The problem of excessive pigment formation – one of the most frequent complaints with which patients come to see a dermatologist or cosmetologist. The causes of hyperpigmentation must be determined based on a detailed interview of the patient, since they can be both congenital and acquired, provoked by UV radiation, drugs and even perfumes or cosmetics, and also be the result of inflammation after chemical peels, laser resurfacing, dermabrasion and other traumatic skin procedures. The choice of tactics for the treatment of hyperpigmentation should be based on the causes of its manifestation and the individual characteristics of the patient's skin.
At present, the interest of dermatologists and cosmetologists in diseases with impaired pigmentation has increased significantly. On the one hand, this is due to the interest of researchers in the study of melanocytes as the ancestors of the most malignant skin tumor — melanoma, on the other hand, the appearance of a person is an obvious indicator of health and material well-being both for himself and for those around him, having a significant impact on the quality of life.
Excessive accumulation of melanin may be due to various factors — genetic, endocrine, metabolic, physical, medicinal, chemical, inflammatory. Hyperpigmentation can include chloasma, post-inflammatory hyperpigmentation, toxic, medicinal melasma, lentigo, ephelids, some photodermatosis, melasma caused by metabolic disorders or endocrine pathology (Addison's disease, tumors producing melanostimulating hormone, pellagra, malabsorption syndrome, etc.).
Classification of primary hyperpigmentation: nature and causes of occurrence
Hyperpigmentations can be divided into primary (congenital/acquired) and secondary (post-infectious/post-inflammatory), as well as localized and generalized according to prevalence.
Most often, patients with acquired hyperpigmentation from exposure to ultraviolet radiation (UVR) or chemical factors or their combined effects turn to doctors. In the structure of pigment-containing skin formations, the proportion of focal non-tumor skin pigmentations is 22.3%, the proportion of the most significant clinical forms such as lentigo, chloasma and post-traumatic skin pigmentation reaches 25.5%, 15.3% and 29.5%, respectively.
Chloasma — acquired uneven hyperpigmentation of dark brown color with clear boundaries in the forehead, cheeks, less often the chin. The main factors contributing to the development of chloasma are UVI and genetically determined increased sensitivity of melanocytes to estrogens. In this regard, chloasma appears during pregnancy, when taking oral contraceptives. Hyperpigmentation does not always disappear after discontinuation of the drug, residual effects may persist for quite a long time.
Freckles (ephelids) — hereditary hyperpigmentation occurs in people with I, II phototypes. These are small plentiful light brown spots on the face, shoulders, chest. They intensify in the spring-summer period, their number decreases with age.
Hormonally determined melasma (skin melanosis) is localized on the face and is a benign, but very unaesthetic phenomenon. The disease is associated with changes in the level of progesterone and estrogen in the body, it is observed more often in brunettes with skin phototype IV. As in the case of chloasma of pregnant women, the spots are irregular in shape and are located symmetrically on the forehead, cheeks, temples, chin and upper lip. Sometimes, against the background of a continuous pigment spot, small, darker rashes are observed.
Most often, dermatocosmetologists diagnose post-inflammatory hyperpigmentation after the resolution of acne rashes, the so-called "post-acne" pigmentation.
However, in practical medicine, secondary hyperpigmentation (SHP) is often encountered as a complication of chemical peels, laser resurfacing, dermabrasion, and other skin-damaging procedures that result from inflammation and/or excessive exposure to UV radiation. That is why it is necessary to avoid medium peels and resurfacing in the summer for patients with IV & V phototypes. Post-inflammatory hyperpigmentation can be prevented by pre-peel skin preparation and proper management of patients during the rehabilitation period. Also, this problem can be provoked by the use of cosmetics and medicines that have a photosensitizing effect.
Secondary hyperpigmentation as a marker of skin aging
VIV is one of the markers of skin photoaging. It is known that skin aging is determined not only by the inclusion of
programmed dystrophic changes in cells, but also the influence of the external environment, which accelerates the processes of skin aging. Along with other clinical signs of skin aging (thickening, tuberosity, yellowish tint, rough microtexture, etc.), lentiginous rashes and mottled pigmentation are observed. An interesting fact is that after reaching the age of 30, there is a decrease in the number of melanocytes by 6-8% every 10 years, but the absolute density of melanocytes in areas constantly exposed to solar radiation is approximately twice as high as in areas protected from UV radiation. An increase in the number of melanocytes in the skin irradiated with ultraviolet radiation and at the same time a violation of the transport of melanosomes to keratinocytes contribute to mottled pigmentation — photoaging marker.
