Acne Update & Hyperpigmentation

Acne Update

The 4% minocycline foam mentioned in a previous blog has been approved and will be available in January, 2020.  It is an effective agent for acne control and it is hoped that it will be used for maintenance after initial control of acne is obtained with a shorter course of oral antibiotics than was commonly used in the past, or, of possible, use in lieu of oral antibiotics.

The topical anti-androgen, anti-sebocyte agent glucosterone is also being tested for use in hormone-related hair loss.  It appears to be effective in early testing.

Hyperpigmentation 

Hyperpigmentation is a common concern for many people.  It often has more serious concerns for people who suffer from it than non-affected people realize, and can be an underlying cause of adversely affected self-images, anxiety and even depression, in addition to the cosmetic consequences.  While there are many causes of hyperpigmentation, the commonest causes are post-inflammatory hyperpigmentation from acne, eczema, psoriasis, sun, sun damage, superficial burns, cuts, injuries, trauma, lupus and other inflammatory causes, and hormonally-related hyperpigmentation causes like melasma and cholasma, caused or aggravated by pregnancy, birth control pills, HRT with progesterone and sunlight, visible light and infra-red light. 90% of melasma occurs in women. The most commonly affected areas are the face, back, chest and backs of the hands. A consult with your cosmetic aesthetician and or dermatologist can help determine the type of hyperpigmentation you have and the best treatment alternatives for you, including rare medical causes like drug reactions, Addison’s Disease and haemochromatosis, which are beyond the scope of this blog.

This time of year is the best time of year to get your hyperpigmentation treated because the sun is less likely to inhibit treatment success and people are usually less socially active.  The treatments for post-inflammatory hyperpigmentation include azelaic acid cream 15 or 20%, retinol, tretinoin, retinol-alpha-hydroxy creams (coming to market soon), aloe vera plant juice, a licorice derivative in creams and lotions, kojic acid, green tea derivatives, hydroquinone bleach, vitamin c products, lighter chemical peeling agents or combination agents like flucinolone, tretinoin and hydroquinone, and other agents. Confusing? Yes.  That is why a consult with your cosmetic aesthetician can be very helpful to start you on the road to successful treatment. 

It becomes especially important to consult with your cosmetic aesthetician or dermatologist when the usual topical and cosmetic product treatments are not enough, or if you suffer from the more difficult to treat melasma. Why? Because they can offer other very effective treatments that will work when topical treatments, sun avoidance and good routine skin care are not enough. Other options include microdermabrasion, micro-needling, micro-needling with radio-frequency, micro-needling medication delivery to skin, chemical peeling, intense pulsed light treatment, photo-dynamic therapy with amino-levulinic acid and laser or intense pulsed light activation and different types of laser treatments.  Your skin care specialist like Michelle Correia, the owner of Purely Skin Aesthetics and Laser Center and her medical director Dr. Ballantyne can be instrumental in your successful treatment.

Research-related news about hyperpigmentation

The current recommendation to use a 30 SPF sunscreen as part of treatment and prevention of hyperpigmentation may be inadequate.  A sunscreen with a SPF of 70-100 may be better.  Besides being a better blocking agent, a higher SPF sunscreen gives longer sun protection than a lower SPF in case like many people one is not religious about re-applying sunscreen ever 80 minutes or if one cannot in some situations.

Products like a non-hydroquinone, non-retinol, multi-agent skin corrector that blocks melanin (pigment) production in several different ways are being developed by Skinbetter Science and looks very promising in initial clinical studies on facial pigmentation and dyschromia (dis-coloration).  It also enhances routine medical topical agents results.

Platelet Rich Plasma, PRP, injections have been used with occasional success in facial melasma, although in recent studies, the benefits have not been statistically significant.

Unilever researchers have found that niacinamide is an effective, protective agent to reduce post-inflammatory hyperpigmentation and may be available in new products from Unilever in the future.

A study published September 30, 2019 in the Journal of the “ European Academy of Dermatology and Venereology” concluded that people with pigmentary disorders, including melasma, have a high prevalence of psychologic conditions, including anxiety and depression. “Pigmentary disorders give rise to psychologic disturbances, which in turn can hamper adequate medical treatment thus aggravating the pigmentary disorder itself.” (Dabas G, Vinay K, Kumar A and Kumaran M, J Eur Acad Dermatol and Venereol. 2019, Hilton L, www.dermatologytimes.com)