True Confession

The People's Skincare Newsletter, Vol. 11, No. 3 August 2018

Inside this issue:

The Brown Spots of Summer

Most of this issue is devoted to unwanted pigment since it becomes most apparent towards the end of summer and continues to bother (if not plague) us throughout the year. It can manifest in a number of ways…from a mild sunburn to a full blown blistering burn, from melasma to hypopigmentation, from atrophied skin to telangiectasia. I will explain these terms because it’s helpful to see on yourself what these conditions may be and seek appropriate remedies if possible. I’m not delving into medical problems, only cosmetic ones which we hope won’t become medical issues.

Understanding Terms of Pigment

Hyperpigmentation (Brown Spots): overproduction of melanin which is your body’s natural protective substance against the sun. As per Wikipedia: “hyperpigentation can be caused by sun damage, inflammation or other skin injuries, including those related to acne. People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.”

Many forms of hyperpigmentation are caused by an excess production of melanin. Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing in the body in such places as the eyes, skin and hair. As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity and where concentration of the cells is greater, hyperpigmentation occurs.

Post-Inflammatory Hyperpigmentation: PIH is a condition in which an injury or excess inflammation to the skin causes increased pigment production. This is particularly true with darker skin types (Fitzgerald Skin Types IV, V, VI) following acne and other conditions which have healed but leave dark spots.

UVA/UVB: that’s your UVAging vs. UVBurning rays. Quoting from Dr. Peter Pugliese’s Physiology of the Skin; A Scientific Guide for the Skin Care Professional:

"One of the first visible signs of sunlight radiation damage is erythema or redness of the skin. Erythema results from dilation of blood vessels in the dermis (note: the dermis lays below the epidermis which is the outermost layer of skin) as a response to by-products of cell damage. Redness can last from a few hours to several days, this is a function of the total energy exposure."

“After irritation, cells decrease DNA production initially then increase production at a much faster rate. This is a photo-oxidation effect which is manifested by an increase in melanogenesis and an increase in melanocytes. The skin becomes darker as a result of this activity which is tanning. Tanning will occur with both UVA and UVB. There is an amount of radiation which the cells proliferate at a maximum rate and no further stimulation can produce more melanin.” In other words, you’re tanned out.

Hypopigmentation: the loss of skin color. It is caused by melanocyte or melanin depletion or a decrease in the amino acid tyrosine which is used by melanocytes to make melanin. If you notice tiny circles of white pigment on otherwise colored skin (either tanned or naturally darker pigmented), this is hypopigmentation. From a cosmetic standpoint, this can be caused by too much UV exposure so that, in essence, your melanin has protected you as much as it’s able and now it’s given up the ghost. Certain laser procedures can cause hypopigmentation as well.

Melasma: also known as the Mask of Pregnancy when present in pregnant women, it is tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy medications.

Wikipedia: “The symptoms of melasma are dark, irregular well demarcated hyper pigmented macules to patches commonly found on the upper cheek, nose, upper lip and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. It is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones.”

“Melasma is thought to be the stimulation of melanocytes by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to melasma. Genetic predisposition is also a major factor in determining whether someone will develop melasma.”

“The incidence of melasma also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks. Other rare causes of melasma include allergic reaction to medications and cosmetics.”

Atrophy: thinning or depression of skin due to reduction of underlying tissue. According to missinglink.ucsf.edu/lm/dermatologyglossary/atrophy.html:

“Atrophy of the epidermis manifests as a thin and wrinkled surface. Atrophy of the dermis or subcutaneous fat manifests as a clinically detectable depression in the skin because of loss of underlying dermis or subcutaneous fat.

Microscopically, atrophic epidermis appears thin and shows loss of dermal collagen. Fat atrophy shows loss of intracellular fat or lipid with the fat cells appearing smaller and closer together as compared to normal subcutaneous fat.”

Note: primary culprit of cosmetic atrophy: excessive UVA/UVB exposure

Telangiectasia: also known as spider veins, are small dilated blood vessels near the surface of the skin or mucous membranes. Wikipedia states: “these dilated blood vessels can develop anywhere on the body but are commonly seen on the face around the nose, cheeks and chin. Dilated blood vessels can also develop on the legs although when they occur on the legs, they often have underlying venous reflux or “hidden varicose veins”.

“Acquired telangiectasia, not related to other venous abnormalities, for example on the face and trunk, can be caused by factors such as acne rosacea, sun and/or cold exposure, age and trauma to the skin such as contusions or surgical incisions.”

