How-to: Pigment Treatment Protocol for Fitzpatrick Skin Type III

Editor's note: As always, Skin Inc. magazine recommends that skin care professionals obtain the proper training before offering any new treatments in their skin care facility.

This client is 50, of Japanese decent, and suffers from a post-inflammatory hyperpigmentation (PIH) condition. It is important to note that Asian skin is prone to sensitivities and irritation, and is genetically predisposed to scarring because the skin has a thinner stratum corneum. This unique global skin type is also at high risk for hyperpigmentation; therefore, careful selection of professional products is prudent. With skill and appropriate product selection coupled with depth of knowledge for the Asian global skin type, success can be achieved. Although many pigment injuries can take weeks and months to resolve, a minimum of eight treatments is recommended. This is a very stubborn and challenging skin condition, and you may not see improvement until the sixth treatment. Hyperpigmentation is a permanent injury to the melanocyte cell and can reappear in as few as eight days if treatment and professional products to treat the condition are suspended.

Skin must be pre-treated with home-care maintenance for up to 16 weeks, depending on skin of color type and pigment morbidity propensity. Also, it is very important to monitor your client, carefully examining the skin with a Wood’s lamp before each treatment. This will assist you in determining how much of the transient pigment is under control.

Cost: $95–125

Duration: 45 minutes

Contraindications: Contraindications of a chemical treatment on any skin type should always be a consideration when implementing application. Every esthetician who uses peeling modalities on a regular basis in their treatments must develop specific guidelines and techniques to avoid PIH, irritation and discomfort and understand all risks. Serious complications are extremely rare, usually only occurring after the deep chemical peels.

Supplies and equipment needed:

Soft, nonabrasive cloth

Cotton pad

4 x 4 gauze applicator

Large cotton-tip applicator

Products needed:

Creamy noncomedogenic cleanser

Hydrating rinsing mist

Salicylic exfoliating cleanser

AHA pre-treatment solution

Tyrosinase pigment cell clarifier

Gel lactic 30% solution

Gel cooling mask

Tyrosinase skin-bleaching fluid

Antioxidant serum

Retinol serum

Hydrating ceramide serum

Stem cell serum

Hyaluronic acid gel

Anti-inflammatory aloe cream

SPF 30 sunscreen

Camouflage makeup with SPF protection

Step 1: Remove all makeup from the facial skin using a creamy noncomedogenic cleanser. Using efferlauge strokes, cleanse skin and follow with a thorough removal of decayed dermal debris using clean, tepid water and a soft, nonabrasive cloth. Avoid too much irritation.

Step 2: Spray cleansed area with a hydrating rinsing mist.

Step 3: Apply a salicylic exfoliating cleanser to the entire face and chest. Remove cleanser with clean tepid water and a soft, nonabrasive cloth.

Step 4: Spray skin with hydrating mist to ensure all traces of cleanser have been flushed from the skin.

Step 5: Using a cotton pad, apply an AHA pre-treatment solution to the cleansed area. Do not scrub the skin; instead, gently and thoroughly saturate fatty acids on the skin surface. Allow fluid to dry thoroughly.

Step 6: Spread a generous amount of a tyrosinase pigment cell clarifier over the entire area. Be sure all areas to be treated are completely coated.

Step 7: Using a 4 x 4 gauze applicator, spread a gel lactic 30% solution evenly across pigmented facial zones. Leave this solution on the skin for no more than one minute. Neutralize the solution with cool water and thoroughly flush all traces of the product from the skin using clean gauze. After the third treatment in the series, graduate to lactic 50%, carefully following the instructions on the product. (Editor’s note: Before using these percentages of acids, you must confirm with your state’s rules and regulations that it is within your scope of practice to do so. It varies from state to state. Log on to www.SkinInc.com/education/statelicensing for complete contact information for each state’s board.)

Step 8: Spray the skin again with hydrating rinsing mist.

Step 9: Apply a gel cooling mask for five minutes.

Step 10: Saturate a large cotton-tip applicator with tyrosinase skin bleaching fluid and apply on dark pigmented areas. Your goal here is to accelerate the lightening of the darker areas to match the normal value of the skin.

Step 11: Using the fingertips, coat skin with a generous amount of antioxidant serum over the bleaching fluid.

Step 12: Follow with an application of a retinol serum all over the face.

Step 13: Using the fingertips, spread a minimum of 3–5 drops of a hydrating ceramide serum over the entire affected facial area, including the neck. Wait two minutes before the next application step to stabilize the inner cellular substances of the stratum corneum. It is normal for the skin to feel some stimulation after this step and your client may remark that stinging is occurring. Stimulation from AHAs or any peeling agent subsides within a few minutes after applying cool or cold water to the skin during removal; however, in the event of persistent irritation (which is rare), application of an aloe cream or ice is recommended.

Step 14: Using the fingertips, apply a stem cell serum followed by an application of a hyaluronic acid gel over entire treated area.

Step 15: Spread a thin coat of a light anti-inflammatory aloe cream over treated skin.

Step 16: Apply a retinol cream over the entire face using your fingertips and gently massage it into skin until it disappears.

Step 17: Apply a generous amount of SPF 30 over the entire face and neck area.

Step 18: Complete the treatment by applying skin camouflage makeup with SPF protection. The client should avoid direct contact with sun, and always wear a hat or carry a parasol when outdoors.