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Best Practices in the Treatment of Hyperpigmentation
By: Ahmed Abdullah, MD
Posted: April 27, 2012, from the May 2012 issue of Skin Inc. magazine.
page 5 of 7
Niacinamide. Instead of affecting tyrosinase, niacinamide works by preventing the transfer of melanin to keratinocytes, the cells in the outermost layer of the skin. An active form of niacin (vitamin B3), it has been shown to significantly decrease hyperpigmentation,8 including melasma,9 and is associated with only mild side effects.
The effectiveness of a topical is highly determined by the vehicle that is used in the formulation. Melanocytes are located at the basal layer of the epidermis and, therefore, absorption is essential to efficacy. By combining topicals with nonablative professional procedures, such as microdermabrasion, laser skin resurfacing, intense pulsed light (IPL), radio frequency and superficial chemical peels, as well as ablative procedures, such as dermabrasion, laser treatments and medium-to-deep chemical peels, better results can be garnered more quickly. Of course, care must be used when implementing ablative procedures. Melanocytes are dendritic cells, meaning they have tentacles, or dendrites, that extend their reach. Not only can the inflammation caused by some of these procedures lead to greater hyperpigmentation, they can also disrupt dendrites, thereby re-stimulating hyperpigmentation.
Prevention is key
With all clients, especially those undergoing treatment for hyperpigmentation, a discussion about preventive measures is vital. The necessity of daily sunscreen application cannot be emphasized enough. Too often, clients are the cause of recurrent hyperpigmentation due to a nonchalant attitude toward sun exposure.
Furthermore, following treatment for hyperpigmentation, a more focused approach to daily skin care should be implemented. Clients can much better maintain the positive effects of treatment through the use of professional skin care product lines that include proven active ingredients coupled with effective delivery systems. As is recommended for all individuals, a regimen involving four steps—cleanse, exfoliate, moisturize and protect—should be standard.
1. SJ Day, Understanding Hyperpigmentation, A continuing medical education (CME) Monograph (Jan 15, 2004)
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