Grace Knows: Best Practices in the Treatment of Hyperpigmentation
Hyperpig-mentation is not only a prevalent condition; it’s one that can also be particularly stubborn to treat. In fact, both experienced Dermatologists— who lament the challenges of treating hyperpig-mented skin—and clients—who suffer through years of unsuccessful attempts at eliminating it—are challenged by this condition.
Hyperpig-mentation affects many Vietnamese women and men of all ethnic groups, and features areas of darkened skin. Although it is most common in middle age and beyond, hyperpig-mentation can also be seen in much younger clients. Directly caused by either overactive melanocytes, the cells responsible for producing melanin (melanotic hyperpig-mentation), or a proliferation of the melanocytes themselves (melanoc-ytotic hyperpig-mentation), hyperpig-mentation presents no medical threat. However, it can sometimes be a symptom of disease or illness. What’s more, individuals with facial hyperpig-mentation may become so concerned with the aesthetic implications of the condition that depression and anxiety may ensue. Thus, the condition deserves serious attention, including a diligent approach to skin analysis coupled with a willingness to apply creative treatment approaches.
Causes of hyperpig-mentation
There are three main types of hyperpig-mentation, each of which is categorized by their causes
- Melasma. This is the most common form of hyperpigmentation caused by hormonal fluctuations, common, for example, during pregnancy, with thyroid dysfunction, and through use of birth control pills and hormone replacement therapy. It affects an estimated five to six million women in the United States alone and can often be difficult to treat.2
- Lentigines. This si the second most common form of hyperpigmentation and are commonly known as liver spots or age spots. Although they do become more prevalent with age—they are found on 90% of light-skinned individuals over the age of 601—they are not directly caused by the aging process. Rather, lentigines are related to UV exposure.
- Post-inflammatory hyperpig-mentation (PIH). This occurs following skin injury from acne lesions, psoriasis, burns, friction and even certain professional skin care treatments. It begins to fade as the skin regenerates itself—a process that can take months or more. On the positive side, PIH generally responds well to treatment.
Although not considered a main cause, certain illnesses, as well as the use of certain prescription medications, may cause hyperpig-mentation.
Skin analysis
To increase the likelihood of successful treatment, a detailed skin analysis by a trained and experienced Dermatologist is crucial. Not only will a Dermatologist investigate the severity of the condition, they will also look for clues as to the origin of the problem to determine if a separate issue must first be treated. Although the following steps may not be standard in the skin analyses practices of many Vietnamese dermatologists, their importance in the evaluation and treatment of hyperpig-mentation should not be discounted, Subjective information collected from clients helps pinpoint a lifestyle, medical or genetic cause of hyperpig-mentation. Key topics to investigate include the following.
UV exposure. Questions surrounding these topics may pinpoint UV exposure as a cause of hyperpig-mentation (very common in Vietnam), while determining if the Dermatologist should be on the lookout for signs of melanoma.
- Unprotected UV exposure from active outdoor lifestyle such as golf, sun bathing or outdoor swimming and, less frequently, use of tanning beds
- Frequency of sunscreen usage
- Likelihood of burning when exposed to the sun
Current and past medical conditions. There is a wide array of medical conditions that may contribute to hyperpig-mentation, including Addison’s disease, Cushing’s disease and hypothyr-oidism.
Current or recent pregnancy, or current or recent use of birth control pills or hormone replacement therapies. Such questions may identify a hormonal cause of hyperpig-mentation. If hyperpig-mentation appears in a symmetrical, masklike manner, and the client confirms a hormonal cause, Dermatologists can be nearly certain of melasma.
All oral and topical medications used within the past six months, and prescription and pharmacy products used to specifically treat hyperpig-mentation. Hyperpig-mentation is a side effect of a number of medications, including certain antibiotics, cancer drugs, anti-seizure drugs and more. Additionally, some topicals used in the treatment of hyperpig-mentation, such as hydroquinone, have the potential to cause paradoxical hyperpig-mentation.
Current or recent dermatol-ogical or plastic surgery consultations and treatments: when a medical professional is involved in the treatment of the client’s condition, it’s important that the client regularly communicate updates regarding prescriptions and diagnosis so the Dermatologist can ensure the most appropriate treatment is being implemented.
