PRIME PRoMotIon |
peels and pigmentation
Jean-Luc H. Vigneron provides a detailed explanation of the treatment of melasma, and investigates chemical peels as a treatment option.
U required.
Pigmentation marks have a number of causes: ■They can be purely actinic, for example freckles, solar lentigo, and later actinic keratosis and senile lentigo (i.e. ‘liver spots’) ■They can be post-inflammatory, for example in acne scarring, or after a dermal, or even epidermal, reconstruction procedure ■They can be hormonal, in the form of melasma ■They can be the result of the effects of light on a substance which produces melanogenesis, such as perfume dermatitis. Perhaps what is most interesting, however, is the
histological level on which the excess of melanin is located. This is because if treatment is to be fully effective, it is imperative to work on the deepest level of the lesion. Therefore, it is important to know which pigmentations are dermal (Table 1).
Jean-Luc H. Vigneron is Dermatologist, Villabianca Dermatologie; past President, Société Française de Dermatologie Chirurgicale et Esthétique (French Society of Surgical and Aesthetic Dermatology); and Current president of the French Dermatological Surgery Specialists Group (GRCD)
Contact information:
www.villabianca.fr
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Wood’s lamp Lighting can be enhanced using Wood’s lamp (also known as a black light). The darker the mark, the more superficial it is. In theory, this technique is attractive, but in practice there are two precautions to be aware of: ■ Do not use a battery-operated lamp ■Maintain a distance of 20 cm from the patient. In addition, it is important to note that a positive result signifies epidermal change, but does not mean that there is no dermal pigment. In these circumstances, one must question whether Wood’s lamp is of any use. The analysis stage itself will allow the aesthetic
practitioner, through clinico-histological correlation, to determine the depth or location of the excess pigmentation.
Peeling techniques for treating pigmentation A peel is a controlled stimulation of the surface of the skin by a chemical substance or by a physical procedure.
July 2011 |
prime-journal.com NWANTED PIGMENTATION IS A
frequent reason for patients requiring a consultation with a dermatologist or aesthetic practitioner, but just because it is commonplace, this does not mean that a clinical analysis will not be
This updated definition no longer refers to destruction of the epidermis, because new substances have proven to be effective without visible exfoliation.
Why use peels to treat hyperpigmentation? There are a number of mechanisms that contribute to the result following the use of a peel to treat pigmentation of the skin: 1. The acceleration of the epidermal turnover leads to: a rise in ectopic melanic accumulations; a balancing of the proportions of different cellular populations, including melanocytes; a secondary dermal effect on the stimulation of fibroblastic synthesis 2. Peels also enable the penetration of depigmenting active ingredients such as kojic acid, phytic acid, idebenone, azelaic acid, and catechol derivatives of phenol. Phytic acid is a major antioxidant and idebenone is a valuable chemical, similar to CoEnzyme Q10, the qualities of which are usually studied in relation to the treatment of neurodegenerative diseases
3. When a peel destroys the epidermis and part of the dermis, excesses of pigmentation in the dermis are eliminated during the process of cutaneous reconstruction. It is worth noting that the undertaking of a treatment
for pigmentation marks will last for at least 1 year and that the patient must be fully informed and in agreement. However, this 1-year period is just a minimum. In areas of strong sunlight, patients will already understand the need to avoid prolonged direct sun exposure, as well as the use of localised treatments over a number of years.
What peeling techniques are available to treat pigmentation?
Superficial peels
Glycolic and kojic acid peels Glycolic and kojic acid peels are effective in 30% of pigmentation cases. There are two forms of glycolic peels: mask and gel. The mask is the starter peel.
Salicylic, lactic, and glycolic acid peels This combination of peels has a range of benefits, providing a powerful yet controlled effect. The
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