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Asian women have been suffering from chloasma, which is the most stubborn and difficult to eliminate among all the color spots that affect the beauty of the face. Even the seemingly omnipotent laser cosmetic technology has a hard time with chloasma, and the financial and time costs of removing melasma are not insignificant.
Here is a compilation of dry facts about chloasma awareness and treatments, take a look at the specifics.
Recognizing Melasma
Genetic susceptibility, sun exposure, and changes in sex hormone levels are the three main factors in the development of chloasma, and there are simple and difficult treatments for different causes.
1. Genetic susceptibility
About half of the patients have a family history of chloasma, and the treatment of chloasma with a family history is very slow to take effect and relatively ineffective
2. Sunlight irradiation
Medium-wave ultraviolet (UVB) and long-wave ultraviolet (UVA) rays in sunlight directly stimulate melanocytes to synthesize pigments; at the same time, it induces an inflammatory response, which can activate the activity of tyrosinase, enhance the function of melanocytes, and increase the synthesis of melanin particles.
3. Abnormal changes in hormone levels
Pregnancy, oral contraceptive pills and oral hormonal drugs can induce and aggravate chloasma in women of childbearing age. Changes in hormone levels such as thyroid diseases, female reproductive system diseases and liver diseases can also induce or aggravate chloasma. Long-term sleep disorders and emotional changes can also affect the changes of hormone levels in the body and aggravate chloasma.
Although estrogen and progesterone have a great influence, due to the great changes of hormones at different times in women's physiological cycle, and some male friends also have chloasma, the reference value is not great. What is more valuable is the detection of thyroid hormone levels. If thyroid diseases are found, immediate treatment can alleviate chloasma.
These discussions are all external factors, which further cause the damage of skin barrier function, inflammatory reaction and the increase of vascular activity, and then increase the synthesis of melanin particles, resulting in chloasma on the face.
1. The skin barrier is damaged
In the lesion area of chloasma, the expression of keratin and ceramidase in the outermost layer of epidermis is abnormal, which shows that the skin barrier on the skin surface of chloasma is damaged, and the damaged skin barrier will cause melanocytes in the basal layer of epidermis to produce more melanocytes in feedback. Factors such as ultraviolet rays and excessive cleaning will aggravate the damage of skin barrier and the occurrence of chloasma.
2. Inflammatory reaction
Histologically, it was found that the inflammatory factors in the area of chloasma increased obviously, and these inflammatory factors would further activate tyrosinase and increase the production of melanin particles. The use of inferior cosmetics such as excessive mercury and lead, cooking (peroxide in oil fume), ultraviolet rays and other stimuli will aggravate the inflammatory reaction of the skin.
3. Vascular factors
In chloasma lesions, the number and diameter of dermal small vessels will be obviously thickened, and the expressions of vascular endothelial growth factor and endothelin 1 will be obviously increased.
4. Increased melanin synthesis
A variety of factors act directly or indirectly on microphthalmia-associated transcription factors in melanocytes to activate melanocyte function and promote melanin synthesis through the upregulation of downstream tyrosinase, tyrosinase-associated protease 1, and dopachrome isomerase.
Treating chloasma by stage
After knowing the cause, the treatment of chloasma is actually the repair of skin barrier and the treatment of chronic inflammation. On this basis, if we look at the treatment methods, we can understand why we can't easily use laser to remove chloasma.
Three-stage treatment
Inflammation stage, repair stage and stable stage
Why staging? In order to better recognize the pathogenesis of chloasma, to treat it more precisely, and especially to avoid rebound after treatment to maintain the treatment effect. In addition to the staging method for chloasma, clinicians will also classify melasma according to its external manifestations.
Staged treatment
There is still some controversy about the disease staging of chloasma. There was a time when many doctors believed that inflammation was an important triggering and initiating factor for the development of chloasma, and chloasma was divided into staged treatments: inflammation, repair and stabilization; it is now generally believed that inflammation exists throughout the process of chloasma, so doctors are more willing to accept the staging methods of:active and stabilization.
In fact, most chloasma starts from the active stage, passes through oral medication or naturally transits to the stable stage. If there are hormonal changes in the body or the stimulation of ultraviolet rays, it will enter the stable stage again, and it will be an irregular and repeated process.