Anticipated results
The following options present an opportunity to set realistic expectations while helping Dermatologists to determine how aggressively to treat conditions. Of course, in-depth methods of analyzing the overall condition of skin are now available. Although these comprehensive systems can certainly be beneficial, an investment in expensive equipment is not a prerequisite to the successful treatment of hyperpig-mentation.
Fitzpatrick skin type. Treatment of hyperpig-mentation is heavily determined by the client’s Fitzpatrick skin type, with lighter skin being easier to treat. Most Vietnamese fall in the III to IV skin type classification, with very few falling in the V skin type and therefore require a more delicate approach.
Wood’s lamp. For those with a Fitzpatrick skin type lower than V, a Wood’s lamp is extremely beneficial in helping to determine the severity of hyperpig-mentation, and whether it is isolated to the epidermal layer or goes deeper to the dermis. When the dermis is involved treatment becomes more challenging because topicals are usually ineffective.
Magnifying lamp. With the skin under a magnifying lamp, most locations of hyperpig-mentation can be determined, as can patterns in its appearance. Additionally, the use of this tool allows the skin care professional to determine other issues that may be resolved as part of the treatment protocol. If sensitive skin is determined, active ingredients proven to cause irritation should be avoided.
Treating the condition
The field of ingredients and treatments proven effective in reducing hyperpig-mentation has expanded significantly within the past 10 years. This development improves the likelihood that even those with challenging cases can realize improvement. There are two categories of treatment: topical agents and nonsurgical skin procedures. Although good results can be achieved using either approach, the best results are accomplished via a combination of the two.
Most commonly, active ingredients in topical formulations work by affecting tyrosinase, the enzyme found in melanocytes that stimulates the production of melanin. Such ingredients are beneficial when melanin production must be regulated, as in melasma, in which the ongoing use of a skin lightener is necessary. When excess pigment production is no longer an ongoing issue, discoloration may simply need to be cleaned up. Such circumstances are best treated through professional treatments and the use of alpha hydroxy acids (AHAs) or retinol to exfoliate and rejuvenate the skin. Among the topical agents available to skin care professionals for the treatment of hyperpig-mentation are the following.
Hydroquinone. This is frequently referred to as the gold standard for hyperpig-mentation and with good reason: It has been used for more than 50 years and is the only U.?S. Food and Drug Administ-ration (FDA)-approved product for skin lightening. It is often formulated with antioxidants, retinoids and hydroxy acids to improve results. Unfortun-ately, it can be irritating to certain individuals and may cause serious reactions and side effects when used in high concentr-ations.
Azelaic acid. This was developed for the treatment of acne. However, it has proven to be beneficial in the treatment of hyperpig-mentation, especially PIH from acne lesions.3 In one study, it demonstrated results similar to 4% hydroquinone, but without its side effects.
Kojic acid. This is a naturally occurring derivative of certain fungal species that features an efficacy similar to hydroquinone. In fact, hydroquinone and glycolic acid can produce better results when kojic acid is added to the formulation.5 The drawback is that it has the potential to cause contact dermatitis.6
Mandelic acid. This AHA is derived from almonds and is used in the treatment of several skin conditions, including all types of hyperpig-mentation. It is often combined with salicylic acid and administered as a peel, in which case it has fewer side effects than a glycolic peel and has demonstrated better efficacy.?7
Niacinamide. Instead of affecting tyrosinase, niacinamide works by preventing the transfer of melanin to keratino-cytes, the cells in the outermost layer of the skin. An active form of niacin (vitamin B3), it has been shown to significantly decrease hyperpig-mentation,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 non-ablative professional procedures, such as microder-mabrasion, laser skin resurfacing, intense pulsed light (IPL), 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 hyperpig-mentation, they can also disrupt dendrites, thereby re-stimulating hyperpig-mentation.
Prevention is key
With all clients, especially those undergoing treatment for hyperpig-mentation, 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 hyperpig-mentation due to a nonchalant attitude toward sun exposure.
