ABCs of white skin treatments

ABCs of white skin treatments

A variety of laser and chemical treatments that can lead to that Eldorado of Asia: white skin.

face

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IN THE MIRROR: The particulars of pigmentation by Dr Nantapat Supapannachart


WHAT CAN BE DONE

Lady Macbeth was the most famous but certainly not the last woman to utter a complaint about it. In fact, living in the tropics, hyper-pigmentation is one of the most common skin problems I deal with in my surgery.
 

THE CAUSES

Sun exposure and genetics are the two main causes of pigmentation. A suntan is your body's sun-protection mechanism and is caused by an increase of melanin, or pigment. Darker-skinned people have more and lighter skinned people have less naturally occurring melanin in the skin. Pigmentation occurs when too much pigment is deposited in the dermal layer.

More commonly found in people with darker skin, there are many types of pigmentation.

Melasma - usually associated with hormonal factors such as increased oestrogen levels during menstruation, pregnancy, birth control use and menopause. The dark spots often develop on the cheeks, forehead and upper lip. Pigments can be deposited superficially (epidermal) or deeper (dermal).

Post inflammatory hyper pigmentation - caused by a local problem such as acne, a wound or an injury to the skin.

As always, prevention is better than a cure - wear sun block and a hat! Sunscreen is the key to preventing and minimising formation of brown spots. Also, without consistent use of sunscreen, no treatment will last.


WHAT TREATMENTS ARE AVAILABLE

Creams

In the case of mild pigmentation, over-the-counter topical bleaching agents containing vitamin C and plant extracts like Mulberry can be effective.

Medical whitening agents such as hydro-quinone and Retin A will help to fade stubborn pigment patches faster. However it is important not use these creams for too long because they can permanently damage pigment cells, creating a rebound effect - once you stop the medication it can become worse, with spots of white and brown.


Dermabrasion

Micro-dermabrasion uses a crystal powder to sand off the first dead-cell layer of the skin. Your face will look brighter and smoother. The pigment problem, however, is deeper and will not be affected. Dermabrasion is a much deeper treatment, is effective in treating melasma and involves the sloughing of the skin containing a lot of pigment. The body then produces new cells.


Chemical peels


These act on the same principle as dermabrasion. A mild or low degree acid/chemical peel will slowly exfoliate skin, making it look clearer and brighter. But after a deep high degree acid peeling, new skin will be formed.


Laser

There are two kinds - cold and hot.

Cold laser or light therapy (IPL) involves shooting light from a lazer into the skin, where it is absorbed by the pigment and turned into heat, which destroys the cell without destroying the skin. It needs to be done multiple times but there is no down time.

The hot laser is called specific pigment, Yag or Ruby laser. It is for people who want the pigment gone fast.

It targets specific areas, which is shot directly, scabs up and is gone in about a week.


Laser resurfacing

If there is a lot of sun damage and all-over pigmentation, in order to get rid of it and create new cells, the skin must be sloughed.

There are also two kinds. The first is Fraxel (fractional) laser, which burns the skin 25-30% at a time, allowing the skin to heal first. This method must be repeated multiple times. Hot laser treatment takes off the whole skin, which requires a down time of a few days. But skin will come up like that of a new baby's afterwards

It is important to reiterate that the new skin is like a baby's skin - very vulnerable to light. If exposed to the sun, new skin will react with even more sensitivity and may create an even bigger problem than before.

Dr Nantapat Supannachart is an American Board-certified dermatologist and laser surgeon. Visit http://www.apexprofoundbeauty.com , or call 08-0500-0123.

(Source: Bangkok Post, IN THE MIRROR, The particulars of pigmentation, 3/03/2011, Dr Nantapat Supapannachart, link)


skin - (See Google Images)

pigment - a natural substance that gives colour to something such as paint, skin or hair
pigmentation - the coloration of living tissues by pigment, especially the skin, hair, mucous membranes, and retina of the eye (See Wikipedia and Google Definitions)

hyper-  - more than usual or normal
hyper-pigmentation -
having more skin coloring than is usual or normal

Eldorado -
1. an perfect thing that people search for but in the end does not really exist, 2. (Spanish: the lost city of gold) an imaginary place of gold, wealth and opportunity, sought in South America by 16th-century explorers (See Wikipedia)

Lady Macbeth - a character in Shakespeare's play Macbeth, the wife of Macbeth, a Scottish nobleman, she persuades him to kill the king and then becomes the Queen of Scotland but later feels guilt for what, Lady Macebeth is famous for saying "Will these hands ne'er be clean?" when they get blood on them after a murder, she becomes obsessed with white hands and even dreams of washing the blood off her hands when shes is sleepwalking (See Wikipedia)
utter - say something
complaint - when someone says that something is wrong or not satisfactory การร้องเรียน
tropics - the hottest area on earth, running around the earth on either side of the equator between the Tropic of Cancer and the Tropic of Capricorn (See Wikipedia)

common - usual, ordinary, occurring often or frequently
surgery - medical treatment in which a doctor cuts open someone's body (or here: makes cuts into the skin) การทำศัลยกรรม, การผ่าตัด

exposure (noun) - not being covered or protected from something
sun exposure - when the sun hits a person's skin for a period of time 
genetics -
the way in which people pass on features of their physical appearance and behaviour to their children and later generations through their genes (See Wikipedia)
suntan
- the darker clour of skin after spending time under the skin
melanin -
a pigment or colouring found in most living things including humans, human skin clour is mainly due to melanin (See Wikipedia and on human skin colour)
deposited
- when some substance gradually gathers or collects on top of something over time, forming a layer
layer - a thin sheet of a substance; a level of material, such as a type of rock or gas, which is different from the material above or below it ชั้น
dermal layer - in the "dermis" layer of skin

