Fears of hydroquinone

Many people express fears of the compound hydroquinone, which is the active ingredient in a number of skin bleaching agents such as the Obagi Clear, Blender, and Sunfader. Hydroquinone is a naturally occurring chemical found in coffee, tea, beer, wine, blueberry, wheat, grass, and other foods. People ingest it daily.

Some side effects such as redness or irritation are common and to be expected.  It should not be used in women who are pregnant, breast feeding, or trying to get pregnant. Over the counter products contain it in up to 2 % strength. The most common prescription strength is 4 %.

Fears of this product stem from a study in which rats genetically prone to kidney tumors were fed hydroquinone many times the normal dose. These rats were found to have kidney tumors. When applied topically to humans, it has never been shown to cause cancer. While hydroquinone can bleach the skin effectively, it's use should be supervised by a doctor, and when used topically (not orally) at the appropriate doses for an appropriate time frame, there should be no concern for cancer.

 

Kojic Acid

Kojic acid is a naturally occurring substance that is found in many species of fungus and is used for a variety of applications. In skin care it is used in many products to act as a brightening agent. Like hydroquinone and other brightening agents, kojic acid will help to remove dark discolorations on the skin. Unlike certain other brightening agents such as hydroquinone (4 % and up), kojic acid is available over-the-counter and is found in many cosmeceutivals. Discolorations on the skin can be genetic (freckles), hormonal (melasma), sun-induced (sun spots), etc. Kojic acid can be used in conjunction with other products such as hydroquinone, retin-A, azeleic acid, vitamin C, and alpha-arbutin for more powerful effects. For example, the A E Skin Brightening Cream combines hydroquinone, kojic acid, and retin-A for strong effects. Additionally, doing treatments such as IPL photofacials and chemical peels while using kojic acid will produce even better effects. Contact Dr. Alex (818-835-1833 info@aeskin.com) for a free consultation.

Melasma

Melasma, also called chloasma, is a disorder where dark or hyperpigmented patches appear on the skin. It usually affects the face. Common areas of involvement include the cheeks, forehead, upper lip, and jaw line. Women are affected about ten times as often as men. It is more common in patients with darker skin tones such as those with ancestry from the Middle East, Southeast Asia, Africa, and South America. Melasma is sometimes called the mask of pregnancy because it can be induced by hormonal changes that occur during pregnancy, and also around menopause. Other causes include sun exposure, genetic predisposition, contraceptive medications, other medications such as dilantin, or unknown or idiopathic causes.

Melasma sometimes goes away spontaneously, that is without any treatment. But when it doesn't, it may be difficult to treat. Bleaching agents such as hydroquinone are the mainstay of treatment. Hydroquinone is available over-the-counter at 2% strength. Usually stronger doses are needed; these require a prescription. Other, less effective, bleaching agents include azelaic acid, kojic acid, and licorice extract. The use of daily sunscreen is also mandatory. Sunscreens with SPF of at least 30 with UVA and UVB protection are recommended by the American Academy of Dermatology. Other medical treatments include retinoids such as retin-A. Procedural treatments which are often used in conjunction with medications include chemical peels and laser therapy.

Below are pictures of patients with melasma who saw improvement after 12 weeks of using the Obagi Nuderm Condition and Enhance system, which contains a cleanser, toner, exfoliant, sunscreen, and 4 % hydroquinone.

A E Skin Brightening Cream

Many people have concerns over skin discoloration. The most common concern is hyperpigmentation, which is darkening of the skin color. This has many causes including sun exposure (most common), pregnancy, hormones, medications, acne, scars, and more. The discoloration is the skin's natural reaction to insults. In the case of sun exposure, for example, the reaction is a tan or in severe cases a burn.

Many products are available for lightening the skin color including hydroquinone (strongest), kojic acid, alpha-arbutin, licorice extract, coffee berry, and more. A number of them are available over-the-counter in low strength. A common complaint I hear is "I've tried everything for the discoloration and nothing works." This is partially true because the patients have tried a lot of over-the-counter products with minimal to no results. In these cases I recommend stronger products that are available by prescription or through doctors only.