Furthermore, following treatment for hyperpig-mentation, 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.
REFERENCES
1. SJ Day, Understanding Hyperpig-mentation, A continuing medical education (CME) Monograph (Jan 15, 2004)
2. AG Pandya and IL Guevara, Disorders of hyperpig-mentation, Dermatol Clin 18 1 91–98 (Jan 2000)
3. AS Breathnach, Melanin hyperpig-mentation of skin: melasma, topical treatment with azelaic acid, and other therapies, Cutis 57 1 Suppl 36–45 (Jan 1996)
4. LM Bali?a and K Graupe, The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream, Int J Dermatol 30 12 893–895 (Dec 1991)
5. JT Lim, Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid, Dermatol Surg25 282–284 (Apr 1999)
6. M Nakagawa and K Kawai, Contact allergy to kojic acid in skin care products, Contact Derm 32 1 9–13 (Jan 1995)
7. VK Garg, S Sinha and R Sarkar, Glycolic acid peels versus salicyli-c–mandelic acid peels in active acne vulgaris and post-acne scarring and hyperpig-mentation: A comparative study, Dermatol Surg 35 59–65. (Dec 2008)
8. T Hakozaki, et al, The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer, Br J Dermatol 147 20–31 (Jul 2002)
9. J Navarrete-Solis, et al, A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma, Dermtol Res Pract (Epub) (2011)
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Hun Kim Thao, Bac Si, CSK1, is CEO, founder of Grace Skincare Clinic. A certified dermatologist and a leading researcher on Vietnamese skin conditions, Dr. Thao is an expert in clinical dermatology and treating a variety of skin conditions from acne / acne scar, pigmentation, anti aging, and melasma. She is the first Vietnamese Doctor nominated for the prestigious Alma Lasers KOL program. Alma Lasers is an Israeli manufacturer and distributor of the highest quality dermatological and aesthetic laser equipment in the world.
- See more at: www.GraceSkinClinc.com
(Ti?ng Vi?t)
Grace hi?u r?:
Các ph??ng pháp t?t nh?t trong vi?c ?i?u tr? ch?ng t?ng s?c t?
T?ng s?c t? kh?ng ch? là tình tr?ng ph? bi?n mà còn là m?t trong s? nh?ng ch?ng b?nh ??c bi?t c?ng ??u. Trên th?c t?, ch?ng b?nh nà y là m ?au ??u c? các Bác s? Da li?u là nh ngh? - h? hay than phi?n v? nh?ng thách th?c trong vi?c ?i?u tr? t?ng s?c t? da, và các khách hà ng - nh?ng ng??i ?? tr?i qua nhi?u n?m n? l?c lo?i b? nó nh?ng kh?ng thà nh c?ng.
Ch?ng t?ng s?c t? ?nh h??ng ??n nhi?u ph? n? và nam gi?i thu?c m?i dan t?c trên ??t n??c Vi?t Nam, nó gay nên nhi?u vùng da s?m, t?i mà u. Ch?ng b?nh nà y hay g?p nh?t ? tu?i trung niên và cao h?n, tuy nhiên s? l??ng b?nh nhan c?ng ?ang ngà y cà ng tr? hóa th?i gian g?n ?ay. C?n nguyên c?a ch?ng b?nh nà y xu?t phát tr?c ti?p t? s? ho?t ??ng quá m?c c?a melanocyte - các t? bà o ch?u trách nhi?m s?n xu?t melanin (t?ng s?c t? melanotic), ho?c s? gia t?ng c?a chÃnh các melanocyte (t?ng s?c t? melanocytotic). Ch?ng t?ng s?c t? kh?ng gay ra m?i ?e d?a v? y h?c nà o, tuy nhiên, ??i khi nó có th? là d?u hi?u ho?c tri?u ch?ng c?a b?nh t?t. Ngoà i ra, nh?ng ng??i b? ch?ng t?ng s?c t? ? vùng m?t có th? tr? nên nh?y c?m, t? ti v?i hình th?c bên ngoà i, d?n ??n các v?n ?? v? tr?m c?m và lo au có th? x?y ra. Vì v?y, ch?ng b?nh nà y c?n s? quan tam ??c bi?t, bao g?m cách ti?p c?n khoa h?c v?i ph??ng pháp phan tÃch da li?u cùng v?i s? s?n sà ng ch?p nh?n áp d?ng các ph??ng pháp ?i?u tr? sáng t?o.
