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4/2/20
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C I R C A D I A ® 2020
Pigmentation DisordersCauses and Treatment
Circadia by Dr. Pugliese
Michael Q. Pugliese
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Skin Color is a Composite
Skin color is made up of four compounds
1. Hemoglobin (oxygenated red blood cell)2. Hemoglobin (non-oxygenated red blood cell
(yellow pigment)4. Melanin (brown to black pigment)
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How We View Skin Color
All skin colors are seen as reflected light.
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The Melanocyte and Pigment
To understand pigmentation disorders you must understand the melanocyte.
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The Melanocyte
Dendrite
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The Melanocyte
• A melanocyte unit (MU) is defined as one melanocyte + 36 Keratinocytes = 1MU • There are about 2000 MU /mm2 in the face
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The Melanocyte
Melanocytes make melanin. But how is melanin made?
Step 1: All melanin starts from the amino acid, tyrosine.
Step 2: Tyrosine is converted to melanin by enzymes.
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The Dark Pathway
Tyrosinase acts here and here
Eumelanin
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Two Types of Pigmentation
1. Constitutive – natural, pigment generated without exposure to UV hormones
2. Facultative – induced pigment that results from UV hormones, inflammation
Two Types of Melanin
1. Eumelanin
-brown or black pigment (dark skin) resistant to most chemical treatments
-absorbs UV and visible light wave lengths as a protective mechanism
2. Pheomelanin
-yellow or red pigment (irish, blond)
- produces more free radicals & can worsen effects of UV exposure
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To Summarize
The melanocyte takes an amino acid called tyrosine and through the action of an enzyme called tyrosinase converts it to a new compound which is then made into melanin by the action of more enzymes.
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So what is next?
Once the melanin has been produced, next the cell must form little packets called melanosomes. Melanosomes are the melanin granuals that must be transferred to the kerationcyes to be utilized for sun protection.
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A very important point
Melanosomes must be transferred to the keratinocytes, in order for skin to have color.
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What is phagocytosis?
Phage Greek word meaning to eat… +cyto meaning cell + osis meaning processSo it means: the process of a cell eating something. Macrophage comes from the same root.
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Melanogenesis
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Cornified cell
Granular cell
Spiny cell
Basal cell
Desmosomes
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Why Skin Colors Differ
• The size and number of melanosomes…Dark skin has big melanosomes andmore of them. 0.5 to 0.8 u
Light skin has smaller melanosomes and less of them.
20 per cell
200 per cell
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Why Skin Colors Differ
• Four types of melanosomes:
• Type I -spherical without melanin ( T-)• Type II- oval with minimum melanin (T+)• Type III- oval with high melanin content (T+)• Type IV- oval dense melanin (T-)
T= tyrosinase positive or negative
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Type I
White, very fair; red or blond hair, blue eyes; freckles.
Always burn, never tans.
Type II
Fair skinned; blue, green or hazel eyes; blond or red hair.
Burns easily.
Type III
Cream White; fair with any eye or hair color; very common type.
Sometimes burns, gradually tans.
Type IV
Mediterranean Caucasian skin, medium to heavy pigment.
Rarely burns, gradually tans.
Type V
Mid Eastern skin type; rarely sun sensitive.
Tans.
Type VI
Black Skin, rarely sun sensitive.
Tans well.
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Summary
• Melanin is polymerized and packed into melanosomes.• Melanosomes are transferred from the melanocyte
to the keratinocyte by dendrites.• Skin color is determined by the size and the
number of melanosomes in a cell.
