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Hyperpigmentation: A Key Side Effect of Chemotherapy
By: Jennifer Linder, MD
Posted: May 28, 2013, from the June 2013 issue of Skin Inc. magazine.
The patient's skin looks visibly healthier in regular light after two months of a chemotherapy and radiation therapy support treatment. There is also a substantial lightening of underlying hyperpigmentation seen in the UV photography.
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Folliculitis is an inflammation or infection of the hair follicles. During chemotherapy, what is often identified as acne is actually folliculitis. It is believed that the drugs used during treatment cause follicular irritations, drawing leukocytes, or white blood cells, to the follicle. Folliculitis can appear on the face, the scalp or anywhere on the body, and needs to be addressed gently, because this compromised skin is hypersensitive and prone to reactions. Traditional acne treatments are too harsh for this condition and could result in greater reactivity, follicular distress and hyperpigmentation. Gentle products that reduce inflammation, fight bacteria and clear the follicles of cell debris—such as low percentage salicylic acid, azelaic acid, hydrocortisone, resveratrol, bisabolol and white willow bark—will help shorten the duration of the outbreak.
It is important to use gentle melanogenesis-inhibitors before, during and after treatment to suppress the instigation of melanogenesis and pigment deposition. Due to the fact that many of the common melanogenesis-inhibitors can be topically irritating, it is absolutely critical to only use ingredients that are not drying, stimulating or irritating once a client is undergoing cancer treatment. You must be especially careful with hydroquinone, because it is likely to irritate this sensitive, allergic reaction-prone skin.
Some effective melanogenesis-inhibiting ingredients include the following.
- Arbutin. Naturally found in wheat, pears, bearberries, blueberries and cranberries, arbutin suppresses the activity of tyrosinase and inhibits melanosome maturation.
- Azelaic acid. Naturally found in many grain products and castor beans, azelaic acid provides antiproliferative and cytotoxic effects on melanocytes—but not the surrounding healthy cells—and inhibits tyrosinase activity.
- Glycyrrhiza glabra root (licorice root) extract. This ingredient suppresses the tyrosinase activity of melanocytes without cytotoxicity.
- Kojic acid. Naturally found in soy, mushrooms and rice bran, kojic acid chelates copper bound to tyrosinase, and decreases the number of melanosomes and dendrites.
- L-ascorbic acid. This ingredient is naturally found in many botanical sources, such as citrus fruit and corn, and converts DOPA quinone back to L-DOPA, preventing melanin formation.
- Lactic acid. Naturally found in milk and sugars, lactic acid suppresses the formation of tyrosinase.
- Morus bombycis root (mulberry root or white mulberry tree) extract. This ingredient inhibits tyrosinase activity, particularly the conversion of tyrosinase to L-DOPA.
- Phenylethyl resorcinol. Synthetically produced, phenylethyl resorcinol inhibits the conversion of tyrosinase to L-DOPA.
- Phytic acid. Found naturally in various types of grains, bran and seeds, phytic acid inhibits the activity of tyrosinase while also inducing the exfoliation of superficial melanin-filled skin cells.
- Retinoids. Synthetically produced, retinoids suppress the activity of tyrosinase, decrease the amount of melanosomes and inhibit melanosome transfer.
- Rumex extract. Naturally found in various herbs, rumex extract inhibits the activity of tyrosinase with no irritation.
- Undecylenoyl phenylalanine. Synthetically produced, undecylenoyl phenylalanine prevents the synthesis of the melanocyte stimulating hormone (MSH) and, as a result, the formation of tyrosinase, melanin and melanosome transfer.
During the course of chemotherapy, clients should avoid the use of products containing dyes, perfumes or other known sensitizers. Additionally, good hydration, anti-inflammatory ingredients and topical steroids can bring relief to this severely stressed skin. Keeping inflammation in check regardless of the cause is helpful in controlling the incidence of hyperpigmentation.
Everyone should be using a broad-spectrum SPF of 30 or greater every day on any exposed skin. UV-induced inflammation is one of the primary causes of hyperpigmentation; therefore, SPF is an important addition for suppressing it, while also protecting the general health of the skin. Clients must understand that the SPF rating of a product only relates to its ability to protect the skin from UVB rays. Products should also offer protection from long- and short-wave UVA rays. With the new U.S. Food and Drug Administration (FDA) sunscreen monograph rules that went into effect in December 2012, only products that have undergone rigorous testing to prove their ability to protect against UVA and UVB rays can be labeled “broad-spectrum.” Protective clothing, wide-brimmed hats, sunglasses and general sun avoidance should be considered, especially between the hours of 10 am–4 pm.
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Heartfelt Stories and Easy-to-Understand Science to Elevate Your Spa Services for Your Clients with Cancer
Oncology Esthetics: A Practitioner's Guide by Morag Currin is a sensitively written book guiding you through the different types of cancers, cancer therapies, common ingredients and how it affects the skin, oncology drugs used in treatment, and side effects. Currin's book discusses different spa services and how they can be modified to suit your clients'needs.
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