Pigmentation Training Manual Slide .pptx

PIGMENTATIO N Pigmentation Overview •Human skin contains specialized cells, called melanocytes, which are located at the base of the epidermis. These cells are programmed to manufacture a brown pigment, called melanin, in response to exposure of skin to sunlight. •Since melanin acts as a sunscre...

PIGMENTATIO N Pigmentation Overview •Human skin contains specialized cells, called melanocytes, which are located at the base of the epidermis. These cells are programmed to manufacture a brown pigment, called melanin, in response to exposure of skin to sunlight. •Since melanin acts as a sunscreen, the production of this pigment by melanocytes is a defence response of the skin to the damaging and potential skin cancer causing rays of the sun. Cont.. • In addition to UV radiation, other factors can stimulate melanocytes to make melanin. • Hormones, such as those in birth control pills can cause melanocyte “activation”, and exposure of the skin to any event that causes inflammation, such as acne, dermatitis, exposure to chemicals, etc., can also result in increased melanin production by melanocytes. Melanin •Melanin production in human melanocytes is controlled primarily by the rate-limiting enzyme for melanin synthesis, tyrosinase, which catalyses the hydroxylation of tyrosine to L-DOPA and the oxidation of L-DOPA to dopaquinone. •The subsequent steps in the pathway to melanin formation can occur nonenzymatically although two additional melanocytespecific enzymes are thought to play a role in • This chart shows that the pathway can diverge to produce either a red/yellow type of melanin (pheomelanin), or brown/black melanin, called eumelanin. The type of melanin made is genetically determined, and results in some people having fair skin and red hair while others are dark-skinned and have dark hair. •The melanin produced by the action of tyrosinase is “packaged” within the melanocyte into unique vesicles called melanosomes. These organelles are then transferred from the melanocyte to surrounding keratinocytes in the skin. •As keratinocytes move from the lower part of the epidermis up to the surface, they can carry the ingested melanosomes with them, and the result is a deposition of the melanin-filled melanosomes near the skin’s surface. This is what gives the skin its brownish tint. This image shows a melanocyte and the production of melanosomes. The deposition of melanin at the skin’s surface provides some sunscreen protection from the damaging effects of UV rays, although in a Caucasian, the amount of SPF that melanin provides is likely no more than an SPF of 4. Therefore, it is important to use a sunscreen regardless of how “tanned” you are! How age spots occur.. • The surface layer of the skin, or the epidermis, contains melanocytes, which produce the melanin pigment that combats UV damage to the skin. But over time, the sun damages those melanocytes. Though most of the epidermis is comprised of a dead skin cell layer, or keratin, to protect against the environment, about one-tenth to one-twentieth of it is made up of melanocytes. The melanin produced by those cells transfers the brown pigment that protects against sun damage to your skin cells. The darker your skin is, the better its natural capacity to protect itself against the UV rays from the sun. • When people with a lower melanin count in their skin are exposed to UV rays, abnormal melanin pigment production can occur and result in the formation of age spots or sun spots. The more time you spend in the sun and the more you allow the sun to damage your skin, the more likely you are to experience extreme age and dark spots. Another factor that can increase your risk is if you have a genetic predisposition to sun spots and age spots. However, since it’s impossible to avoid the sun entirely, almost everybody will experience some age spots as a function of aging. Types of Pigmentation • Chloasma and Melasma are used to describe hormonal pigmentation often appearing during pregnancy, with ovarian or thyroid dysfunction and when taking the contraceptive pill or other medication. It usually occurs towards the centre of the face where as sun damage occurs towards the outer area of the face. It is resistant to treatment and sometimes can temporarily improve it but then return darker than before. Melasma will often fade in time but is better controlled with Tyrosinase inhibiters and/or qswitch lasers. Types of Pigmentation cont. Chloasma Sun Damage Types of Pigmentation cont. Solar Lentigines Solar Lentigines occur in fairer skin types and are caused by repeated sun and sun bed exposure and evolve slowly over time. The colour of these lesions can be improved with Chemical peels, Intense Pulse Light and Photodynamic Therapy. In the long term the DNA of the cell is altered and the underlying skin is permanently damaged. Pigmentation – Sun Damage Pigmentation – Sun Damage