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Common Triggers• Pregnancy• Menopause• Birth Control Pills• Medications/Illness• Internal Inflammation• Stress• Sun exposure • Heat • Inflammation
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Prevention and Treatment
ProtectionTyrosinase/Melanin formation Inhibitors
ExfoliationInhibiting Inflammation
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Common Skin Lightening IngredientsHydroquinone
- Tyrosinase inhibitor - Inhibits cell metabolism by affecting RNA & DNA synthesis = cytoxic effects to cells- Safe at 2%
Azaleic acid- Naturally occurring dicarboxylic acid obtained from pityrosporum ovale = a live organism known to discolor skin- A weak tyrosinase inhibitor- Has antiproliferative and cytotoxic effect on melanocytes
Kojic acid
- Fungal metabolic product that inhibits tyrosinase - Highly sensitizing, irritating
- May cause contact dermatitis- As effective as hydroquinone but more irritating - 1%-3%
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Arbutin- Glycocalated (sugar) from of hydroquinone found in plants - Tyrosinase Inhibitor
Black Cohosh - has been shown to block melanocyte receptors from receiving alpha-MSH signals from keratinocytes
Glabridin- An ingredient in licorice extract - Inhibits tyrosinase activity w/o toxicity - Anti-inflammatory properties
Vitamin C- Weak tyrosinase inhibitor
- Can increase collagen production by 25% in 72 hours- Also decreases inflammation
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Acerola Cherry and Bearberry extract – natural skin lighteners that work by blocking tyrosinase activity.
Wheat Germ extract – induces melanocytes to produce more pheaomelanin, the red/yellow melanin.
Plum extract - shown to BLOCK the transfer of melanin from the melanocyte into the keratinocyte.
Niacinamide- melanosome transfer inhibitor.
Mandelic Acid- moderate tyrosinase inhibitor, also has antimicrobial and keritolyticeffect.
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Skin lightening agentsBeta-White (active INCI: Oligopeptide-68): Reduces MITF factor to decrease constitutive and facultative pigmentation pathways. Decreases tyrosinase activity and melanin synthesis to reduce overall skin pigmentation.
Chromabright (Dimethylmethoxy chromanyl palmitate): lightening effect (lipotec) likely inhibits tyrosinase in mechanism similar to ascorbyl palmitate
SymWhite (active INCI: Phenylethyl Resorcinol): Tyrosinase inhibitor
Alpha-Arbutin: tyrosinase activity inhibitor
Sepiwhite MSH (active INCI: Undecylenoyl phenylalanine): alpha-MSH antagonist bind MC1-R
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BV-OSC (active INCI: Tetrahexyldecyl Ascorbate): likely decreases tyrosinase activity TegoPep4 even (active INCI: Tetrapeptide-30): anti-inflammatory activity that decreases tyrosinase activity and inhibits melanocyteactivationNiacinamide USP (aka Vitamin b3): tyrosinase activity inhibitor
ReguFade (active INCI: trans-resveratrol): “attenuates key steps of melanin biosynthesis”
MelFade (active INCI: Arctostaphylos Uva Ursi, magnesium ascorbylphosphate): Tyrosinase inhibitor
Tyrostat (active INCI: Rumex Occidentalis extract): Tyrosinase inhibitorMelanostatin 5 (active NCI: Nonapeptide-I): biomimetic peptide antagonist of alpha-MSH. Prevents further activation of tyrosinase and thus blocks melanin synthesis for better control over skin tone and brown spots
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a different approach
• MSH inhibiting Peptide• Blocks melanocyte cell receptors so message to begin
melanogenisis is never received
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Solar Lentigines (photo damage)
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Sun induced carcinomas
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Melasma
Note areas over nose and cheeks
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ochronosis
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Hypopigmentation Causes
No melanocytes
Genetic, autoimmune, infection. Etc
Enzymatic defects
No tyrosinase, little tyrosinase, or melanosomeproblem.
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MandeliClear Peel - pH-3
• Self Neutralizing• Clients can expect mild to heavy peeling • These peels should not be combined with any other
treatments or services unless specified• Maximum of 3 layers
Indications:Lightening of post-inflammatory pigmentation due to: acne, melasma or photodamage, mild acne scarring. Fitzpatrick 1-5
ContraindicationsAspirin or salicylic sensitivity, pregnant or nursing, open wounds or suspicious lesions, highly sensitive skin types.