OK…now if you’re still with me… Pigment issues as noted above are incredible complex and difficult to “cure”. In fact, for many pigment issues there is no cure but rather “maintaining the damage”. You can try treatments below which may yield temporary improvement but you should also be vigilant about simple skincare approaches before, during and after lasers, IPL, microneedling, etc.

Here are several medical approaches. Depending upon how much unwanted pigment bothers you and how deep your pockets are, you can try (1) laser treatments (which sadly can occasionally cause hypopigmentation), (2) Intense Pulsed Light IPL, and microneedling. Of the three, I have done IPL (both as a patient and as a practitioner) and saw satisfactory results almost immediately.

Epionce Approach to Pigment

Dr. Carl Thornfeldt, head and chief cosmetic formulator of Epionce, gave a paper in 2012 at the American Academy of Dermatology annual meeting in which the delivered the clinical assessment results of Epionce MelanoLyte Skin Brightening System vs. Obagi Nu Derm for Hyperpigmentation. Here are his introduction and summary discussion.

Introduction: "Due to the high irritation rates, photosensitivity and atrophy of the skin, many of the current therapy options for hyperpigmentation require a patient to stop use of the treatment product for a period of time. There is then a relatively high risk or recurrence of the hyperpigmentation during this time period. Patients are often unhappy with the negative side effects in conjunction with the resolution results of their treatment regime. The Epionce MelanoLyte Skin Brightening System (MSBS) was developed to help solve the problems of current regimes.

The current gold standard for hyperpigmentation is prescription 4% hydroquinone combined with tretinoin 0.05%. Ascorbic acid, exfoliants or herbal extracts are added to the above to improve efficacy and tolerance of the prescription products. One of the most popular is the Obagi Nu Derm System, a complex multi-stage regimen containing all of the above ingredients.

MSBS contains a unique blend of synergistic active ingredients, each of which individually has been found to improve the appearance of human skin in in-vivo trials. Moreover each has been compared to and shown to have superiority to the most commonly used actives. Neither product (MelanoLyte TX and MelanoLyte Pigment Perfecting Serum) contains hydroquinone, tretinoin, ascorbic or glycol acid, soy, tea, ionic acid or niacinamide. Each of the actives in the MSBS has a different mechanism of action, thus all contribute to expected improved efficacy and safety.

In a dermatologist-assessed controlled clinical trial, the concept behind MSBS was validated. The study was conducted during the winter in Colorado to maximally stress the skin for risk of reactions to the product and rebound post-inflammatory hyperpigmention.

Summary: The Epionce MSBS appears to be the first non-prescription system to directly compare itself to the Obagi Nu Derm system--the prescription gold standard for treating visible signs of hyperpigmentation. The MSBS regimen is shown to be comparable in efficacy but is overall profoundly safer. The increase in safety should allow for regular use of the MSBS, providing continued resolution of visible hyperpigmentation over the long term."

You will notice that “safety” is mentioned several times. That is because both tretinoin and hydroquinone can be highly irritating causing erythema, scaling, itching, burning/stinging, and peeling. If your doctor puts you on the regimen to improve hyperpigmentation, you will need to start the program and stop it after several months to give your skin a break from the irritating side effects. Then when you back on the regimen, the cycle starts again. In the meantime, when not using the prescription plan, your skin will continue to hyperpigment. That’s known as a Catch-22!

The Epionce MSBS plan works IF you are consistent with using the products MelanoLyte TX and MelanoLyte Pigment Perfecting Serum together for best results. Remember that this is a non-prescription medicinal-botanical approach which yields results more slowly but more safely than the typical prescription products. Improving pigment takes a lot of time and patience. With the MSBS system, you will work for the rewards but they will become noticeable and satisfying with time.

My pigment issues are primarily redness on both sides of my face. Redness, due to vascularity caused by excessive sun exposure as a child and as a moronic adult, is NOT addressed by the Epionce MSBS which works primarily on brown hyperpigmentation. Dr. Thornfeldt advised that I try the new Renewal Calming Cream and start a supplement called Quercitin which I’m pretty sure are working slowly to reduce redness. Key word is slowly.

If you’re confused about what to do about your hyperpigmentation, contact me and we can discuss. Most dermatologists stick with th prescription approach and are unfamiliar with Epionce’s non-irritating botanical regimen. One size doesn’t fit all and I will work to help with your pigment. I can’t diagnose disease of course but can refer to a dermatologist if I suspect something unusual. And as we age, more and more seems unusual!