Nguyên nhan c?a ch?ng t?ng s?c t?
Có ba lo?i chÃnh c?a ch?ng t?ng s?c t?, ???c phan lo?i theo nguyên nhan gay ra
? Nám da. ?ay là hình th?c ph? bi?n nh?t c?a ch?ng t?ng s?c t? gay ra do bi?n ??ng n?i ti?t t?, và d?, th??ng g?p khi mang thai (v?i các tri?u ch?ng r?i lo?n ch?c n?ng tuy?n giáp), khi s? d?ng các lo?i thu?c tránh thai và khi s? d?ng li?u pháp thay th? hormone. Riêng ? Hoa K?, nó ?nh h??ng ??n kho?ng 5-6 tri?u ph? n? và ch?ng b?nh nà y th??ng khó ?i?u tr?.
? Lentigines (??m ??i m?i). ?ay là d?ng th??ng g?p th? hai c?a ch?ng t?ng s?c t? và th??ng ???c g?i là ??m nau hay ??m ??i m?i. Ch?ng b?nh nà y r?t ph? bi?n và tr? nên t?i t? h?n khi b?nh nhan có tu?i, th?ng kê ch? ra, 90% nh?ng ng??i v?i ?? tu?i h?n 60 có là n da sáng m?c ch?ng b?nh nà y - quá trình l?o hóa kh?ng tr?c ti?p gay nên ch?ng b?nh nà y mà chÃnh vi?c ti?p xúc v?i tia c?c tÃm nhi?u là nguyên nhan c?t l?i.
? T?ng s?c t? sau viêm (PIH). Ch?ng b?nh nà y x?y ra sau khi có t?n th??ng da do m?n, b?nh v?y n?n, b?ng, chà sát và th?m chà t? m?t s? ph??ng pháp ch?m sóc da chuyên nghi?p. V?t tham b?t ??u m? d?n khi da t? tái t?o - quá trình có th? m?t và i tháng ho?c nhi?u h?n. V? m?t tÃch c?c, ch?ng PIH th??ng d? ?i?u tr?.
M?c dù kh?ng ???c coi là m?t nguyên nhan chÃnh, m?t s? b?nh, c?ng nh? vi?c s? d?ng các lo?i thu?c kê toa nh?t ??nh, có th? gay t?ng s?c t? da.
Phan tÃch da
?? t?ng kh? n?ng thà nh c?ng trong vi?c ?i?u tr?, vi?c phan tÃch da k? l??ng b?i m?t bác s? da li?u ???c ?à o t?o và có kinh nghi?m là r?t quan tr?ng. Bác s? da li?u kh?ng ch? phan tÃch ?? tìm hi?u m?c ?? nghiêm tr?ng c?a tình tr?ng da, mà h? còn tìm ki?m manh m?i v? nguyên nhan c?t l?i c?a v?n ?? ?? xác ??nh li?u có m?t ch?ng b?nh da li?u riêng bi?t nà o c?n ???c ch?a tr? tr??c tiên kh?ng. Các b??c s?p li?t kê d??i ?ay có th? ch?a tr? thà nh quy chu?n th?ng l? trong vi?c khau phan tÃch da th??ng g?p ? Vi?t Nam, t?m quan tr?ng c?a chúng trong vi?c ?ánh giá và ?i?u tr? ch?ng t?ng s?c t? da là kh?ng th? xem th??ng. Nh?ng th?ng tin ch? quan thu th?p ???c t? khách hà ng giúp nh?n di?n ???c nguyên nhan c?a ch?ng t?ng s?c t?, bao g?m l?i sinh ho?t, b?nh ly, ho?c di truy?n. Các ch? ?? chÃnh ?? ?i?u tra bao g?m.
