Treatments to reduce dark spots and lighten the complexion are often sought by patients worldwide. Dr Daniel Sister looks at the causes of pigmentation and ingredients that offer results
A new trend has been observed recently. If people were looking for extreme suntan before, the new interest is in skin whitening. In Western culture tanned skin is the signature of vacation time, and is still considered desirable, but the increased risk of skin cancer due to sun exposure and subsequent press coverage is changing mentalities.
In Eastern culture, beauty is associated with a bright, light complexion. In the past years we have seen an explosion of skin bleaching products without any consideration for the medical implications. As a result reports about the toxicity and carcinogenicity have been issued and in many parts of the world, ingredients such as corticoids, hydroquinone and mercury derivatives are banned in skin whitening formulations.
In medical literature there are mentions of vitamin A and C, citric acid, flavonoids, amino acids being suitable for skin lightening, however most are unstable and can be an irritant to the skin.
Different facial skin abrasive techniques such as chemical peelings, laser and LED can be efficient but include down time.
Human skin colour is mainly regulated by the mechanism of the tyrosinase enzyme involved in melanin production. Melanin is produced by melanocytes cells in a melanogenesis process which involves small membrane-bound packages called melanosomes. Once they become full of melanin, they move into the slender arms of melanocytes from where they are transferred to keratinocytes. Under normal conditions melanosones cover the upper part of keratinocytes in order to protect them from DNA damage occurred by sun exposure.
The colour of normal skin is the result of a constitutive pigmentation and optional pigmentation (depending on the UV irradiation). It results from the superposition of four main colours:
• yellow carotenoids;
• red oxyhemoglobin of dermal capillaries;
• blue reduced hemoglobin from dermal venules;
• brown melanin present in keratinocytes
The difference in skin colour between lightly and darkly pigmented skin is due to the quantity of eumelanin (brown black polymer) and pheomelanin (yellow to red hue). Tyrosinase is required to produce melanin pigment in melanocytes from the amino acid tyrosine.
Glutathione is a tripeptide consisting of cysteine, glycine, and glutamate and functions as a major antioxidant. It is synthesised endogenously in humans. Glutathione protects thiol protein groups from oxidation and is involved in cellular detoxification for maintenance of the cell environment. Reduced glutathione (GSH) has a skin-whitening effect in humans through its tyrosinase inhibitory activity.
The problem is that glutathione is a big molecule and can’t penetrate the skin as a cream, gel or serum. Many foods we eat contain glutathione, however to achieve lighter, brighter skin it has to be injected. Mesotherapy is the best method of delivery, and I use Surface White, injecting 0.02 ml to 0.05 ml of drug solution, perpendicular to the skin given a 4 mm deep injection with an interval of 5 mm between each injection.
Another important ingredient is gamma-amino-butyric acid (GABA). It is the main whitening product in both Surface Serum and Surface Cream—part of the Whitebox treatment. It is a safer and more natural alternative to other bleaching agents which can have serious side effects. The GABA molecule is an amino acid naturally synthesised by the human body. Is has shown many positive effects on human health, and specifically on skin rejuvenation.
Folic acid will also help to improve the skin tone and quality as proven by a study where topical application of a folic acid and creatine-containing formulation significantly improved firmness of mature skin in vivo. Treatment of fibroblast-populated dermal equivalents with folic acid and creatine increased collagen gene expression and procollagen levels and improved collagen fiber density, suggesting that the in vivo effects are based on the overall improvement of the collagen metabolism.
Sometimes referred to as the “youth molecule” for its age-defying properties, superoxide dismutases (SOD) is believed to be one of the most powerful antioxidants known to science. SODs naturally exist in your body, but their numbers become depleted as we age.
Researchers believe that much of the damage that occurs to skin, including sun damage, fine lines, wrinkles, age spots, and sagging, are caused by the continuous destructive action of free radicals.
In 2004, researchers studied SOD on breast tissue. A total of 44 patients who had gone through breast radiotherapy for mammary cancer (radiation produces many free radicals) were treated with an ointment that contained SOD for 90 days. The ointment was found to reduce radiation-induced fibrosis—scarring. The SOD stopped the free radicals from damaging the skin connective tissues, resulting in a more normal regeneration of skin without scarring.
In 2001, researchers studied SOD in the laboratory, observing its effect on myo-fibroblasts, which are key components in creating skin fibrosis, or scarring. After treating skin in the lab with SOD, researchers found that SOD seemed to reverse myo-fibroblasts into normal fibroblasts, resulting in a more normal, even skin structure.
Dr Beilin in Paris conducted a study, using the Whitebox treatment system, which incorporates Surface White, a mesotherapy product containing glutathione, and Surface Cream and Surface Serum which contain 3% and 10% GABA complex respectively. Products were used twice daily with 20 women using GABA 3% and 21 women using GABA 10%, with once weekly mesotherapy sessions for five weeks. She concluded that mesotherapy alone is efficient, and the Surface Whitening protocol also incorporating the dermal cosmetics with GABA complex, demonstrated significant results on skin whitening and on dark spots reduction. To optimise the facial skin whitening effect, mesotherapy for five weeks should be combined with two months of twice daily application of GABA complex.
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