SPA TREATMENT: See Spot Go

Treating hyperpigmentation is a crucial step in clients’ antiaging efforts—and in boosting your spa’s bottom line.

Hyperpigmentation treatments are more in demand than ever, and for good reason. Our 50-plus age demographic is growing exponentially, and so are the various spots, blotches and other pigment variations on these clients’ skin. “Hyperpigmentation is one of the top consumer skincare concerns, and a thorough understanding of hyperpigmentation and a selection of treatments and products to address it is fundamental to keeping these clients coming back,” asserts Christian Jurist, medical director of global education for Pevonia International. “A successful spa menu should always include at least one brightening treatment that offers immediate results, as well as cumulative benefits specifically targeting hyperpigmentation.”

However, with the increase of available hyperpigmentation treatments comes inevitable confusion for spa professionals. What’s the best way to attack this all-important skincare issue? DAYSPA breaks it all down here—from causes to treatments—to help you determine the most effective “spot-removal” strategy for your clients. —By Tracy Morin

Spot The Cause

The process of hyperpigmentation occurs in multiple steps, and the process is complex. “Pigmentation starts with the melanocyte, whose primary function is to make melanin pigment packets called melanosomes,” explains Christi Roberts, educational program administrator, GlyMed Plus/Advanced Aesthetics. “The amount of melanin in the melanosomes, and the number of melanosomes distributed into the keratinocytes [outer skin cells], determine the color of skin. The basic unit of melanin is tyrosine. When melanocytes are activated, the tyrosine is acted upon by an enzyme called tyrosinase, and is ultimately transformed into dopaquinone [a metabolite that helps produce melanin].” The resulting packets of pigment formed, Roberts goes on to explain, are ultimately carried, via keratinocytes, to the surface of the skin.

There are several root causes of hyperpigmentation, which include photo damage and sun exposure, inflammation, hormones, illness, medications, and various skin injuries, including those related to acne. Because of this variation in causes, some cases of hyperpigmentation are harder to treat than others. Here, knowledge is key.

“Understanding the process by which pigmentation is triggered and produced enables the skin specialist to formulate a treatment that can block or slow down the production of pigment and thus help facilitate the resolution,” notes Roberts. “In addition to biological understanding, skin practitioners must also understand the different types of pigmentation that occur and whether they are epidermal or dermal pigmentation, and their causes. Not all pigmentation is created equally and thus should not be treated the same.”

For instance, melanin isn’t the only instigator, points out Karen Asquith, national technical training manager, North America, G.M. Collin. “There’s also lipofuscin, an aggregate of oxidized proteins and lipids that have lost their function and produce a pale yellow-brown pigment, made of free-radical-damaged protein and fat,” Asquith explains.

The goal of most depigmentation treatments is to inhibit the enzyme that plays a key role in the pigment synthesis, tyrosinase, but other objectives include inhibiting the transfer of pigment to the epidermal cells, stimulating turnover of stained cells and breaking down the accumulated pigment. “Brightening the skin can only occur if the skin is treated comprehensively—and prevention is key!” says Jurist. “Proper exfoliation, hydration, reparation and protection are fundamental pillars in skin care for both face and body; skin can show remarkable improvement when its delicate balance is maintained.”

Treatment often starts with preventing triggers. If sun damage is the problem, clients must always use broad-spectrum sunscreen. If acne is causing inflammation, the acne needs to be treated first. Hormonal changes (such as in pregnancy) may be addressed with a lightening product during the hormonal imbalance. Mark Lees, Ph.D., president and CEO of Mark Lees Skincare, has found that some clients have success simply by using sunscreen, avoiding tanning and removing already stained cells through an AHA product. However, he notes, if no improvement is shown after six weeks, or if the hyperpigmentation is too deep, a visit to the dermatologist may be in order.

Hyper Intelligence

The long list of ingredients available for treating hyperpigmentation reads partially like a science textbook, and partially like a nature encyclopedia. But thanks to skincare experts, all of the terms make sense when placed into a treatment context.

