUSIONS: Once-daily topical BT gel 0.5% is not only efficacious at reducing facial erythema but also exhibits response within 30 minutes of application in a significant number of patients throughout both Phase III studies.

J Drugs Dermatol. 2014;13(6):699-704.

I hope this has been useful. Have a lovely CNY!

Stay bold and beautiful!

Dr Daniel Chang – Making Asia more beautiful, one face at a time.

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