The Right Tone

Jan 23rd, 2012

Traditional methods for treating hyperpigmentation are fading, making way for a new age in “spot removal.”

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Need more proof that blotchy skin is making potential clients appear older?

Consider this: In a study published in 2006 in Evolution and Human Behavior, subjects were asked to estimate an individual’s age based on facial images that were computer-manipulated to show differences in skin tone. Guesses ranged from 17 to 37 years. This, concluded researchers, demonstrated that uneven skin tone alone can account for up to 20 years of age perception.

“People are more aware that uneven pigmentation is a big factor in how old they’re perceived to be,” says Dr. Charlene DeHaven, clinical director at Innovative Skincare.

The triggers for hyperpigmentation? Too much sun, too many free radicals and too many hormones are still the broadly categorized culprits. The chemical processes that lead to dark spots haven’t changed either, as melanin formation works pretty much as it always has.

What is changing is the array of products and treatments available to day spas to treat hyperpigmentation, including new botanicals and man-made compounds that tackle melanin formation better than any single ingredient, and new combinations of active ingredients that, when used with peels and masks, offer skincare professionals exciting new ways to enhance their clients’ natural beauty.

A Spot of HIstory: Spot lightening and complexion brightening procedures have a global history that spans many centuries. More than 2,000 years ago, the Mediterranean stunner Cleopatra treated her own skin with fermented milk baths.

A Deeper Understanding

Hyperpigmentation is a common skin condition in which the body overproduces melanin, the pigment responsible for hair and skin color. To understand the process better, one could start with the keratinocytes, the most common type of skin cells. Their basic function is to make keratin, a protein that provides strength to skin, hair and nails. A trigger—radiation, say, from solar UVA and UVB rays—launches production in the keratinocytes of melanocyte-stimulating hormone, or MSH. Keratinocytes release MSH to the melanocytes, the free-ranging cells in the very bottom layer of the epidermis that carry an enzyme called tyrosinase. And this is where things start to get “spotty.”

Tyrosine, an amino acid found in plants and animals, helps to produce melanin. While tyrosine oversees skin color, tyrosinase produces the unwanted hyperpigmentation. So just as the tyrosine in a banana helps create its yellow skin color, when oxidation occurs, tyrosinase is what causes the yellow peel to turn brown—not far off from what happens with clients’ skin.

Controlling melanin production and behavior in human skin without causing harm is a tall order. Commonly used anti-pigmentation preparations—such as those containing hydroquinone, glycolic acid, kojic acid, licorice and vitamin C—have proved only partially successful.

“Melanin suppression through the use of hydroquinone OTC at 2% for home care, plus a series of 30% alpha hydroxy acid or glycolic acid salon peels has been the norm for many years,” acknowledges Tino Lerma, medical esthetic educator and international trainer at Pevonia Botanica. But irritation, inflammation and post-inflammatory hyperpigmentation in predisposed skin have led to a decline in that double-punch method. Hydroquinone, though still in use, is controversial because it has been known to cause inflammation, potentially leading to even more hyperpigmentation. “Hydroquinone-based formulations kill melanocytes, triggering an inflammatory healing process,” Innovative Skincare’s DeHaven points out. “If you use cytotoxic products, you also have to deal with that inflammatory response right up front or your client will fall behind in the lightening process,” she cautions.

A Spot of History: The late 20th century brought the battle against hyperpigmentation into spas, where skin therapists sought to obliterate discoloration with acid peels, galvanic current treatments and brightening masks.

Lerma believes that lactic acid at 30% is a safe choice for professional use because of its tyrosinase inhibition abilities. He also advocates enhancing the lightening effects of treatments with in-spa services featuring freeze-dried vegetal DNA from baby spinach and romaine lettuce, which helps accelerate the digestion, breakdown and diffusion process of accumulated melanin by keratinocytes. Professional use–only masks formulated with light AHAs and extracts of peach and lemon seem to work well as brighteners, he adds.

The big news in hyperpigmentation treatment, says Jeff Murad, vice president of product development at Murad Inc., is the “tons of ingredients” (see “Top 10 Spot Busters” on next page) currently being introduced at various points in the melanin production sequence. “Ingredients for hyperpigmentation treatment used to just target tyrosinase, but because there are multiple steps in the creation of dark spots, we’re finding ingredients that target different parts of the pathway,” he says. “We’re always finding new botanicals with some sort of function in removing or repairing dark spots, and we’re developing new synthetic ingredients, like peptides. And we’re exploring new ways to combine the two.”