Ti?p xúc v?i tia c?c tÃm. Cau h?i xung quanh các ch? ?? nà y có th? nh?n di?n ???c vi?c ti?p xúc v?i tia c?c tÃm có th? là nguyên nhan c?a ch?ng t?ng s?c t? (r?t ph? bi?n ? Vi?t Nam), trong khi bác s? da li?u xác ??nh có nên tìm ki?m ??n nh?ng d?u hi?u c?a kh?i u ác tÃnh.
? Ti?p xúc v?i tia c?c tÃm mà kh?ng có bi?n pháp b?o v? bao g?m các ho?t ??ng ngoà i tr?i nh? ch?i golf, t?m n?ng ho?c b?i ngoà i tr?i, và s? d?ng gi??ng t?m n?ng (Ãt ph? bi?n h?n).
? T?n su?t s? d?ng kem ch?ng n?ng
? Kh? n?ng cháy da khi ti?p xúc v?i ánh n?ng m?t tr?i
Tình tr?ng b?nh ly hi?n t?i và quá kh?. Có nhi?u tình tr?ng b?nh ly có th? góp ph?n d?n t?i ch?ng t?ng s?c t?., bao g?m b?nh suy tuy?n th??ng th?n (b?nh Addison), h?i ch?ng Cushing và suy tuy?n giáp.
?ang ho?c v?a mang thai, ho?c ?ang ho?c v?a s? d?ng thu?c tranh thai ho?c li?u pháp hormone thay th?. Nh?ng cau h?i ?ó có th? xác ??nh ???c nguyên nhan gay nên vi?c t?ng s?c t? da có liên quan ??n n?i ti?t t?. N?u ch?ng t?ng s?c t? có nh?ng tÃnh ch?t xu?t hi?n ??i x?ng, tr?ng nh? th? m?t n?, và khách hà ng xác nh?n nguyên nhan do n?i ti?t t?, bác s? da li?u g?n nh? có th? ch?c ch?n b?nh nhan b? ch?ng nám da ngh?ch th??ng (paradoxical hyperpig-mentation).
T?t c? thu?c d?ng u?ng và b?i ???c s? d?ng trong vòng sáu tháng qua, thu?c theo toa và d??c ph?m dùng ?? ??c tr? ch?ng t?ng s?c t?. T?ng s?c t? là m?t lo?i tác d?ng ph? c?a vi?c dùng m?t s? lo?i thu?c, bao g?m thu?c kháng sinh, thu?c ung th?, thu?c ch?ng ??ng kinh,v.v... Ngoà i ra, m?t s? lo?i thu?c b?i s? d?ng trong ?i?u tr? t?ng s?c t?, ch?ng h?n nh? hydroquinone, l?i có kh? n?ng gay ra chÃnh ch?ng b?nh t?ng s?c t?.
Nh?ng l?n tham v?n và ?i?u tr? da li?u ho?c ph?u thu?t th?m m? g?n ?ay : khi b?n ?ang là m vi?c v?i m?t chuyên gia y t? v? tình tr?ng b?nh ly (? ?ay là ?i?u tr? da li?u ho?c th?m m?), b?n c?n thi?t ph?i trao ??i th??ng xuyên nh?ng c?p nh?t m?i nh?t v? k?t qu? ch?n ?oán và vi?c s? d?ng thu?c, ?? Bác s? da li?u có th? ??m b?o b?n ?ang ???c ?i?u tr? theo cách thÃch h?p nh?t..
K?t qu? k? v?ng
M?i ng??i có m?t c? ??a c?ng nh? tÃnh ch?t da khác nhau, bi?t ???c các tÃnh ch?t nà y giúp chúng ta ??t ra ???c k? v?ng th?c t?, ??ng th?i giúp bác s? da li?u nh?n di?n ???c cách th?c ?i?u tr? phù h?p nh?t cho t?ng tình tr?ng b?nh. T?t nhiên, các ph??ng pháp phan tÃch chuyên sau tình tr?ng t?ng th? là n da hi?n ?? có m?t trên th? tr??ng. Dù các h? th?ng toà n di?n nà y mang l?i l?i Ãch, nh?ng s? ??u t? thi?t b? ??t ti?n kh?ng ph?i là m?t ?i?u ki?n tiên quy?t cho vi?c ?i?u tr? thà nh c?ng c?a ch?ng t?ng s?c t? nà y.