Salicylic acid 7%, Lactic Acid 7%, Resorcinol 7% Mandelic Acid 9%
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Vitamin A Accelerator
• Self Neutralizing• Clients can expect mild to heavy peeling • These peels should not be combined with any other treatments or services unless
specified
Indications: Suitable for all skin types- aging, dry, fine lines, lightening of post-inflammatory pigmentation, photo damaged
ContraindicationsVitamin A sensitivity, pregnant or nursing, open wounds or suspicious lesions, highly sensitive skin types. Retinol 2.5%- Promotes cell turnover, Increases collagen and elastin through fibroblast stimulation
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Australian Super-Berry Antioxidant Mask
Pepperberry - Rich in antioxidants Riberry-Contains antioxidants (vitamin E & anthocyanins) and essential minerals (magnesium, calcium, potassium). Muntries-Nourishes the skin and provides a barrier against moisture lossLactic acid- stimulates GAGS, and functions as a tyrosinase inhibitorMandelic acid- Alpha hydroxy acid with tyrosinase inhibiting properties
Indications: Dry, Dehydrated, Lackluster skin Benefits: brightening, Antioxidants, increase cell turnover, Hydration
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Vitamin C Reversal Serum
Key Ingredients:Magnesium ascorbyl phosphate 10% - Highly stable form of vitamin C, antioxidant & inhibits the breakdown of collagen Sodium hyaluronate- (multiple weight HA) binds moisture and soothesPanthenol - (provitamin B5) regenerative, soothing
Skin Type Indications: All Skin Types
Benefits: • Hyaluronic Acid Base • Highly stable form of Vitamin C • Fights free radical damage • Brightening • Firming
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Light Day Sunscreen Broad Spectrum SPF -37
Key Ingredients:Avobenzone, Octinoxate, Octocrylene - absorbs UVA & UVB rays SolaStay- award winning photo stabalizerPhytoCellTech Solar Vitis (Grape Seed Stem Cell)- regenerate, hydrate and protect against UV Damage/Oxidative damageLipochroman 6- protects cells from internal free radical damagePreventhilia- peptide that prevents damage caused by UV radiation to the DNA and proteins.
Skin Type Indications: All Skin Types
Benefits: • UVA/UVB Protection• Fights free radical damage • Hydrating • Anti-aging day cream with sun protection• Environmental protection
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Amandola Milk Cleanser
Key Ingredients:Lactic acid - Exfoliating, brightening, hydratingMandelic acid - Exfoliating, brightening, anti-bacterialOat protein- powerful antioxidant, anti-irritantSweet almond milk- nourishing and moisturizing
Skin Type Indications: Dry Dehydrated, Hyperpigmentation, Dry Acne, Aged
Benefits: • Non-foaming cleanser• Active AHA cleanser• AHA Exfoliation• Brightening• Hydrating • At home mask
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Licorice & Bearberry Brightening Mist
Key Ingredients:Extracts of Licorice, Bearberry, and Mulberry- contains natural lightening agentsBearberry leaf (Arctostaphylos Uva-Ursi) extract and magnesium ascorbyl phospate (Melfade PF)- tyrosine inhibitorMelanostatine 5- a brightening peptide which inhibits the synthesis of melanin induced by α-MSH
Skin Type Indications: Damaged, pigmentation, aging
Benefits: • Brightens • Hydrates • Protects
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Bright White Serum
Key Ingredients:Trans-Resveratrol (Regufade)- powerful skin brightenerTetrahexyldecyl Ascorbate(BVOSC)- oil-soluble Vitamin C ester that reduces melanin synthesisPhenylethyl Resorcinol (SymWhite)- tyrosinase inhibitor, skin lightener and antioxidant Marrubium Stem cell extract- activate the skins self-defense systemsTyrostat-11(Canadian plant extract)- inhibits tyrosinase, limits tanning, anti-erythemia effect, age spot reduction
Skin Type Indications: Damaged, pigmentation, aging
Benefits: • Brightens • Evens out skin tone• SPOT TREAT
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White Veil Brightener
Key Ingredients:Niacinamide- tyrosinase inhibitor, melanosome transfer inhibitorAlpha-Arbutin- tyrosinase inhibitorChromobright- BrighteningSepiWhite MSH- prevents the production of tyrosinase, regenerative, antioxidant, brighteningAminopropyl ascorbyl Phosphate- stabilized form of Vitamin C which stabilizes E and is an antioxidantB-White- to decrease constitutive and facultative pigmentation pathways.
Skin Type Indications: Damaged, pigmentation, aging
Benefits: • Brightens • Antioxidant• Evens out skin tone