cont. Freckles • Freckles are common in fair skinned people and usually occur across the nose and cheeks. Those who have freckles seem to be more prone to skin cancers. The most appropriate treatment is IPL (Intense Pulsed Light) which has a wow effect after treatment as the freckles darken and gradually disappear. Poikiloderma • Poikiloderma or pure Sun Damage is a combination of pigmentation and the destruction of skin cells, blood vessels, collagen and elastin. It is commonly found on the sides of the neck and décolletage where less attention has been applied to protect the skin or photosensitive fragrances and chemicals have been applied. Poikiloderma cont. Post Inflammatory Pigmentation Post Inflammatory Pigmentation is usually caused by an inflammatory response of the skin to trauma, infection, allergic reactions, picking or surgical procedures, burns and skin irritations such as dermatitis combined with UV exposure during the first days of healing. Loss of Pigment • Loss of pigment can be permanent and is caused by UV exposure or skin trauma. It is usually combined with hyperpigmentation, the only treatment option combines Intense Pulse Light or chemical peels to lighten and blend darker pigmentation with surrounding skin. • Several treatments of Regen PRP(Platelet Rich Plasma) are used with amazing results to repair damaged skin cells and stimulate the Melanocytes to repopulate the damaged skin cells. Because the Vitamin A and C skin receptors have been damaged, it is important to use topical Face products. Causes of pigment • It is very important to be able to assess the cause of the pigmented problems in the skin as not all hyperpigmentation problems can be resolved with IPL. There are many causes of pigmentation including; • • • • UVR(ultra violet radiation) • Medication • Fragrance EFAD essential fatty acid deficiency • Chemical Hormones • PIH (post inflammatory Birth marks Hyperpigmentation) trauma. • Vit B12, C &A deficiency. Essential fatty acid deficiency • EFAD causes a shortening of the dentrites of melanocytes. • This leads to an uneven distribution of pigment throughout the spinosum layer of the epidermis, causing a heavy deposition in a small surrounding area. Chloasma /Melasma • Stimulated by oestrogen in conjunction with sun exposure • Pregnancy or being on the pill major triggers • Found as patches on cheeks, nose [butterfly effect], forehead an upper lip. • Hard to remove. • May need Q Switched or fractional laser treatment • Many medications are known photo-sensitizers • Have a list in treatment room • Make the skin more likely to burn/pigment on exposure to light • Don’t treat if on the drug long term • When off the drug wait until beyond the “half life” • Pharmacist are useful • Many fragrances/perfumes have fixatives that react to light • Pigmented stains are often found on sides of neck where perfume has been worn • Body lotions and products often contain citrus based substances which are photo-sensitive • Clients need to avoid use of such products during IPL/Laser treatment • Perfume stains may sometimes resolve with IPL/Laser treatment. • Congenital condition • Found anywhere on the body • Usually dermal • May need Q switched or fractional laser treatment. Post inflammatory hyper-pigmentation – PIH • Trauma to the skin [cut, surgery, burn, acne etc] may resolve leaving hyper pigmented mark [PIH]. • Most often seen on darker skin types [Fitz 4, 5, 6]. • IPL/Laser treatment may also cause PIH, so care needs to be taken treating these skins • IPL/Laser are not likely to resolve PIH. Areas to treat • Face • Hands • Chest/Neck • Arms • Shoulders/Back Process • For pigmentation, Intense Pulsed Light uses light to absorb melanin (the dark pigment in your skin) This light converts to heat, which damages the target cells without disrupting the skins surface. Preparation • Improve skin barrier defense systems • Improve keratinocyte health • Improve density of spinosum layer for better melanin distribution • Improve melanocyte dendrite length and cell membrane health – EFAs • Prevent lipid peroxidation – antioxidants • Prevent Vitamin C oxidation and replace on daily basis – vitamin C • Correct DNA damage – vitamin A Filters for pigment • Available filters 510, 560 • The darker the skin the longer the pulse width and lower the fluence • The lighter the skin the shorter the pulse width and greater the fluence • Normally a 560 filter is better for deep lesions and 510 for pigment closer to surface. 1 Treatment 1 Treatment Darkenin g of pigment post treatme nt, following day Adverse Reaction Following day Following week Healing 3-4 weeks post *Client has spray tan present Normal Response post treatment 2 hrs post treatment Skin Check • Client must have skin checked by their doctor prior to IPL treatment. A letter will need to be shown to the therapist. • It is very important that therapists do not treat pigmented areas that have not been checked.