The A E Skin Brightening Cream is a powerful blend of products leading to fast improvement in discoloration. It contains hydroquinone at three times the strength of over-the-counter products (fears of hydroquinone are addressed here). It also contains kojic acid, another brightening agent, as well as tretinoin, which enhances cell turnover and stimulates collagen formation. When used in combination with other products such as exfoliants, antioxidants, and sunscreens and procedures such as chemical peels and photofacials, impressive results can be seen.

This product should not be used in women who are pregnant, trying to become pregnant, or breast feeding.

Importance of a Daily Skin Care Regimen

The importance of a daily skin care regimen can not be emphasized enough. This is important whether or not you are having a procedure done. A good facewash twice daily is the first step; clean skin is healthy skin. Sunscreen is important to prevent discoloration, fine lines, and laxity and to prevent skin cancer. Anti-oxidants such as vitamin C also prevent sun damage. Exfoliants such as tretinoin and salicylic acid help remove the surface layer of dead skin cells. This gives the skin a youthful radiance. Bleaching agents such as hydroquinone, kojic acid, and licorice extract decrease hyperpigmentation (dark discoloration) and prevent it from occurring after a procedure.

Essentials of a skin care regimen

Great skin does not occur on its own. An appropriate skin care regimen is required for healthy and beautiful skin. A skin care regimen should be performed twice daily. The regimen starts with washing the face. Clean skin is healthy skin. Brushes like the Clarisonic Pro can be used to more effectively remove oil, dirt, debris, or makeup. Next is a toner, which helps close pores and prepares the pH of the skin for the subsequent steps. After this, vitamins, nutrients, and growth factors are added, for example vitamin C serum or Skin Medica's TNS Essential serum. Eye creams are also applied here. The following step is when a variety of other products can be added, prescription or non-prescription. These include exfoliants such as salicylic acid, acne products such as benzoyl peroxide, steroid creams, antibiotic creams, bleaching agents such as hydroquinone, kojic acid, or licorice extract, and retinoids (nighttime only). The regimen concludes with a moisturizer followed by sunscreen with SPF of at least 30 and UVA and UVB protection (daytime only). Determine the best regimen for you, stick to it, and look forward to looking and feeling your best!

What is your skin type?

The Fitzpatrick skin type scale was developed in 1975 by Dr. T.B. Fitzpatrick in the Department of Dermatology at Harvard University. There are six types, numbered in Roman numerals from I to VI. Type I is the fairest and type VI is the darkest. Red and blonde hair with freckles and blue eyes are common in lighter skin types while black hair and dark brown eyes are common in darker skin types. It is based not only on the color of the skin, but more importantly, the reaction of the skin to sun exposure. This scale is important when considering procedures because darker skin types have a propensity for a phenomenon called post-inflammatory dyspigmentation, which is a change in color after inflammation caused (in this case) by a procedure. For example, procedures such as chemical peels, laser resurfacing, or dermabrasion have the potential to cause color changes in dark skin types. One way to reduce the possibility for this is to use bleaching agents such as hydroquinone for 4-6 weeks prior to the procedure and continue for several weeks after the procedure.

Type I: very fair, always burns, never tans

Type II: fair, burns easily, sometimes tans

Type III: light olive, rarely burns, usually tans

Type IV: olive, rarely burns, always tans

Type V: brown, rarely burns, tans profusely

Type VI: dark brown, never burns, tans profusely

What is a photofacial?

A photofacial is a simple procedure where a laser or light-based device is used for color correction. It works great for dark spots, freckles, and generalized redness. It uses the same principle as laser hair removal, so you may experience hair loss in the area (good or bad). It works especially well when used in combination with bleaching creams such as hydroquinone.