“There are many stages involved in the formation of pigmentation, and therefore a combination of ingredients that intervene at various stages of melanogenesis are necessary to achieve the desired results,” explains G.M. Collins’ Asquith. Adds GlyMed Plus’ Roberts, “Tyrosinase inhibitors would be key to control pigmentation and brighten/lighten existing pigmentation, and they’re powerful antioxidants. There are many botanical types of tyrosinase inhibitors, and each works in a different capacity to either block production of tyrosine or reduce other aspects of the equation.”

Here are the ingredients you’re most likely to see listed on the packaging of hyperpigmentation products. Some botanical ingredients are listed by their common plant names; others by their less easily recognizable extract names.

• 1-Methylhydantoin-2 IMIDE is a natural amino acid derivative that inhibits melanosome transfer, interfering in another process of melanogenesis.
• Achromaxyl is a fermented and hydrolyzed protein that inhibits tyrosinase activity.
• Alpha arbutin is a botanical that “prevents hyperproduction of melanin and further activation of tyrosinase, thus blocking melanin synthesis for better control over skin tone and brown spots,” says Dasha Saian, operations manager for SAIAN.
• Alpha hydroxy acids work to peel off stained parts of the skin, though stains return.
• Arginine, a natural amino acid, can hasten repair of sun-damaged tissue.
• Azelic acid “is a dicarboxylic acid that has minimal effect on normal pigmentation and the greatest effect on heavily pigmented melanocytes, making it very effective in treating post-inflammatory hyperpigmentation (PIH) and darker skin of color,” says Roberts. “It inhibits tyrosinase as well as DNA synthesis and mitochondrial activity in hyperactive melanocytes. Azelic acid may be the most thoroughly researched and studied compound next to hydroquinone.”
• Bearberry inhibits tyrosinase activity and may lead to a direct reduction of melanin.
• Bellis daisy is a wildflower that decreases tyrosinase synthesis, reduces keratinocyte production and blocks the binding and transfer of melanocytes.
• Diacetyl boldine is an extract from the bark of the Chilean boldo tree that works at the tyrosinase level to reduce and control pigmentation. “Diacetyl boldine is encapsulated into microliposomes to make it more effective at reaching its target in the skin, more resistant to degradation and more consistent in its results,” says Pevonia’s Jurist.
• Glycolic acid helps remove the uppermost layers of the skin via exfoliation, providing a more even appearance.
• Grape seed contains proanthocyanidins, which help lighten UV-induced hyperpigmentation.
• Green tea contains polyphenols that may interfere with pigment transfer, and provides UV protection, too.
• Hexapeptide is a skin-lightening peptide (see In the Pipeline on page 56 for more on peptides for treating hyperpigmentation).
• Hydroquinone (see next page)
• Kojic acid “effectively exfoliates the skin and helps reduce the dark pigmentation,” notes Saian. Roberts adds, “It works by decreasing the number of melanosomes that are generated, which leads to less transferred pigment.”
• L-ascorbic acid 2-glucoside is a botanical that inhibits tyrosinase activity. “It interacts with the copper ions and converts the dopaquinone back to L-Dopa, preventing melanin formation,” says Roberts.
• Lactic acid exfoliates and hastens cell turnover, and helps ward off adult acne.
• Licorice root (extracts include licochalcone and glabriden) inhibits tyrosinase and functions as an anti-inflammatory. “Licorice root and its derivatives, such as licochalcone, are strong antioxidants with brightening effects,” says Mark Lees. Adds Roberts, “Licorice has the ability to absorb UVA and UVB rays; some claims say it’s more powerful than kojic acid and 75 times more effective than ascorbic acid.”
• Magnesium ascorbyl phosphate (MAP) is a vitamin C derivative. “It’s popular in Japan, but vitamin C acids often cause irritant problems,” Lees says.
• Mulberry root extracts are anti-inflammatory, and potent inhibitors of tyrosinase.
• Mushroom extract and white willow bark extract decrease melanin production and inflammatory response from triggers.
• Norwegian kelp extract interrupts the communication between the melanocyte and keratinocyte, and increases controlled exfoliation, helping to remove pigmented areas.
• Oligopeptide-34 decreases the MITF gene expression, resulting in a reduced level of tyrosinase. “Oligopeptide-68 is one of the most effective skin brightening ingredients,” says Lees. “Due to its biomimetic liposomic time-release peptide delivery system, identical to the skin’s own structure and composition, it’s capable of rapidly equalizing skin tone and reducing unwanted hyperpigmentation.”
• Pidobenzone is a melanin suppressant. “It makes no lightening claim, though it’s pretty effective,” Lees notes.
• Retinol triggers cell division to promote more rapid turnover and exfoliation.
• Rosemary has an inhibitory effect on carnosic acid and tyrosinase activity.
• Stone crop suppresses melanin and offers UV protection.
• Sulforawhite activates the proteasome system, which is responsible for breaking down the lipofuscin.
• Turmeric oil is a natural astringent and antioxidant.
• Tetrahydrocurcumin (THC) inhibits tyrosinase activity.
• Vitamin C “Once the spots reveal themselves, reach for topical products that are high in vitamin C, which has been shown to be effective in reducing hyperpigmentation and providing powerful antioxidant protection,” advises Jeff Murad, VP of product development at Murad.
• Yellow dock is a natural astringent with acne-banishing properties. It also inhibits tyrosinase activity.

