Age Spots, Brown Spots, Hyperpigmentation, all part of skin aging

When we are
young we see brown spots on the skin as a sign of another persons age. When we
turn into that older ‘other’ person, we want to rid ourselves of these
tell-tale signs of aging. There are definitely ways of reducing or eliminating
these age marks on our skin. Firstly we need to understand the cause of these
brown age spots. This insidious damage is caused by the sun’s ultraviolet
radiation (UVR) hitting our skin and the cascading problems that it causes. How
do we know these spots are caused by sun damage? Unless you have some medical
condition, you can easily see that they are sun damage related spots by looking
at your butt/behind/derriere. It is free of brown spots (unless you were an
avid nude sunbather). Any other area of your skin that was seldom exposed to
sun, will also be free of brown spots. The most spots will be found on the most
exposed skin – the face, neck, chest, arms and hands.

 

There is another
scientific discussion about brown spots created by the body through the
ineffectual breaking down all the components of a dead cell…creating a kind of
‘sludge’, so to speak, and this disoloured sludge creates brown marks that
cannot be removed the same way sun related pigmentation can be removed. More on
that topic in a later discussion paper.

 

What is Hyperpigmentation and who is prone to exhibit it?:

Hyperpigmentation
is characterized by large amounts of pigment changes. It is caused by inflammation. The inflammation has three primary sources: 1. Sun, 2. Acne, 3.
Skin damage/wounds.
Another cause in women is hormones which usually create temporary skin darkening as in the
‘pregnancy mask’ or also known as Melasma or Chloasma. This can also be brought
about by hormones in birth control pills.

 

All skin types and colours can be affected by excess melanin
production.
The lighter complexions show it
more readily, but even dark skin tones can show hyperpigmentation. Darker skin
tones are particularly affected by inflammation caused by acne and wounds. The
colour of melanin varies by skin type as well – it can be brown with red,
yellow or black tones. Melanin has a
mighty important role to play as a protection mechanism for the body.
It
works to:

  • Scatter
    UVA, UVB, Visible light – which means it protects us from the cell-killing
    effects of natural radiation.
  • It
    scavenges free radicals – which are constantly created in the skin by UVA
    rays.
  • It
    protects the DNA in epidermal cells – and any damage to a cell’s DNA means
    the body will usually kill off that cell.
  • It
    protects cell membranes from oxygen free radicals.
  • 1
    melanocyte can produce enough melanin to protect 33 epidermal cells. This
    1:33 ratio makes it easy to see that it doesn’t take a lot of
    malfunctioning melanocytes to create a brown splotch on your skin….

 

This is how it is produced.
In most cases, inflammation stimuli in the skin will result in a signal from
the brain that will express the enzyme tyrosinase which catalyses the
production of tyrosine into melanin granules. These melanin granules then
spread throughout the affected area of the epidermis. Typically the melanin
forms as a cap over the cell so protecting the DNA in the nucleus from being
damaged from further inflammatory actions. That is why a sun tan should be seen
as the skin protecting itself from further damage rather than as trying to make
itself look sexy…. So the main function of melanin is protection. The only
problem is that it kicks into action only after damage has occurred.
Hyperpigmentation caused by sun damage (based on life style choices in our
teens and twenties) will usually show on lighter skinned people after age 40.
Darker skin tones usually show it after age 50. Genetics also plays a role in
this phenomenon in that some people seem to be immune from some aspects of
aging while others show it earlier than usual. The inevitable is that anyone
who engaged in a lot of sun bathing or sun based activities WILL display
hyperpigmentation as they age. It is just a matter of time. Wouldn’t it be nice
to go back in time and do things differently?

 

This then leads to the question as to how to get rid of
these blotches on the skin, and how to then prevent them from re-occurring?

 

Firstly, you have to exfoliate a lot.
Melanin is produced in the lowest layer of the epidermis, so to erase the dark
spots that it has created means you have to keep exfoliating the area until all
evidence of the melanin has been removed, layer by layer, and only new, fresh,
normal-coloured skin cells are visible. Exfoliating takes time so you have to
give yourself a couple of months to see the results because the skin has to
produce new skin cells to replace those you are exfoliating. The more severe
the exfoliating treatment (like laser treatments and chemical peels) the
quicker the layers of skin are exfoliated and the faster the response time to
you showing off non-hyperpigmented skin. The dangers of these treatments are
that they can leave some skin types even more scarred, plus, a person is
immobilized for a while because the skin needs to heal and be protected. This
is what is known as down time. If you cannot afford the down time then a slower
process of using Alpha Hydroxy Acids and Retinoids/Vitamin A will be the best
course of action. See the video on exfoliation.

 

What are Alpha Hydroxy Acids and Retinoids?