Also, a photofacial is not necessarily limited to the face. It can be used on other areas with age spots or dark spots such as the backs of the hands and arms or upper chest, just about anywhere with undesired pigmentation.

Be sure to consult with a doctor if you have suspicious moles in the area so a potential cancer will not be affected.

A E Skin Ultimate Rejuvenation

The A E Skin Ultimate Rejuvenation is a new and exciting combination laser therapy designed by Dr. Alex to provide improvement for many different aspects of aging all performed in one session. The treatment is customized for each person. It starts with an IPL Photofacial using Broad Band Light which primarily targets dark discolorations as well as  rosacea and generalized redness, but is also useful for closing enlarged pores, improving the radiance of the skin, and stimulating collagen production. The second step, which is done with lighter skin types, is the Skin Tightening. A different laser is used at low settings but with a rapid repetition rate to heat up the skin. This stimulates collagen production to improve fine lines, wrinkles, and laxity. The next step is a Micro Laser Peel. Using a third laser, this step removes a thin layer of dead skin cells from the surface of the skin to provide a smooth texture and replaces dull skin with glowing skin. The fourth step is the Pro Fractional Therapy, which uses the same principle as the Micro Laser Peel but with significantly greater depth and without treating the entire surface. Only a small fraction of the skin surface is treated and the surrounding untreated areas allow for rapid healing with minimal down time. The depth of this step is customized for each person and it is outstanding for deeper wrinkles and acne scars. The final step is optional and useful for dark discoloration; this is a hydroquinone treatment. This liquid brightening agent is applied to the skin just like a chemical peel but is more potent than a topical Brightening Cream because it penetrates to a greater depth after the Pro Fractional Treatment. Women who are pregnant or breast feeding should not be treated. The Ultimate Rejuvenation treatment is now available at A E Skin. Contact us for a free consultation to determine what is best for you.

The Truth about Natural Skin Care Product Ingredients

Natural and botanical skin care products have become very popular in recent times because many think that the do not contain synthetic chemicals and provide benefits superior to products produced in a laboratory. Many people are surprised to hear that many of these products undergo a significant amount of chemical processing before they are incorporated into skin care products, which affects their activity. Additionally, there are many things that occur in nature that are dangerous when applied to the skin, for example poison ivy.

 

Many so called laboratory grade products, both prescription strength and over-the-counter strength, are originally discovered  in naturally occurring products. For example, retinoids such as retin-A and retinol are vitamin A derivatives. Hydroquinone, the strongest available brightening agent, is found naturally in coffee, beans, beer, wine, and vegetables; we consume it daily. Other naturally occurring skin care product ingredients include glycolic acid, salicylic acid, vitamin C, vitamin E, ferulic acid, and hyaluronic acid.

 

The most important difference between natural or botanical products and those developed in a laboratory is the consistency of the active ingredient. Laboratories have very sophisticated testing measures to ensure that the product is both pure and free from contaminants and at the exact strength required. There is a high degree of variability of active ingredients when they are derived from plants. This is due to inconsistencies in the plant source (leaf, root, fruit, etc.), growth conditions (soil, water levels, climate, etc.), harvesting conditions including transportation, and preparation method (crushing, boiling, distilling, etc.).

 

Another important difference between plant derived skin care products and those produced in the laboratory is that plant contain many other ingredients in addition to the active ingredient, some of which may not be beneficial. Laboratory grade products are pure and contain no other ingredients except those required for stability or cosmetically pleasing effects.

 

Finally, there is a tremendous amount of data to back products that are produced in the laboratory. This is due to rigorous testing requirements set forth by the FDA. For instance, some of these required tests compare patients who use the product with those that do not. Additionally, the products are tested to make sure they do not cause allergic reactions. It usually takes a few years before a product is approved by the FDA. Botanical products are not subject to these testing requirements and often there is little to no evidence that they actually work.

 

Be sure to understand the difference between "natural" ingredients and laboratory grade ingredients when choosing skin care products. Contact Dr. Alex (818-835-1833 info@aeskin.com) for a free consultation.