The Hydroquinone Question

In any discussion of hyperpigmentation treatment, the subject of hydroquinone sparks a lot of discussion. Here’s what some of the experts have to say:
This ingredient is still in use but has fallen out of favor. I recommend use only under the careful and direct management of a physician, because it can actually cause more pigmentation when it kills melanocytes.”
—Charlene DeHaven, MD, clinical director, Innovative Skincare

Hydroquinone is the only drug for lightening skin according to the FDA, but a percentage of people are allergic to it, and it’s banned as an OTC in a number of countries. Still, it’s the best we have—controversial, but the classic.”
—Mark Lees, president and CEO, Mark Lees Skincare

Hydroquinone is known as the gold standard in sun and age spot lightening and, used in conjunction with hexapeptide, provides an extremely potent cocktail to quickly reduce hyperpigmentation and help prevent new pigmentation from forming over the long term.”
—Jeff Murad, VP of Product Development, Murad

Although there has been controversy around hydroquinone, it is one of the most widely used and successful compounds for hyperpigmentation. It inhibits tyrosinase and other melanocyte metabolic processes and is especially effective on the longer, thicker dendrites of the melanocytes and melanosome concentrations, making it superior in the treatment of darker skin of color. Although you can obtain 4% with a prescription, the 2% OTC strength is safer and just as effective for pigmentation disorders as higher percentages, and without the risk of rebound pigmentation and cytotoxic dangers. As of December 2011, professional estheticans can legally use and make available formulations in 2%.”
—Christi Roberts, educational program director, GlyMed Plus/Advanced Aesthetics

Delivery Systems

Primary to any topical treatment is its ability to deliver active ingredients to the skin, and that’s surely true of hyperpigmentation products. As the previous ingredient list illustrates, these products can come in a variety of formulas—and the delivery system that’s best depends on the ingredients within those formulas. Pevonia’s Jurist agrees that many formulas can work: freeze-dried (for purity, strength and ease of administration); serums, thanks to their low molecular weight and deep and easy penetration (however, according to Jurist, they are best used in high concentrations as boosters and in conjunction with a correlating care cream to seal and hydrate); gels, optimal for all skin types and user-friendly, but best for the delivery of acids in professional and homecare formulas due to their uniformity of penetration and light texture; and even time-release capsules.

Murad prefers lighter bases, such as gels and serums, for pigmentation treatments. “The lower oil content allows for better penetration of the actives into the skin, and the lighter consistency of gels and serums makes subsequent application of a moisturizer with broad-spectrum UV protection much easier and more comfortable,” he notes.