Alpha Hydroxy Acids (AHA’s)
are a class of chemical compounds that may be either naturally occurring or
synthetic. They break down the bonds between dead skin cells so that they
enable faster exfoliation (desquamation) of the epidermal skin cells. As a
result of this, AHA’s have also been seen to naturally stimulate collagen and
epidermal cell growth (this is a good thing). AHA’s work best at pH levels that are lower than that of the skin.
The skin is normally between pH 4.5 and pH 5.8, so a good AHA will be between
pH 2.2 – pH 2.5 (citric) and pH 3.0 – pH 3.5 (glycolic). For home use, Citric
acids will normally be in a 15% concentration whereas Glycolic acids will be in
a 10% concentration. All AHA’s will
cause mild to moderate irritation of the skin
– and you feel it in the form
of a sting (or some people feel it as an itch). This sting will go away when
the AHA is neutralized with water. People with very sensitive skins may turn bright red for a while. If the
irritation (sting and/or redness) does not dissipate, then use cool water on
the skin and stop using the AHA.

 

Combining AHA treatments with peptides and lipids has
a great effect
on your skin by strengthening it, creating even skin tone,
protecting the skin barrier function, and lessening the appearance of wrinkles
and fine lines. Several common AHAs
include:

·      
Glycolic acid is the most
widely used of out of the group and is usually manufactured from sugar cane. It
is fairly well known and considered the most effective of the AHAs. Examples
are Age Limit
and Glyco-A-Gel.

·      
Lactic acid, derived
primarily from milk is considered to be milder and less irritating than
glycolic acid, and is therefore considered to be better for those with
sensitive skin. Its origins can be traced back to Cleopatra, who purportedly
used sour milk on her skin. Clear Skin Ultra Gel
is a combination of Lactic and Glycolic acids.

·       Citric acid from citrus
fruits, malic acid
from apples and pears and tartaric acid
from grapes are not as common but they still work well. Citric Acid also
doubles as a valuable antioxidant to protect against free radical damage to the
cell.

 

Vitamin A as used in the cosmetics industry is in the form
of retinoids.
Vitamin A has to transform into
retinoic acid in the skin cell in order to be biologically utilized. It plays various roles in the skin: 1.
It exfoliates the outer dead cells, 2. It lessens the appearance of brown
spots, 3. It increases collagen production, 4. It stimulates new cell growth
and normalizes sluggish cell growth, 5. It is a strong antioxidant.

 

Vitamin A is fat
soluble which means it can be stored in the body. This is good because it will
be available when the body needs it, but it is bad and can be toxic to the body
if too much is stored. This will not be the case with using topical Vitamin A
products, it only refers to high dosages of Vitamin A in the form of a dietary
supplement. People on Vitamin A acne treatments (e.g. Accutane/Isotretinoin)
need to be aware of that. Pregnant or breast-feeding women need to consult a
doctor, and generally I prefer they don’t use topical Vitamin A products
either.

 

There are various forms of Vitamin A used in skin care.
Retinoic acid is used in prescription drugs (like Accutane – though it has been
withdrawn from the market) for acne treatment and is readily available to the
cell and works the fastest. There are many side effects to Accutane and this is
the reason it is no longer available. Retinoic acid in a topical drug, like
Retin-A (tretinoin) is also the most readily available to the skin of all the
topicals.

 

In the cosmetics industry Retinol or Retinaldehyde is used.
It goes through a 2 step process before becoming retinoic acid in the cell so
it therefore works slower than pure retinoic acid. It is usually found in
cosmetics in concentrations of 1% or less. I can advise you as to which
concentration to use for your skin type. See Treatments and Serums.
It also has the most potential to become an irritant to your skin. Other forms of Vitamin A used in cosmetics
are much milder than Retinol.
They are Retinyl Palmitate, Retinyl Acetate,
and Beta Carotene. These will work a lot slower than Retinol as they have a 3
or 4 step process to go through before they become retinoic acid in the cell.

 

Any form of Vitamin A applied topically can create skin
irritation, so it is advisable to start slowly

(maybe once every 3 days for 2 weeks, then increase to every 2 days, and maybe
after 4 – 6 weeks, you can apply once a day). It is best to apply it at night
only. I may get you to start on a .25% retinol cream to get your skin
aclimatised to Vitamin A, and then work you up to a 1% concentration. Retinols are not recommended for anyone
with Rosacea or other vascular disorders (spider veins, redness etc). In such
cases an AHA is better, and a lactic or citric acid is better than a glycolic.
Retinoids may also dry out your skin, so ensure that you use moisturizers (like Skin Renu) with lipids
(squalane) in order to strengthen and build the skin barrier.

 

The least active form of exfoliation is a topical product
incorporating enzymes.
These enzymes catalyse the
break down of dry, dead skin cells. This is the least irritating form of
exfoliation and for people who have very sensitive skin it is the only course
of action other than doctor applied laser treatments. Enzymes are a very good
form of everyday exfoliation, and they always form part of my facial process.
However they also work a lot slower than AHA’s and reinoids, so you have to be
patient and give yourself a lot of time to achieve a more even skin tone. See
Ultra Gentle Surface Peel.