Active stage: recent enlargement of the lesion area, deepening of color, redness of the lesion, redness of the lesion after scratching.
Stable stage: no recent expansion of lesion area, no deepening of color, no redness of lesions, no redness of lesions after scratching.
Typing treatment: In order to refine the precise treatment and make a personalized treatment plan, it is necessary to classify chloasma:
According to the involvement of blood vessels, it is divided into:
1. Simple pigmented type (M type): no discoloration of the lesion on compression of the slide, and an increase in color contrast between the lesion area and the non-lesion area under the Wooch's lamp;
2. Pigmented and vascular (M + V type): partial discoloration of the lesions on compression of a slide, with an insignificant increase in color contrast between the lesion and non-lesion areas under a Wool's lamp.
There are also some typing methods, according to the skin level of pigment aggregation is divided into epidermal (epidermal hyperpigmentation) and mixed (epidermal hyperpigmentation + superficial dermal phagocytic melanocytes). The distribution of pigmentation can also be categorized into mid-face, buccal and mandibular types, which are rarely used nowadays.
Medication as the main treatment
Acid peeling/photoelectricity as a supplement
Since melasma is difficult to treat and can hardly be completely resolved by a single treatment, it is especially important to prevent triggering factors.
1. Avoid triggering factors and adjust lifestyle:
Avoid sunlight, cooking heat/occupational heat stimulation, avoid the use of poor-quality cosmetics such as those with excessive mercury and lead content; avoid taking medications that cause changes in sex hormone levels and photosensitizing medications; ensure adequate sleep, and a combination of work and rest; and maintain a good state of mind.
2. Repair the skin barrier:
The use of efficacious skin care products with scientific basis is beneficial to the prevention and treatment of chloasma. Repairing the skin barrier means applying more moisturizers, which is very understandable. After we wash our face every morning, do we feel that our skin is hydrated and bright and more radiant.
3. Sun protection:
I used to say that every chloasma patient needs sun protection every day. Now I will say that everyone needs sun protection every day. It is suggested that long-term physical shading of sunscreen on the basis of external use is beneficial to the prevention and treatment of chloasma and reduce recurrence.
4. Whitening skin care products:
Whitening functional skin care products containing licorice extract, levovitamin C, nicotinamide, tranexamic acid, glutathione, ellagic acid, mulberry leaf extract, aloin and other ingredients can lighten chloasma. And some new compound whitening preparations (anti-oxidation, soothing) extracted from plants, such as camellia yunnanensis, purslane, thorn fruit and notoginseng, can also effectively improve the symptoms of chloasma.
Staging + TypinggTreatment
1. Active period: avoid photoelectric therapy, and choose skin care products with stability to carry out basic treatment and cooperate with systematic drug treatment.
2. Stable period: On the basis of systematic and external drug treatment, you can choose the medical cosmetic treatment method of beauty.
Glutathione:
The sulfhydryl group in the glutathione molecule inhibits the activity of tyrosinase by binding to copper ions in the enzyme and reduces melanin production; most are chosen for intravenous infusion, often in combination with vitamin C.
Glycyrrhizin:
It exerts its therapeutic effect mainly by relieving the inflammatory response of the skin.
External medicine
Hydroquinone and its derivatives, tretinoin, azelaic acid, tranexamic acid
Hydroquinone and its derivatives:
The first line of topical treatment for melasma (although less common in clinical practice), commonly used in concentrations of 2% hydroquinone cream and 4% hydroquinone cream, the higher the concentration the stronger the depigmentation effect, but the greater the skin irritation, it is recommended to start with a low concentration, or apply after moisturizing cream to reduce irritation and help build tolerance.
Usually used once a night, a small amount of local topical application, treatment 4-6 weeks can have obvious results, use 6-10 weeks the best results. The main adverse effects include irritant contact dermatitis and permanent pigment loss. Arbutin and deoxyarbutin are glucoside derivatives of hydroquinone, which are less irritating than hydroquinone when used topically, and are mainly suitable for simple pigmented types.
There is a Kligman triple formula in the medical literature: hydroquinone, retinoic acid and glucocorticoid topical combined use, but because hydroquinone, retinoic acid are skin irritation, the two superimposed use of skin irritation is more pronounced, and glucocorticoid long-term use of the face is prone to dependence on resistance, coupled with the partners are difficult to distinguish between the strong and weak hormone, this treatment has not been popularized and applied.