“We’ve realized that if you affect a biochemical process in more than one area, it’s much more effective,” says DeHaven. “With the present state of treatment technology, you won’t get enough results if you’re looking for one magic ingredient.”

Whether you go with a solo ingredient or a unique combo, you’ll find that more products now carry the technology to deliver those ingredients where they need to go. In the past, only serums, with their concentrated formulas and water-soluble properties, could penetrate effectively. But now, creams are able to perform just as effectively—more so, in some cases. Both serums and creams may contain peptides or proteins, and proteins may actually be easier to formulate in creams.

“The advantage of a serum is its active ingredient’s low molecular weight, which allows it to absorb quickly into the skin,” Lerma notes. “The advantage of a cream is it seals in active ingredients better, protecting the skin and helping drier skin types with hydration and reduction of water evaporation.”

A Spot of History: Wu Zetian, China’s only female emperor, used crushed pearl cream— lauded for its ability to impart a youthful glow—even though she ascended the throne at age 65, some 20 centuries ago.

Two-Pronged Approach

Because hyperpigmentation tends to recur, clients must be vigilant and accept the need for both professional and at-home treatment. The multitiered in-spa approach calls for the use of products, equipment and a lot of judgement. “The trick to treating hyperpigmentation is twofold,” explains Monica Villar, vice president of education at GlyMed Plus. “First, you have to address the visible, topical damage with exfoliants, chemical peels, microdermabrasion or ultrasound. Second, you need to incorporate tyrosinase inhibitors to suppress further melanin production.”

Manufacturers and spa directors have developed complete facial protocols to treat hyperpigmentation, which might include a deep peel with alpha hydroxyl acids, concentrated serums containing combinations of ingredients and a brightening mask. “To achieve optimal results, those treatments should be performed weekly and in a series that’s specific to the intensity of the hyperpigmentation—which should be determined by a skincare professional,” stresses Karen Asquith, national director of education at G.M. Collin.

Lerma recommends a one-two punch of professional freeze-dried products and lightening masks. They must, he says, be performed at one-week intervals for six to 12 weeks, minimum, to yield visible results. “Depending on the type and depth of pigmentation, the client may see results sooner or later,” he notes. “Everyone is different. You’ll need to continue the series as needed per skin type and condition.”

There’s one other spa treatment that’s just beginning to become widespread, notes Rebecca Gadberry, a veteran skincare expert, chemist and owner of YG Labs. It’s called stem cell activation. “The idea is not to inhibit melanin formation directly,” she explains, “but to encourage stem cells to replace aging cells that exhibit lipofuscins, the dark spots produced by the oxidation of lipids and proteins in the skin, and melanin accumulation. An overall brightening of the skin is one of the results.”

A Spot of History: In the mid-1900s, Porcelana led the market in at-home skin lighteners, promising housewives nirvana in the form of creamy-clear hands and arms.

For the at-home piece of the hyperpigmentation treatment puzzle, consumers may use concentrates, spot treatments or creams with the latest ingredients at night, and sunscreen during the day. Today’s take-home products pack more punch than ever before—and they’re safer, too. “Skincare professionals used to have some real worries about sending people home with products for ongoing treatment,” DeHaven says. “Now, as long as you educate clients properly, you can prescribe effective homecare products. Also, it doesn’t involve a complicated regimen. If it gets too complicated, people won’t use it.”

Murad advises giving clients one of the newer ingestible, antioxidant- rich supplements that can boost immunity to sun damage. Lerma suggests home-use mini-enzyme peels to help remove melanin-laden dead cells, but warns that they should be used very carefully and probably avoided during the summer, when clients may be outdoors for extended periods. In a good percentage of cases, the eye area can also be addressed with niacinamide (a form of vitamin B3) to improve the condition of the skin and reduce pigmentation that causes dark circles.

If an at-home regimen includes, as many do, a spot treatment and a cream, you’ll need to instruct your clients as to proper product use, cautions Asquith. The spot treatments usually contain exfoliating active ingredients combined with melanin inhibitors, so they must be used on the pigmented areas only. The partnering cream is normally for broader use. The regimen must be performed daily as directed, and a daily SPF application is mandatory as well. Regular exfoliation one to three times a week is also necessary for achieving maximum results.

Keep in mind, GlyMed’s Villar notes, that if your hyperpigmented clients stop using a topical tyrosinase inhibitor for a week or so, their skin will probably initiate melanin production once again. Be sure they know it’s necessary to continue home care indefinitely. The ingredients listed on the bottles may have changed, and the precise in-spa and take-home regimen may be slightly different, but lighter, more even, younger-looking skin still comes from preventing the damage you can and treating the damage you can’t.