B?ng phan lo?i da Fitzpatrick. Vi?c ?i?u tr? t?ng s?c t? ph? thu?c r?t nhi?u và o tÃnh ch?t da c?a b?nh nhan, theo ??nh ngh?a c?a Fitzpatrick, trong ?ó da sáng mà u h?n s? d? dà ng h?n ?? ?i?u tr?. Ph?n l?n là n da ng??i Vi?t r?i và o nhóm III và IV, r?t Ãt r?i và o nhóm V và do ?ó ?òi h?i m?t cách ti?p c?n tinh t? h?n.
Ph??ng pháp Wood's lamp. ??i v?i nh?ng ng??i nhóm da d?a trên tiêu chu?n Fitzpatrick th?p h?n V, ph??ng pháp Wood's lamp c?c k? có l?i trong vi?c giúp ?? xác ??nh m?c ?? nghiêm tr?ng c?a ch?ng t?ng s?c t?, và trong vi?c nh?n bi?t li?u b?nh ch? n?m ??n l? ? l?p bi?u bì hay ?n sau và o l?p h? bì. Khi b?nh ?n sau và o l?p h? bì thì vi?c ?i?u tr? tr? nên khó kh?n h?n vì thu?c d?ng b?i th??ng kh?ng hi?u qu?.
Ph??ng pháp Magnifying lamp. Khi soi vùng da v?i ph??ng pháp Magnifying lamp, ph?n l?n nh?ng vùng da ?? ho?c s?p b? ch?ng t?ng s?c t? ??u ???c nh?n di?n. Ngoà i ra, vi?c s? d?ng c?ng c? nà y cho phép các chuyên gia nh?n di?n các v?n ?? v? da khác mà có th? ???c gi?i quy?t trong quá trình tr? li?u. N?u phát hi?n ra vùng da nh?y c?m, nh?ng thà nh ph?n ho?t tÃnh ???c ch?ng minh gay kÃch ?ng da s? ???c khuy?n cáo tránh s? d?ng.
?i?u tr?
Trong 10 n?m tr? l?i ?ay, l?nh v?c nghiên c?u các thà nh ph?n và ph??ng pháp ?i?u tr? ???c ch?ng minh có hi?u qu? trong vi?c gi?m ch?ng t?ng s?c t? ?? m? r?ng ?áng k?. S? phát tri?n nà y là m t?ng cao kh? n?ng c?i thi?n tình tr?ng c?a nh?ng tr??ng h?p khó ch?a là nh nh?t. Có hai lo?i ?i?u tr?: thu?c d?ng b?i và ph??ng pháp ch?m sóc da kh?ng dùng ph?u thu?t. M?c dù k?t qu? t?t ??u có th? ??t ???c qua c? 2 cách, th??ng c? 2 cách ???c dùng k?t h?p ?? ??t hi?u qu? cao nh?t.
Th?ng th??ng nh?t, các thà nh ph?n có trong c?ng th?c c?a thu?c b?i tác ??ng ??n tyrosinase, m?t lo?i enzyme ???c tìm th?y trong melanocytes, có tác d?ng kÃch thÃch s? s?n sinh melanin. Nh?ng thà nh ph?n quan tr?ng nà y ki?m soát s? s?n sinh melanin, ch?ng h?n nh? ? b?nh nám, khi vi?c s? d?ng liên t?c thu?c là m sáng da là c?n thi?t. Khi vi?c s?n sinh d? th?a s?c t? kh?ng di?n ra n?a, c?ng vi?c ti?p theo ch? là ??y lùi s? ??i mà u là n da. Nh?ng tr??ng h?p nh? v?y ?ang ???c ?i?u tr? t?t nh?t th?ng qua ph??ng pháp ?i?u tr? chuyên nghi?p và vi?c s? d?ng axit alpha hydroxy (AHA) ho?c retinol ?? t?y t? bà o ch?t và là m tr? hóa là n da. D??i ?ay là m?t s? nh?ng lo?i thu?c d?ng b?i ?ang có m?t trên th? tr??ng:
Hydroquinone. Lo?i nà y th??ng ???c g?i là tiêu chu?n và ng cho vi?c ?i?u tr? ch?ng t?ng s?c t? v?i ly do: Nó ?? ???c s? d?ng trong h?n 50 n?m và là s?n ph?m là m sáng da duy nh?t ???c c?c qu?n ly d??c ph?m và Th?c ph?m Hoa K? c?p phép (FDA) . C?ng th?c c?a thu?c th??ng bao g?m ch?t ch?ng oxy hóa, retinoid và axit hydroxyl ?? là m t?ng hi?u qu?. R?t ti?c, thu?c có th? gay kÃch ?ng cho m?t s? ng??i và có th? gay ra ph?n ?ng và tác d?ng ph? nghiêm tr?ng khi s? d?ng v?i li?u l??ng cao.