Asquith, however, prefers the use of a concentrated serum combined with a cream. “The serum is used directly on the prominent pigmentation spots and is a more concentrated complex, often containing AHAs as well as other actives for intensive treatment,” she relates. “The cream is then used over the entire face and will contain a different combination of active ingredients to interfere with various stages of melanogenesis.”

Lees agrees that serums are effective because they’re typically the first product to come into contact with skin, but notes that other procedures—such as microdermabrasion, peels and lasers—can speed up the results for the client. However, he warns, microdermabrasion and peels, though helpful for pigment on the top layers of the skin, can be harmful if overdone, actually leading to more pigmentation because they can stimulate an immune response, leading to inflammation and melanin production.

In The Pipeline

Expect the following developments in hyperpigmentation research:
More nature-based ingredients: More people are clamoring for “natural” ingredients—and researchers are noting their great results. “Research shows natural ingredients that are promising, like active soy, which helps to inhibit the production of excess melanin, and Indian gooseberry, which appears to inhibit the transfer of melanosomes to the outer skin cells,” says Pevonia’s Jurist.

A greater role for peptides: “Every day there’s a new peptide discovered, so I believe something will come out on that end,” Mark Lees predicts. “They’ll probably work in about the same way as what’s out there now but might have a different attack mode in terms of the biochemistry that leads to melanin production.”

Greater focus on overall tone: Now that researchers have refined the science of lightening individual spots through prevention of melanin formation, the focus going forward will be on methods of indirectly evening skin tone more generally, speculates Jeff Murad. “This will be done by minimizing the effects of light and shadows caused by enlarged pores, fine lines and rough texture, as well as using new methods to help the skin eliminate the buildup of waste materials that leads to blotchiness and dull, uneven skin tone,” he explains.

Ingestible treatments: A pill to suppress hyperpigmentation? Jurist says that it has been in the works for many years, but the general public will simply have to wait for it to become a reality.

Notes From The Spa Side

Julie Puccio, owner, Bella Nova Day Spa and Salon, Houston, TX
“As someone who has personally faced this problem, I am dedicated to providing quick and effective results for our clients. First, we help the client identify the problem with a Woods Lamp face analyzer. The majority of the time, the hyperpigmentation has increased slowly, and the lamp gives us a realistic picture of what’s to come. We then take a three-step treatment approach, which we sell as a package—Step 1: Bye Bye to Spots, a brightening facial from 5 Star Formulators that uses retinol, glycolic, botanical lighteners, ascorbic acid/vitamin C, and other vitamins and minerals to help correct, blend and improve uneven skin tone and hyperpigmentation of damaged and photoaged skin. Step 2: Two weeks later, we administer a PCA peel. Step 3: Two weeks after that, we do a Palomar photofacial. The results are absolutely amazing and, most importantly, visible to the naked eye! Follow-up care, of course, is sunscreen with SPF 30 every single day. We get amazing results with one package, but in a series of three or six, it’s truly remarkable.”

Cheryl Hernandez, esthetician, Hawaiian Experience Spa, Chandler and Scottsdale, AZ
“We use Éminence Organic Skincare at our spa—we like that their ingredients are all-natural and organic. Our most popular treatment would be our Native Facial. It consists of all of the Stone Crop products, which were especially made for hyperpigmentation. The stone crop plant is like aloe vera, but on steroids! It is very healing, hydrating, soothing and lightening—and great for every skin type. This particular facial is only $49 with a spa membership.”

Julie Mahoney, president, Oasis Day Spa, South Weymouth, MA
“We have two options for hyperpigmentation treatments. For a clinical approach, we perform a Jan Marini RX facial that combines a progressive glycolic peel layered over a retinol-based mask. We send the client home with the company’s full five-step program with Retinol Plus—because home care is essential for maintenance. For a more holistic approach, we perform the Repêchage Biolight Miracle facial, which provides immediate lightening with just one facial. It uses natural ingredients like bellis daisy and hexapeptide-2, known to help reduce melanin activity, and a glycolic peel combined with seaweed. This facial also has the additional benefit of firming!”

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