Retinoids:
Clinically commonly used 0.05% ~ 0.1% retinoic acid ointment or gel, 1 time per night, the course of treatment is about 6 months; may appear skin dryness, erythema and itching, burning and other adverse reactions; Early C and late A have antioxidant effect, in addition to delay aging, can increase the resistance of stable chloasma skin, the same need to be mainly early local small amount of use, gradually build up tolerance. It is mainly applied to simple pigmented type.
Azelaic acid:
Clinically, 15% azelaic acid gel and 20% azelaic acid cream are commonly used twice daily for approximately 6 months. Itching, burning, pins and needles, and numbness may occur in a small percentage of individuals. For mild acceptable skin irritation, immediate discontinuation of the drug is not recommended, and tolerance can be built up using small increments. It can be used for both purely pigmented and pigmented-vascular types. (Mainly for purely pigmented types).
Tranexamic acid:
Commonly used clinically as a 2%-5% cream twice daily for about 4 weeks. Topical use is less irritating than hydroquinone, and adverse effects include erythema, dryness, and flaking. Suitable for purely pigmented and pigmented combined with vascular types.
The above is only a list of commonly used topical drugs, most of the topical drugs have different degrees of irritation to the skin, and need to be used in conjunction with efficacious skin care products that have the function of repairing the skin barrier.
Medical cosmetic treatments
Phototherapy, chemical peeling, plasticizing therapy
In terms of photoelectricity treatment, for pure pigment type (M type) melasma in stable period: mainly include picosecond laser, Q-switched laser, intense pulsed light, non-peeling fractional laser and so on; for pigment combined with vascular type (M+V type), you can choose pulsed dye laser and long-pulse-width 1064nm laser.
Q-switched laser:
The common wavelength is 1064nm Q-switched Nd:YAG laser with large spot and low energy treatment mode, which was once called "white face doll" by the package for a period of time, mainly treating chloasma through selective photothermal effect, accelerating the selective photothermal decomposition of mature melanin vesicles, and the big advantage is destroying melanin vesicles and melanin particles inside the cell, thus avoiding the rebound and aggravation of chloasma induced by damage to melanocytes. The major advantage is that it destroys melanosomes and melanin particles inside the cells, but also maintains the integrity of the cell membrane of the outer layer of the cells, thus avoiding the rebound and aggravation of melasma induced by the damage of melanocytes.
Picosecond laser:
Compared with Q-modulated lasers, picosecond lasers have shorter pulse widths, act more precisely, and produce a selective mechanical photo-oscillatory effect on pigments, avoiding the risk of thermal stimulation induced by traditional lasers that can cause discoloration to rebound;
755 nm picosecond alexandrite laser can form laser-induced photodestructive effect in the epidermis and stimulate collagen synthesis, which improves photoaging while removing pigmentation and treats melasma from multiple angles;
The 1064nm picosecond uses the flat sweep treatment mode of large spot and low energy, and like the 755nm emerald green gemstone picosecond laser, it has lower adverse reactions after treatment, and all of them are the most ideal choices in photoelectricity treatment at present.
Non-exfoliative fractional laser:
Common wavelengths are 1540 nm, 1550 nm and 1565 nm lasers, which can de-selectively inhibit pigment synthesis and increase collagen in the skin for an overall brighter complexion.
IPL (Intense Pulsed Light), commonly known as "photon" and "photorejuvenation".
It is a member of the laser family, if the laser is a single wavelength of monochromatic light, IPL is a composite light in a certain range of wavelengths, so it is also known as composite color light.
Now some new terms: intense light, OPT, AOPT, DPL, BB light, CC light, milk light and so on are all belong to intense pulsed light.
For simple pigmented melasma (M-type) and pigmented combined with vascular melasma in the stable period, different filters are chosen, and the filters of different instruments will be different, which requires higher technical requirements for the operators.
Pulsed dye lasers, pulsed dye lasers and intense pulsed light at 585 nm or 595 nm (wavelengths 500-1,200 nm)
Targeting pigmentation while selectively acting on capillaries to inhibit vascular proliferation can be an option in patients with pigmented combined vascular (M+V) types.