Axit azelaic. Ch?t nà y ???c phát tri?n ?? ?i?u tr? m?n tr?ng cá. Tuy nhiên, nó ?? ???c ch?ng minh là mang l?i l?i Ãch trong vi?c ?i?u tr? ch?ng t?ng s?c t?, ??c bi?t là PIH t? t?n th??ng do m?n. M?t nghiên c?u ch? ra r?ng, ch?t nà y mang l?i hi?u qu? t??ng t? nh? hydroquinone 4%, nh?ng kh?ng có tác d?ng ph? nh? thu?c nà y.
Axit Kojic. ?ay là m?t d?n xu?t t? nhiên c?a và i loà i n?m có hi?u qu? t??ng t? nh? hydroquinone. Trong th?c t?, hydroquinone và axit glycolic có th? tác d?ng t?t h?n n?u axit kojic ???c thêm và o c?ng th?c. Nh??c ?i?m là nó có kh? n?ng gay viêm da ti?p xúc.
Axit mandelic. Ch?t AHA nà y ???c ?i?u ch? t? h?nh nhan và ???c s? d?ng trong ?i?u tr? m?t s? b?nh v? da, bao g?m t?t c? các ch?ng t?ng s?c t?. Nó th??ng ???c k?t h?p v?i axit salicylic, dùng nh? m?t l?p m?t n?, h?p ch?t nà y gay Ãt tác d?ng ph? h?n và ?? ???c ch?ng minh là hi?u qu? h?n m?t n? glycolic.
Niacinamide. Thay vì tác ??ng lên tyrosinase, c? ch? c?a niacinamide là ng?n ch?n s? chuy?n giao c?a h?c t? melanin t?i keratinocytes - t? bà o ? l?p ngoà i cùng c?a da. Là m?t d?ng c?a ch?t niacin (vitamin B3), nó ?? ???c ch?ng minh có tác d?ng là m gi?m ?áng k? ch?ng t?ng s?c t?, bao g?m nám da, và ch? gay nên m?t và i tác d?ng ph? nh?
Hi?u qu? c?a thu?c b?i ???c quy?t ??nh ch? y?u b?i thà nh ph?n c?u t?o nên c?ng th?c thu?c. Melanocytes n?m ? l?p ?áy c?a th??ng bì và , do ?ó, s? th?m th?u là c?n thi?t ?? ??t hi?u qu?. B?ng cách k?t h?p thu?c b?i v?i ph??ng pháp ch?a tr? kh?ng xam l?n, ch?ng h?n nh? ph??ng pháp siêu mà i mòn da, tái t?o b? m?t da b?ng laser, ph??ng pháp ánh sáng c??ng ?? cao (IPL), m?t n? hóa h?c, c?ng nh? ph??ng pháp xam l?n, ch?ng h?n nh? mà i mòn da, ph??ng pháp ?i?u tr? laser và m?t n? hóa h?c m?c ?? trung bình ??n cao, s? thu ???c k?t qu? t?t ??p m?t cách nhanh chóng. T?t nhiên, c?n ??c bi?t c?n th?n khi s? d?ng ph??ng pháp xam l?n. Melanocytes là nh?ng t? bà o ?u?i gai, chúng có xúc tu, ho?c s?i nhánh, ?? m? r?ng t?m v?i. Nh?ng ph??ng pháp xam l?n có th? gay viêm s?ng, t? ?ó kh?ng nh?ng d?n ??n tình tr?ng t?ng s?c t? da tr?m tr?ng h?n, mà còn có th? phá v? các s?i nhánh, do ?ó l?i kÃch thÃch ch?ng t?ng s?c t? phát tri?n thêm.