 

How do you stop hyperpigmentation from reoccurring?

First and foremost: Protect
yourself from the sun. Never suntan. Always wear a sunscreen. See the video Sunscreen: The Critical Facts as well as Sunscreen Myths.

 

Secondly: Use products
that will reduce and remove melanin from the skin. The ingredients used in the
4 step process can be as follows (note that the specific ingredient must be
present and not just the generic plant source):

  1. Suppress
    tyrosinase formation by one of the following; Kojic Acid (from rice or
    mushrooms) or Arbutin (from bearberry).
  2. Inhibit
    tyrosinase activity by one of the following; Uva Ursi  (bearberry extract), glycyrrhiza
    glabradin (licorice extract), Kojic acid (rice or mushroom extract),
    Ascorbic acid/Vitamin C (in the form of Magnesium ascorbyl phosphate or
    Sodium ascorbyl phosphate).
  3. Reduce
    melanin (bleach skin) by one of the following; high concentration
    bearberry extract, or 2% hydroquinone (4% hydroquinone is a prescription
    drug).
  4. Remove
    melanin by one of the following; Alpha Hydroxy Acids (AHA’s – see above),
    Retinoids (Retinol etc), Enzymes. See Exfoliators.

 

Thirdly: Protect yourself from the
sun. Never suntan. Always wear a sunscreen. A mineral sunscreen like Mineral Sunscreen SPF 40
and Mineral Sunscreen SPF 35 for face and body.

 

What are the dangers of this step?

You are
preventing the normal process of the skin in protecting itself against
radiation damage from the sun (UVA and UV. The skin produces melanin in order
to protect the DNA in every cell. If you take away it’s ability to do that then
the onus is on you to take on the role
of protector
. If you do not assume the role of skin protector, you could be
opening yourself up to the potential for skin cancer. Here’s what you must do:

  1. Wear
    a UVA/UVB sunscreen on
    exposed skin EVERY DAY.
  2. Do
    not sunbathe or use tanning beds.
  3. Choose
    to sit in the shade rather than in the sun.

 

A
note on Hydroquinone – USE IT WITH CARE:

  • It
    can irritate the skin – so start using it slowly similar to the way I
    recommend the slow introduction of retinoids.
  • It
    is not recommended for use in large sections of skin.
  • It
    is not recommended for use longer than 3 months.
  • No
    over-the-counter cosmetic is allowed to contain more than 2% hydroquinone.
  • 4%
    hydroquinone can only be obtained by prescription from a dermatologist.
  • In
    Europe and the UK, plus parts of Asia, Hydroquinone is banned from being
    available over-the-counter. There are also strict regulations as to how
    doctors can prescribe it.
  • Extended
    use of high dosage hydroquinone has lead to conditions where the skin
    creates very dark patches, DNA can be destroyed, tumours have developed,
    and liver damage occurs.

 

Laser and chemical peels.

These treatments
burn your skin to varying degrees. They will cause it to turn red, dry out and
flake off (sometimes in the form of large sheets of skin, sometimes as masses
of dry snowflakes). Either way, there is downtime associated with the
procedure. Depending on the severity of the procedure you may not be
comfortable going to work or socializing.

 

Laser treatments
and some deep chemical peels may only be performed by medical practitioners.
Licensed estheticians may perform lighter peels like Jessners, TCA peels,
Retinol peels and Glycolic peels. The esthetician must be trained to do these
as incorrect procedure can result in damage to the skin (as can also happen in
a doctors office). Incorrect procedure can actually result in even more
hyperpigmentation. Skin of colour has greater potential for scarring than
pale/white skin. Each client has to be assessed based on their skin colour and
strength. Each client is required to sign a form that states they understand
what they are doing and the inherent risks.

 

I have been
trained in peels by an Arizona based company PCA. See the Blue Turtle Spa menu of services.

 

The upside of
peels and laser treatments is that they produce very good and very fast results
(once the healing process is complete). They rapidly exfoliate so brown spots
disappear a lot faster. Initially brown spots may get darker – it is a concentration
of melanin in dry/dying cells. It is therefore important to use melanin
inhibitors. Laser and chemical peels also stimulate collagen production, so
having an effect of reducing wrinkles. You normally undertake a series of them.
The absolutely critical part of these treatments is to protect yourself every
day with a mineral sunscreen 
and to stay out of direct sunlight otherwise your investment of money and time
in the process of ridding your skin of hyperpigmentation, will be wasted.

 

One interesting
point to note is that the laser can be set at various intensities to perform
different tasks – and the intensity for stimulating collagen production does
not necessarily work well on reducing hyperpigmentation. There are ablative,
non ablative and fraxel lasers being used today and you need to be sure that
the doctor you are engaging is using the right laser for the job that you want
performed.

The information provided here is not meant to diagnose or cure any medical conditions.

 

Come and see us for a skin consultation and Rejuvenating facial
treatment. See treatment details at www.blueturtlespa.com.

 

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