PPP- PIGMENTS- freckles, sunspots, melasma, hori’s, Nevus of Ota, cafe au lait, post inflammatory hyperpigmentation (PIH) / DARK EYE CIRCLES / Rosacea (red face) / 黑斑, 雀斑,黄合斑,老人斑

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skin diagram
https://www.youtube.com/watch?v=Dd3mEXe279E

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This segment will cover 

1) Pigmentation

2) Dark eye circles

3) Red, sensitive skin 

Under Pigments, I will discuss the common pigmentary woes affecting Asian skin. Key is the use of creams, peels and lasers for this type of condition. There are many lasers. And choosing the right laser will form the cornerstone in the treatment.

https://www.youtube.com/watch?v=QO-OzRIPvvk

TOP 10 pigmentation concerns 

  1. Freckles

  2. Melasma

  3. Sunspots

  4. Hori’s Nevus

  5. Nevus of Ota

  6. Becker’s Nevus

  7. Tattoos

  8. Underarm pigmentation

  9. PIH (Post inflammatory hyperpigmentation)

  10. Acanthosis Nigricans

 

Lifestyle changes – 3 Ss

  1. Sunblock, Q 4 hours
  2. Shade, stay away from the sun. Stay cool, in the shade.
  3. Shield, sun glasses and wide brim hat, UV coated umbrellas when you head out for lunch especially

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.
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HOW DOES IT WORK?

20140902143521_70729-1
laser for pigmentation

Pigmentation Solution: My 3 step FORMULA

1. Treatment: Laser/ light/ peels
2. Cosmeceuticals: Sunblock + Lightening agents – ORAL and topical
3. Skin renewal: Boost hydration and repair

Cosmetologist applying permanent make up on lips
MEDICAL PEEL
Carbon peeling. Laser pulses.
LASER FACIAL, LIGHT TREATMENT
SKINBOOSTERS
SKINBOOSTERS

POST LASER WHAT TO EXPECT?

SAMSUNG DIGITAL CAMERA
solar lentigo
Lasers and pigments
Here is a schematic cartoon showing how laser breaks down pigments into granules, which are subsequently engulfed by macrophages.

FRECKLES

What are they?

– Freckles are spots which commonly appear with sun exposure and are found on the cheeks and nose.
– They  darken with sun exposure.
– They show up in the teenage years, increasing with age.
– They lighten with sun protection and a combination of therapies.

How can we treat it? 

– In my opinion, treatment includes strictly avoiding the sun and using sun protection, using skin lightening agents and laser + light therapy.
– Here is an example of freckles.
freckles
freckles

images2

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freckles
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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.
– Melasma is a condition that can be controlled and not cured. 
– It is a spectrum, and there is no one size fits all regime.
– A carefully personalised programme works best as every melasma is different.
– 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.
1. Use good sunscreen, apply it 15min before going out. And reapply it every 2 hours.
2. Use gentle lightening agents
3. Laser light +/- Cosmelan
melasmaBefore-After-Photos-Melasma-with-Laser-IPL-Damage
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melasma
skin-pigmentation-diagnosis
melasma
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melasma
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melasma
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melasma
melasma
melasma
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.
– They  first appear in your 30s and can get increase in number with age.  
– Some age spots thicken and darken with time.

How can we treat it?

 – They may be lightened with sun protection, lightening agents and lasers light. (sunspots, solar lentigo)
solar lentigo
solar lentigo
freckles
SOLAR LENTIGO/ SUN SPOTS / AGE SPOTS 
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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?

– They can be lightened with a careful combination of sun avoidance, lightening agent and lasers.
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hori’s nevus
Fig3a
hori’s
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Hori’s nevus
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hori’s nevus
HORI’S NEVUS
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NEVUS OF OTA

– Present at birth

– A blue grey pigmentation deep in the dermis

– They darken with sun exposure

– Can be lightened with sun protection, lightening agents and lasers.

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Nevus of Ota
images
Nevus of Ota
NEVUS OF OTA
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BECKER NEVUS

– birthmark commonly found in males
– one sided 
– epidermal nevus
– associated with hair growth 
becker’s nevus
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CAFE AU LAIT SPOTS

What are they? 

– These are light brown macules that can be found over jawline, neck, face. 
– Effectively treated with sunblock, lightening agents and pigment lasers, but can recur.
download (1)

download (2)
CAFE AU LAIT
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cafe au lait
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Cafe au lait
It is vital to distinguish this from a melonocytic nevus – which can turn malignant.
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CAFE AU LAIT SPOTS
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TATTOOS 

– Q Switched lasers are good for black, blue, brown tattoos.
– No. of sessions depends on the location, size, age, colour of tattoo and whether it was performed by a professional or amateur tattoo artist.
ber-ba-tattoo-removal
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UNDERARM PIGMENTATION

Causes:

-Contact Allergy: From DEODORANTS commonly
PIH from shavingTiny hair stubbles can also add to the darkening
InfectionYou might have a skin infection that causes darkening
Acanthosis Nigricans. A skin condition that causes hyperpigmentation
Hormones/Pregnancy. Changes in your body may cause discoloration
leftarm-300x222
PIH
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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. 
skin-perfect-brothers-walnut-acne
Acne treatment and PIH

(courtesy of skinperfectbrothers.com)

POST inflammatory pigmentation or PIH can happen anywhere on the body

download (2)
PIH
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ACNE PIH

 

download-1
post inflammatory hyperpigmentation

PIH ( Post inflammatory hyperpigmentation)

download (3)
PIH

What is it?

It is an area of localised hyperpigmentation (excess melanin), as a result of damage to the skin from inflammatory process. It can range from light brown to black. It is temporary.

8asmqoq
PIH Post inflammatory hyperpigmentation

Distinguish PIH from PIE, which is post inflammatory erythema. This consists of superficial blood vessels that grow during the wound healing stage and is common after inflammtory acne, especially in lighter skin people. Darker skin folks would end up with Post inflammatory hyperpigmentation.

How can we treat it?

  1. Sun block
  2. Laser light
  3. Antioxidant and lightening agents

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

ACANTHOSIS NIGRICANS

Hereditary vs acquired

Common acquired causes

  1. DM
  2. Obesity
  3. Drug induced

Common in skin folds,neck,axilla and groin.

download-1

download
ACANTHOSIS NIGRICANS

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Here are treatment videos of laser, IPL for your pigmentation woes.

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, freckles, solar lentigo, age spots, sun spots, hori’s nevus, nevus of ota, cafe au lait, melasma, post inflammatory hyperpigmentation, skin redness, scars, 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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– OLYMPUS DIGITAL CAMERA

DARK EYE CIRCLES

Please refer to the Dark Eye Circle Page for further information.

cosmo
DARK EYE CIRCLES

 

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DARK EYE CIRCLES

 

soyouwanna
DARK EYE CIRCLES

 

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EYEBAGS

 

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panda eyes

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TEAR TROUGH

 

 


ROSACEA

acne rosacea
ROSACEA

rosaceadiets

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?

rosacea.org

(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?

totalpict

(from totalpict.com)

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

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!

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Dr Daniel Chang

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To learn more about:ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.
Threadlifts, pls click here Facelift, V-Lift.Dermal fillers, pls click here ABCs to Dermal Fillers. 
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