2) Dark eye circles
3) Red, sensitive skin
TOP 10 pigmentation concerns
Nevus of Ota
PIH (Post inflammatory hyperpigmentation)
Lifestyle changes – 3 Ss
- Sunblock, Q 4 hours
- Shade, stay away from the sun. Stay cool, in the shade.
- 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.
HOW DOES IT WORK?
Pigmentation Solution: My 3 step FORMULA
POST LASER WHAT TO EXPECT?
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.
CAFE AU LAIT SPOTS
What are they?
(courtesy of skinperfectbrothers.com)
POST inflammatory pigmentation or PIH can happen anywhere on the body
PIH ( Post inflammatory hyperpigmentation)
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.
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?
- Sun block
- Laser light
- Antioxidant and lightening agents
What are the causes?
- Injury. This can be as a result of over zealous chemical peel, laser, or other energy based devices.
Hereditary vs acquired
Common acquired causes
- Drug induced
Common in skin folds,neck,axilla and groin.
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.
DARK EYE CIRCLES
Please refer to the Dark Eye Circle Page for further information.
- Easy Flushing
Intermittent and easy blushing and flushing is often an early sign of rosacea.
- Persistent Redness
Persistent facial redness is a strong indicator.
- Papules, bumps, pimples
These bumps on the face resemble acne, but the distinguishing feature is the absence of blackheads and whiteheads,
- Telangiectasia – Visible Blood Vessels
In many people with rosacea, visible capillaries are seen, on the nose, cheeks, etc.
- Eye Irritation
Commonly, watery eyes, bloodshot eyes, can be indicative of ocular rosacea.
- Stinging, burning or Itch
When you notice your skin reacts quite easily to sunlight, and various cosmetic products.
- Dry Appearance
A dehydrated skin is common.
So what are the subtypes of Rosacea?
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.
So what happens if we dont treat Rosacea?
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
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!