Skin Hyperpigmentation + Photoaging Flashcards
What are the main agents of photoaging?
Hydroquinone (skin bleach) and AHA
What are the causes of photoaging?
- Endocrine
- Inflammation
- Trauma
- Drugs
How many melanocytes are typically found per mm^2?
800-1000
What is vitiligo?
Loss of pigment
What ingredient in self tanning products are used to increase the tanning of lightened areas?
Dihydroacetone
What is dihydoracetone used for?
Ingredient in self tanning products are used to increase the tanning of lightened areas
What are the general types of hyperpigmentation for self care?
- Freckles (ephelides)
- Age spots/liver (solar or senile)
- Melasma at centrofacail region (can occur at pregnancy)
What are ephelides?
Freckles
How does hyperpigmentation present itself?
Discoloration; more intense brown due to overactive melanocytes
Darker skin people have (more/less) active melanocytes, and vice versa with lighter skin people
more
What endocrine conditions contribute to increased melanin?
- Pregnancy
- Addisons
- Cushings
- Hyperthyroidism
- Liver changes
- Nutrition deficiency
- Dermatosis
What are the main treatment approaches for hyperpigmentation?
- Skin bleaching
- Exfoliant/chemical peel
- Certain product/drugs
- Protecting the skin
What is the main pharmacologic treatment for hyperpigmentation?
Hydroquinone 2%
How does hydroquinone work?
Decreases tyrosinase enzyme, which decreases melanin
What can you add to hydroquinone to increase its effect?
AHA, retinoin, or topical steroids
How often should hydroquinone be applied?
Twice daily
Should you apply hydroquinone before or after mosturizer?
Before
What can you expect from the first few weeks using hydroquinone?
Transient inflammation; use topical hydrocortisone to alleviate it
When should you see the doctor if you used hydroquinone?
No improvements in 3 months
Besides hydroquinone, what are some other products to help with hyperpigmentation?
Lumixyl + Kojic Acid
What are both Lumixyl + Kojic Acid MOA’s?
Inhibits tyrosine
Which treatment of hyperpigmentation is a fungus species?
Kojic Acid
Which treatment of hyperpigmentation has few AE’s than hydroquinone?
Lumixyl
Which treatment of hyperpigmentation is NOT FDA approved and is used as an off-label?
Lumixyl
What alternative agent for hyperpigmentation prevents transfer of melanin to skin cells?
Niacinamide/Niacin (B3)
How is Vit. B3 different in terms of treatment of hyperpigmentation?
Does not affect tyrosinase activity
If a pregnant pt comes up and asks if Hydroquinone is okay to use, what do you say?
Could be used if absolutely necessary (Category C), BUT best to refer to dermatologist/OB
What are intrinsic factors of photoaging?
Stuff you CAN’T control; genetics, aging, sleep, endocrine
What are extrinsic factors of photoaging?
Stuff you CAN control; environment, UVR, smoking, RX
UVA vs UVB
Which is the primary source of sunburn
UVB
UVA vs UVB
Which penetrates deeper, depletes collagen, and makes skin lose elasticity
UVA
What is the clinical presentation of photoaging?
Change in color, texture, etc. Decreased elasticity, more wrinkles
What are the treatment goals of photoaging?
- Reverse damage
2. Maintain skin from further damage
What is the most common pharmacological treatment for photoaging?
Aquaglycolic Hand and Body Lotion 14%
What are some pharmacologic treatment for photoaging?
- AHA >20%
- Safe concentration <10%?
- pH ≥ 3.5
- Combination w/ sunscreen
What is AHA (Aquaglycolic) MOA?
Exfoliates dead skin cells, increases elasticity, decreases cracking,
What is a way to improve AHA use on photoaging?
Lower pH
How should you use AHA?
Wash skin, wait 10-15 min before applying
Start QOD (night) for 1 wk, then increase to twice daily.
Make sure to use sunblock (SPF30) and moisturizer