Fitzpatrick Skin Type Classification System

The Fitzpatrick skin type is a classification system designed by Dr. Thomas Fitzpatrick of Harvard University in 1975. A person's Fitzpatrick skin type is determined primarily by the skin's reaction to the sun and secondarily by the person's genetic background and natural skin color. It is used to predict the possibility of adverse effects following any type of treatment. For example, people with higher skin types have an increased risk for developing dark discoloration after procedures such as chemical peels and laser resurfacing. These risks can be minimized by pre-treatment and post-treatment with brightening agents such as hydroquinone, kojic acid, azeleic acid, arbutin, and licorice extract. The classification system is shown below on a scale of I to VI with type I being the fairest and always burning but never tanning after sun exposure and type VI being the darkest and never burning but always tanning after sun expoure. Patients with lighter skin types tend to have blonde or red hair and blue or green eyes, and often have many freckles. Patients with darker skin types tend to have black hair and dark brown eyes.

Post Inflammatory Hyperpigmentation

Post inflammatory hyperpigmentation (PIH) is a term used to describe the dark discoloration that can occur on the skin after a variety of cosmetic (or other) treatments such as laser procedures, chemical peels, and injections. PIH can also occur after other things such as cuts, burns, and sun exposure.

It is important to understand the difference between PIH and scarring, as they are commonly confused. PIH is a pigment change in the skin caused by certain cells called melanocytes. Scarring, on the other hand, is the formation of abnormal collagen in the skin. When touching a scar, you can feel an elevation or depression in the skin or a difference in the texture. This is not the case for PIH, where the skin remains flat and smooth. The reason to differentiate scarring and PIH is because the treatments are different.

PIH tends to occur on those with darker skin, namely those with Fitzpatrick skin types IV - VI. These skin types are common in certain groups such as Africans, African-Americans, Hispanics, Asians, Middle Easterners, and Mediterraneans. For this reason it is recommended that these people start a skin care regimen for several weeks prior to cosmetic treatments to minimize the risk of PIH. Recommended skin care products include brightening creams, exfoliants, antioxidants, and sunscreens. Without pre-treatment the risk for PIH is higher.

Fortunately PIH is temporary and treatable. It will usually go away on its own and the length of time it takes for this varies from person to person but can range anywhere from one week to over one year. Treatment for PIH includes a skin care regimen with brightening creams to lighten the discoloration. These products usually include ingredients such as hydroquinone (the strongest), kojic acid, alpha-arbutin, azeleic acid, and licorice extract. Sunscreen use with SPF at least 30 with UVA and UVB protection is mandatory to prevent the discoloration from becoming worse. Retinoids, antioxidants, and other products may be added for further benefit. Treatments such as photofacials, fractional lasers, and chemical peels may also help. The best way to treat PIH is by preventing it in the first place; this means knowing your Fitzpatrick skin type and getting on a good skin care regimen for several weeks prior to cosmetic treatments.

Minimizing Risks for Those with Dark Skin Getting Cosmeteic Procedures

Cosmetic procedures are performed on people with all skin types. Those with darker skin have specific concerns and at the same time specific risks. Such people can get darkening of the skin, or hyperpigmentation, after various insults including sun exposure, acne blemishes, cuts, burns, and even cosmetic procedures. This results in discoloration and an uneven skin tone. These are among the top reasons why people with dark skin see cosmetic physicians. Using brightening agents and other products for several weeks prior to cosmetic procedures minimizes the risk for hyperpigmentation after the procedure. Brightening agents include hydroquinone, kojic acid, alpha arbutin, and licorice extract. Other agents include retinoids such as retin-A, hydroxy acids such as glycolic acid, antioxidants such as vitamin C, and sunscreens. Some of these are available by prescription only while others are available over the counter; and certain products should not be used in women who are pregnant or breast feeding. See a doctor to see what's best for you.