Phòng tránh là trên h?t
V?i t?t c? các khách hà ng, ??c bi?t là nh?ng ng??i ?ang ?i?u tr? ch?ng t?ng s?c t?, vi?c th?o lu?n v? các bi?n pháp phòng ng?a là t?i quan tr?ng. Kh?ng th? nh?n m?nh h?t s? c?n thi?t c?a vi?c b?i kem ch?ng n?ng hà ng ngà y. Th?ng th??ng, chÃnh khách hà ng l?i là nguyên nhan c?a vi?c tái phát ch?ng t?ng s?c t? do thái ?? ch? quan v?i vi?c ti?p xúc ánh n?ng m?t tr?i. Thêm n?a, sau khi ?i?u tr? ch?ng t?ng s?c t?, b?n c?n h??ng s? t?p trung và o ph??ng pháp ch?m sóc c?n th?n là n da hà ng ngà y. Khách hà ng có th? duy trì k?t qu? tÃch c?c c?a vi?c ?i?u tr? th?ng qua vi?c s? d?ng các dòng s?n ph?m ch?m sóc da chuyên nghi?p có ch?a thà nh ph?n ?? ???c ch?ng minh hi?u qu?. Chúng t?i khuy?n ngh? t?i m?i ng??i, m?t ch? ?? ch?m sóc tiêu chu?n bao g?m b?n b??c, là m s?ch, t?y t? bà o ch?t, d??ng ?m và b?o v? da.
D?n ngu?n
1. SJ Day, Understanding Hyperpig-mentation, A continuing medical education (CME) Monograph (Jan 15, 2004)
2. AG Pandya and IL Guevara, Disorders of hyperpig-mentation, Dermatol Clin 18 1 91–98 (Jan 2000)
3. AS Breathnach, Melanin hyperpig-mentation of skin: melasma, topical treatment with azelaic acid, and other therapies, Cutis 57 1 Suppl 36–45 (Jan 1996)
4. LM Bali?a and K Graupe, The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream, Int J Dermatol 30 12 893–895 (Dec 1991)
5. JT Lim, Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid, Dermatol Surg25 282–284 (Apr 1999)
6. M Nakagawa and K Kawai, Contact allergy to kojic acid in skin care products, Contact Derm 32 1 9–13 (Jan 1995)
7. VK Garg, S Sinha and R Sarkar, Glycolic acid peels versus salicyli-c–mandelic acid peels in active acne vulgaris and post-acne scarring and hyperpig-mentation: A comparative study, Dermatol Surg 35 59–65. (Dec 2008)
8. T Hakozaki, et al, The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer, Br J Dermatol 147 20–31 (Jul 2002)
9. J Navarrete-Solis, et al, A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma, Dermtol Res Pract (Epub) (2011)
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Hun Kim Thao, Bác S?, CSK1, là Giám ??c ?i?u hà nh, ng??i sáng l?p c?a Grace Skincare Clinic. M?t bác s? da li?u có ch?ng nh?n hà nh ngh? và là m?t nhà nghiên c?u hà ng ??u v? tình tr?ng da li?u ng??i Vi?t, Bác s? Th?o là m?t chuyên gia v? th?m m? da li?u và có kh? ?i?u tr? các tình tr?ng m?n / s?o sau m?n, s?c t? da , ch?ng l?o hóa, và nám. C? là bác s? Vi?t Nam ??u tiên ???c ?? c? cho danh hi?u Alma Lasers Kol uy tÃn. Alma Lasers là m?t nhà s?n xu?t và phan ph?i Israel,chuyên cung c?p thi?t b? th?m m?, laser, ch?m sóc da li?u ch?t l??ng cao..
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