Melanogenesis is one of the complex phenomena of adaptation of an animal organism to the environment. The mechanisms of melanin synthesis, as well as the regulation of the activity of pigment cells, are not completely clear, there are many hidden questions, but today it is clearly established that ultraviolet rays serve as a trigger. According to modern authors, the predisposing factors for pathological pigment formation are: in 52 & ndash; 63% of cases, excessive ultraviolet radiation, in 25 & ndash; 32% — hormonal disorders not associated with pregnancy, or inflammatory processes, and in 18 & ndash; 24% — pregnancy.
Treatment of secondary hyperpigmentations: means and methods
Methods for correcting IGP include:
- daily use of medicines or medical cosmeceuticals with a whitening effect for a sufficiently long time;
- Regular use of sun protection, even on a city day that is not very sunny;
- professional cosmetic manipulations aimed at enhancing the desquamation of the epidermis;
- destruction of melanin-containing cells.
- reducing melanin production (depigmenting drugs, mesotherapy),
- exfoliating procedures (peelings, microdermabrasion, laser skin resurfacing, cryotherapy),
- Selective photothermolysis (laser therapy, Intense Pulsed Light (IPL) therapy).
At present, there are many medical cosmetics for home care, but their effectiveness is less pronounced than hardware methods and professional procedures. Chemical peels are a method of dealing with secondary hyperpigmentation. Currently, peels with alpha hydroxy acids (AHA, alpha hydroxyl acids) — phytic, mandelic acids and retinoids. All these peels are quite effective, although there is some difference between them: retinoids give a more pronounced and faster effect, but require rehabilitation (from 3 to 7 days), while AHA, mandelic acid exfoliate gradually and gently, but require more procedures .
In addition, a comprehensive assessment of the patient's skin is necessary, for example, in case of photoaging, the median TCA (trichloroacetic (TriChloroAcetic) acid) peeling will be the most effective, in the presence of post-acne — salicylic, and with melasma — pyruvic peeling. Before TCA peeling (35%), it is necessary to use cosmetic products containing tyrosinase blockers for a month. The procedure can be one-time, if necessary, it can be repeated, but not earlier than in a month.
Contraindications for all types of peelings are fresh sunburn, pregnancy, lactation, herpes in the acute period, feverish conditions, a tendency to form keloid scars, individual intolerance to the peeling components.
One of the popular methods of injection cosmetology is mesotherapy (intradermal injection of various vitamin cocktails). In order to treat hyperpigmentation, tyrosinase inhibitors and drugs that lighten melanin are used. Vitamin C, placenta extract, linoleic, alpha-linoleic, glycolic acids, multivitamin complexes, emoxipin are used to correct pigmentation.
One of the hardware technologies used in the treatment of hyperpigmentation is cryotherapy with liquid nitrogen. In secondary hyperpigmentation, liquid nitrogen is applied directly to the area of hyperpigmentation. Its local action causes exfoliation of epidermal cells, stimulates regeneration processes. Cryotherapy can be prescribed for epidermal (pigment lies in the surface layers of the skin) age spots.
Microdermabrasion, or hardware peeling, is used to correct hyperpigmentation in aging skin prone to hyperkeratosis. The technique is also effective for post-inflammatory pigmentation after acne, where, as a rule, there is an altered skin relief. This method, unfortunately, has a number of disadvantages: postoperative infection, leukoderma, the formation of epidermal cysts and scars.
In recent years, combined methods of treatment have been considered the most successful: a combination of topical agents with various cosmetic procedures.
Laser technology is a modern highly effective method of pigment removal. The method of laser therapy for VGP is based on the phenomenon of photothermolysis: the ability of pigment cells to absorb the energy of a laser beam, which subsequently leads to their destruction.
When VGP is combined with signs of photo- and chronoaging, laser resurfacing of the facial skin (CO2 laser, erbium laser) with ablation is used or without .. In modern medicine, the method of fractional photothermolysis has gained wide popularity, in which the supply of laser radiation to the tissue is carried out by fractionation (distribution) into hundreds of microbeams that penetrate to a sufficiently large depth (up to 2000 microns). This effect reduces the energy load on tissues, which in turn contributes to rapid regeneration and avoids complications.
Thus, aesthetic medicine, which functionally unites doctors of various specialties, is actively developing today, including in terms of improving existing and developing new conservative methods for correcting a person's external data. Attempts to develop a universal method for the treatment of skin hyperpigmentation are still ongoing. A long history of therapy for aesthetic problems of pigmentation disorders has accumulated numerous methods for correcting these conditions, including a wide range of products from external applications and ointments to high-tech invasive procedures using surgical methods of dermabrasion and high-intensity laser radiation.
According to the materials of the journal “Attending Doctor”
Share:
Add a comment