Recent Derm. Journal Articles

“Use of OTC Lightening Agents Widespread in the US”, J. of Clinical Aesthetic Dermatology, 2018 July; Saade, et. al.

“The use of over-the-counter (OTC) lightening agents is widespread among those patients with hyperpigmentation disorders in the US according to a recent study. Furthermore those with melasma and post-inflammatory hyperpigmentation (PIH) were more likely to use an OTC cream. The study was a cross-sectional study of consecutive patients with a disorder of hyperpigmentation seen in a US-based outpatient dermatology clinic in Boston. The majority of patients studied were women with Fitzpatrick Skin Types IV to VI (medium brown to blue/black). Researchers found:

  • The most frequent diagnoses were melasma (42.9%) and PIH (33.9%)
  • Of total respondents, 51% reported use of OTC agents and 44.9% reported use of prescription lightening products
  • Hydroquinone was the most commonly used cream (59,1%) with triple combination cream (fluocinolone acetonide, hydroquinone and tretinoin)
  • After multivariable adjustment, factors associated with greater odds of sing an OTC lightening agent included a diagnosis of melasma or PIH

Note…that’s it, this study only indicates usage of OTC agents, not results of said. These patients were prescribed the most common approach to hyperpigmention, not the “slow but safe” method as presented by Epionce. Hopefully there will be a follow-up study showing results.

“Hyperpigmentation Patients: Less Sunscreen Usage”, J. of American Academy of Dermatology; ePub 2017 Feb. 15, Maymone, et. al.

“Patients diagnosed with PIH, men, and those with disease duration less than one year reported lower sunscreen usage, a recent study found. These groups might benefit from increased counseling on sun-protective behaviors. (DO YOU THINK???) Researchers conducted a cross-sectional study with 404 adults who complained of cutaneous hyperpigmentation. They found:

  • 67% reported using a product containing sunscreen and 91% endorsed using one with a SPF factor of over 21
  • Among the participants, 48.5% were not sure if their sunscreen provided broad-spectrum protection and only 7.6% reapplied every 2 hours
  • The odds of a patient with melasma using sunscreen were 6.7% times the odds of a patient with PIH using sunscreen
  • Additional predictors for sunscreen use were female sex and disease duration of over one year
  • In multivariate analysis, the odds ratio of sunscreen use among African Americans compared with white was 0.31

Note: if you “complained of cutaneous hyperpigmentation”, why would you not use a full-spectrum (UVA/UVB) sunscreen with an ingredient like zinc or titanium dioxide? People amaze me! Sometimes I use the gym in the afternoon and watch sunscreen behavior with adults and kids. Anecdotal observation: 80% spray themselves or their children with SPF immediately before entering the pool where it’s immediately washed off. Sigh. They could probably benefit from “increased counseling on sun protective behaviors.”

Other News

  • Don’t you think it’s time for an Epionce sale? I do! 10% off all products from now through August 31st. Only products in my inventory, no special orders and not available by ordering from epionce.com. Try the MelanoLyte TX and MelanoLyte Pigment Perfecting Serum or the new Renewal Calming Cream or your usual favorites!
  • This fall Epionce is poised to release a new product. Stay tuned for an announcement and a Big Surprise come November!
  • I will be on an extended solo road trip from Sept. 14 through Oct. 5 and will not be available to supply products should you need them. You can email epionce.com and use my code #20090528 to place your order. They ship for free and are prompt.

I am returning to Kentucky to pursue my interest in American whiskey (that’s bourbon and rye), stopping at distilleries in Kansas and Colorado. Once I’ve hit Kentucky, I’m going to a one-day workshop to be come a Certified Bourbon Steward, then going to the Bourbon & Beyond music festival in Louisville, followed by five days with a Road Scholar program on the bourbon industry with visits to most of the distilleries on the Bourbon Trail. Just in case this isn’t enough of a good thing, I’ll spend three days in Paducah, KY which is not only home to one of most acclaimed Kentucky restaurants with a huge whiskey collection (the Freight House, thanks Phyllis for the suggestion) but is also a designated UNESCO Creative City for for fiber arts. Total milage for this trip should be around 5,000.

But enough about ME! I hope you’re having a great summer full of adventures and lots of rest. I always look forward to hearing from you and thank you profoundly for keeping in touch.

All my best,

Susan
Peels to the People

503-781-8209
susanthompson@peelstothepeople.com

www.peelstothepeople.com