Skin Hyperpigmentation, Photoaging, Hair Loss Flashcards
Signs and Symptoms: Hyperpigmentation
Persistent macular discoloration
- most common on face or other sun exposed area
Ephelides (Freckles)
- uneven skin pigmentation first appear in childhood and worsened by sun
Melasma (Chloasma)
- macular hyperpigmentation often associated with pregnancy (mask of pregnancy) or birth control use
Lentigines
- appear at any age anywhere on skin
- solar or senile lentigines (age spots or liver spots)
Treatment of Skin Hyperpigmentation
- Goal of treating skin hyperpigmentation
- Topical skin-bleaching agents (hydroquinone) with or without alpha-hydroxy acid (AHA)
- Avoid UV radiation
- Use sunscreen agents and protective clothing
Exclusions for Self-Treatment: Hyperpigmentation
- < 12 years of age
- Hyperpigmentation of large BSA
- Disease-induced or drug-induced
- Lesions that are changing in shape or color
Hydroquinone (MOA, Admin., AE, Pt skin type)
- FDA approved for nonprescription use: 1.5-2%
- MOA: selectively damages melanocyte membrane
Administration Guidelines
- twice a day on clean dry skin, maintenance once or twice daily
- apply before any moisturizers or other products
- on reaching desired skin tone use prn
- if no improvement within 2 months, dc and f/up with PCP
Adverse Effects
- mild tingling or burning
- do sensitivity test
- watch for hypopigmentation
Patient’s Skin Type
- cream base for dry skin
- lotion for normal skin
- gel for oily skin
Synthetic Oligopeptide (MOA, adv.)
- 0.01% improves hyperpigmentation
- MOA: similar to hydroquinone, inhibits tyrosinase
- Advantages: well tolerated, less toxic than hydroquinone
- Not approved by FDA, available as Lumixyl
- Apply pea size amount bid with results in 8-16 weeks
Kojic Acid (MOA, AE)
- Derived from certain fungus species usually found in cosmetic products
- (1% - 4%) is combined with AHA’s +/- hydroquinone
- MOA: inhibits production of tyrosinase
- Adverse effects: include contact dermatitis, erythema
- KA 2% + glycolic acid 10% has similar results to hydroquinone 2% + glycolic acid 10%
Rucinol (MOA, extra)
- MOA: a resorcinol derivative that inhibits both tyrosinase and tyrosinase-related protein-1 (TRP-1), an enzyme used in
melanin synthesis - Application: several studies show that rucinol 0.3% serum or cream, applied bid for 8-12 weeks improved pigmentation
- Tolerated well, but expensive. 30ml serum costs $139
Tranexamic Acid (MOA, extra)
- MOA: inhibits UV-induced plasmin activity which leads to decreased tyrosinase activity in melanocytes
- Some studies show improvement in hyperpigmentation within 12 weeks
- Studies have looked at topical, IV and oral forms
- Used as adjunct ingredient in some OTC serums, can cause local irritation
Mandelic Acid and Niacinamide
Mandelic Acid
- Type of AHA, derived from almonds, works well for hyperpigmentation. Combined with salicyclic acid and used as peel, it has less side effects than a glycolic acid peel with better results
Niacinamide
- A vitamin B3 derivative which works by inhibiting transfer of melanin to keratinocytes. Similar to Niacin with mild side effects
Patient Education & Counseling: Hyperpigmentation
- Lighten only hyperpigmented skin
- Use of broad spectrum sunscreen + protective clothing
- Results may take up to 3 months, however follow up with PCP if no improvement within 2 months
- Referral to primary care provider
Signs and Symptoms: Photoaging
Skin color changes
- yellow color, discolorations, distended capillaries
Surface texture changes
- loss of smoothness, collagen and elastin, dry coarse skin
Functional capacity changes
- sebaceous glands break down, enlarged pores
Treatment of Photoaging
Prescription drugs
- tretinoin, adapalene and tazarotene
Cosmeceuticals
- AHAs, BHAs, Kinerase, vitamins A, C, B3, E and coenzyme Q10 products
α-Hydroxy Acid (AHAs): Indications, AEs, Product selection
Indications
- melasma, acne, solar lentigos and photoaging
Adverse effects
- mild stinging, burning and dryness, Polyhydroxy Acids are new generation of AHA’s with less irritation and similar results
Product selection guidelines
- creams for dry skins
- lotions for combination or normal skins
- gels or solutions for oily skins
- Cosmetic Ingredient Review Expert Panel, says AHA’s in cosmetic products are safe if <10% concentration and the final pH => 3.5
β-Hydroxy Acids (BHAs)
Salicyclic acid
- most common
- less soluble in water than a-hydroxy acids
- may be beneficial to acne prone skin
Kinerase (N-furfuryladenine)
Antiwrinkle product
- treat wrinkles, blotchiness & dryness
- expensive product
Retinol & Retinaldehyde (Vit A Derivative)
Retinol
- Added to many skin care products, MOA is a two step enzymatic process that converts it to retinaldehyde then retinoic acid
Retinaldehyde
- Well tolerated, similar effects to tretinoin, however very unstable and on light exposure degrades to inactive form
Ascorbic Acid (Vitamin C)
- MOA as an antioxidant, removes free radicals
- Has potential to be used topically for prevention and correction of human skin aging
- May have photoprotective properties
Idebenone
- A synthetic derivative of Ubiquinone (coenzyme Q10) with potent antioxidant properties
- MOA: quenches free radicals in the epidermis and has a beneficial effect on preventing and/or reversing photoaging
- Found in cosmetic creams and lotions promoted as anti-aging and/or antioxidant properties
Patient Education & Counseling: Photoaging
Skin protection
- avoid peak sun exposure, use UVA/UVB sunscreen of at least SPF 30
Good skin hygiene practice
- prevent dry skin, cleanse with mild soap or a soap-free cleanser
Use of an α-hydroxy acid product
- start at hs, qod for 7 days, then use bid as tolerated
- results seen in 2 months, sometime as early as 4 weeks
Signs and Symptoms: Hair Loss
Androgenetic alopecia
- family history, non-scarring, - gradual hair loss
Alopecia areata
- patchy hair loss, pre-existing disease eg diabetes
Telogen effluvium
- diffuse hair loss, metabolic/hormonal disturbances
Exclusions: Hair Loss
- < 18 yrs age
- no family history of hair loss
- sudden or patchy hair loss
- autoimmune disease or skin infections
- postpartum women with hair loss
- scaling, sunburn, or other damage to scalp
Minoxidil (Indication, AE, Contra, Drug Interactions)
At least 4 mo for hair growth, refer after 4-6 mo
Indications
- Minoxidil 2%, 5% solutions and 5% foam products (MEN)
- Minoxidil 2% solution and 5% foam products (WOMEN)
Adverse effects
- local itching or irritation
- with long term use possible transient hypertrichosis
Precautions/Contraindication
- scalp damage, pregnancy, cardiovascular disorders
Drug interactions
- Avoid with topical corticosteroids, retinoids, petrolatum
Patient Education and Counseling: Hair Loss
Non drug options
- camouflage, hair transplants
Minoxidil use with expectations
- use for at least minimum recommended period
- use continuously for best results
Referral to a primary care provider
