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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