PS: For photoelectricity treatment, we need to pay attention to the single, repeated photoelectricity treatment is easy to lead to hyperpigmentation, hypopigmentation / loss of pigmentation and recurrence, etc. Therefore, the number of consecutive photoelectricity treatment should not be more than 15, and the interval of 1 year can be considered to repeat the treatment. The parameters of photoelectric treatment should be set with mild intensity, the starting energy should not be too high, and the treatment interval should not be too short.
Chemical stripping:
Common chemical peeling agents include fruit acids and complex acids. Among them, fruit acid resurfacing is an effective adjunct to the treatment of simple pigmented melasma, which reduces hyperpigmentation by promoting the turnover of keratin-forming cells and accelerating the transit and expulsion of melanin particles from the basal layer to the stratum corneum.
Main adverse reactions: temporary erythema, mild swelling, tingling, burning and other discomfort. Caution should be exercised if the area to be treated has allergic or herpes simplex infectious diseases, if the head and face have undergone radiotherapy, cryotherapy or dermabrasion in the last 3 months, or if the patient is allergic to fruit acids.
For melasma fruit acid treatment, generally we start from a low concentration of 20%, 35%, 50%, 70%, and increase the concentration step by step according to the skin reaction after each treatment. It is usually done at intervals of 2~4 weeks, with 4 times as a course of treatment. The treatment needs to be operated by medical personnel, and improper operation can easily lead to post-inflammatory hyperpigmentation and temporary aggravation of pigmentation, especially dark-skinned patients should be cautious.
Mesotherapy
It is also called mesotherapy, hydro-electronic injection technology, and is now commonly known as "hydro-photo-needle". Through the row of needles to a group of drugs injected in the dermis layer of the skin, does not belong to the photoelectric project, no photothermal stimulation, the epidermis, the dermis have the corresponding therapeutic effect.
The medications used for the injection include, but are not limited to, hyaluronic acid, tranexamic acid, and vitamin C. Hydrotherapy injections precisely deliver the medication to the location of the discoloration, avoiding the side effects of intravenous or oral medication, and facilitating the absorption of the medication into the skin locally.
The hyaluronic acid in hydrafacial injections is an important component in maintaining skin hydration and has the ability to repair the skin barrier; increasing the water content of the skin and helping to lock in moisture in our skin. It helps brighten skin tone, lighten pigmentation and refine skin texture, and the chances of melasma temporarily worsening after treatment are very low.
The above is a comprehensive discussion of the medical aesthetic treatments available, and the current use is still dominated by chemical peel treatments, picosecond lasers, pulsed dye lasers and hydrafacial treatments.
Chinese medicine treatment
Choose drugs that are not harmful to the human body, and at the same time, consider the contraindications of the Chinese medicines
In Chinese medicine, chloasma is called "liver spot", which is mainly due to liver depression and stagnation of qi, stagnation of qi and blood stasis, weakness of the spleen and stomach, and insufficiency of the liver and kidneys. Treatment is based on the principles of dredging the liver, strengthening the spleen, tonifying the kidney, regulating qi, activating blood circulation and removing blood stasis, and the treatment course is relatively long, usually 3-6 months. About the treatment methods of Chinese medicine.
Our first principle is to choose drugs that do not harm the human body, while considering the contraindications of Chinese medicine. The choice of drugs is mainly to activate blood circulation and remove blood stasis to dredge the liver and regulate qi. Chinese medicines such as saffron, rhubarb, stinging insects are mainly used, and the adult medicines are mainly based on Easy Pill, Six-flavored Dihuang Pill, and Tao Hong Si Wu Tang.
Others
Treatments for Melasma Combined with Other Facial Problems and the Priority of Treatment
Melasma with freckles, age spots, brownish green nevus and other skin diseases, you can improve melasma first before considering these combined pigmentation treatments; melasma combined with acne, rosacea, capillary dilatation, sensitive skin combined diseases, it is recommended that these inflammatory and vascular diseases be treated first, because in itself these inflammatory and vascular treatments are helpful for the improvement of melasma as well.
Melasma is recognized as one of the more difficult problems to treat.
Our goal must be to brighten skin tone, lighten pigmentation, refine overall skin texture, maintain stability and reduce recurrence as the goal.
Do no
It is recommended that you must go to a professional medical institution in a timely manner to choose a suitable solution for your treatment after a medical consultation.
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