melasma -
"a tan or dark skin discoloration, particularly common in pregnant women, thought to be caused by the stimulation of melanocytes by estrogen and progesterone" also occurs when women take oral contraceptives (See Wikipedia)
discoloration -
a change in color that no longer looks healthy, new or clean
contraceptives -
drugs taken to prevent pregnancy (See Wikipedia)

hormone
(noun) -  a chemical released by a cell in one part of the body, that sends out messages through the blood stream that affect cells in other parts of the body (See Wikipedia)
hormonal (adjective)  
factors - one of the things that effects a situation or event ปัจจัย
oestrogen - estrogens, "one of the two dominant hormones secreted naturally by women's bodies, the other being progestin. The two, together, regulate the reproductive system and affect menstruation, pregnancy and menopause" (See Wikipedia)

menstruation - the monthly flow of menses (blood and cells) from the lining of the uterus of females (humans and other primates) (See Wikipedia)
menopause - the time in a woman's life (usually from age 45 to 50) in which the menstrual cycle ends and she can no longer have babies (cessation of reproductive fertility) (See Wikipedia)

pregnancy - when a baby is growing inside a woman
birth control - the general activity of controlling when pregnancy occurs, through drugs (contraceptives) or completely naturally by following the body's natural cycles (See Wikipedia)

cheeks - the soft parts of your face below your eye and between your mouth and ear แก้ม
forehead - the upper part of a person's face between their eyes and their hair (See Wikipedia)
superficially -
on the outside

dermis
(noun) - the thick sensitive layer of skin that is just below the epidermis. It contains blood, the ends of the nerves, blood vessels, and sweat glands (See Wikipedia)
dermal (adjective)
epidermis (noun) - (See Wikipedia)
epidermal (adjective)

post -
after
inflammation (noun) - swelling and redness inside the skin or other part of the boddy. "part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.[1] Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process. Inflammation is not a synonym for infection, even in cases where inflammation is caused by infection. Although infection is caused by a microorganism, inflammation is one of the responses of the organism to the pathogen" (See Wikipedia)
inflammatory (adjective) 
local - located at one part of the body (not spread over whole body)
acne - a very common skin disease among teenagers with swollen red bumps on the skin (See Wikipedia)
wound - an injury in which your skin or flesh is damaged, usually seriously บาดเจ็บ บาดแผล

Lentigines/liver spots - dark patches of different sizes seen in older people caused by sun damage.

Freckles - Westerners get freckles when they are young, but as long as they continue living in countries with temperate climates they rarely get melasma. Conversely, living in a tropical climate, many fair-skinned people also develop hyper-pigmentation.

Lentigines - (plural of "Lentigo") same as "liver spots" (See Wikipedia)
liver spots -
marks on the skin that appear as a person ages "associated with aging and exposure to ultraviolet radiation from the sun. They range in color from light brown to red or black and are located in areas most often exposed to the sun, particularly the hands, face, shoulders, arms and forehead, and the scalp if bald" (See Wikipedia and NIH)
freckles - small spots on the face กระ, จุดเล็กๆ มีสีต่างๆ (See Wikipedia)
temperate climate - a place that is neither very hot not very cold
rarely - not happening often นานๆ ครั้ง, ไม่บ่อย
tropical - relating to the hottest area of the Earth, between the Tropic of Cancer and the Tropic of Capricorn ในเขตร้อน
climate - the general weather conditions usually found in a particular place สภาพอากาศ
fair-skinned - white-skinned

prevention - the act of preventing something, or things that people do in order to prevent something

sunburn - when a person stays outdoors too long with with sunlight hitting the skin which damages the skin red and hurt, "a burn to living tissue, such as skin, which is produced by overexposure to ultraviolet (UV) radiation, commonly from the sun's rays. Usual mild symptoms in humans and animals include red or reddish skin that is hot to the touch, general fatigue, and mild dizziness. An excess of UV radiation can be life-threatening in extreme cases. Exposure of the skin to lesser amounts of UV radiation will often produce a suntan" (See Wikipedia)

sunscreen - a cream rubbed into the skin to prevent sunburn; a lotion, spray, gel or other topical product that absorbs or reflects some of the sun's ultraviolet (UV) radiation on the skin exposed to sunlight and thus helps protect against sunburn (See Wikipedia)
block - to stop something from moving through or along something else กีดขวาง ปิดกั้น
sun block - the same as "subscreen"

key - important คนสำคัญ
minimising - reducing to the lowest possible level
formation -
the gradual creation, existence and appearance of something
consistent - doing a task the same way (not changing all the time) อย่างสม่ำเสมอ อย่างเสมอต้นเสมอปลาย
treatment - the process of providing medical care การรักษา
last - remain for a long time, exist for a long time
will not last - will not remain for a long time, will not exist for a long time
no treatment will last - you will not have the good things the treatment does to you for a long

over-the-counter - bought from a pharmacy or drug store without needing a prescription (doctor's permission)
topical -
applied "on top of" the skin (not injected into the skin)

bleach - a strong chemical used to kill bacteria and to make cloth white (See Wikipedia)
agent -
chemical agent, a chemical or other substance that has a certain effect on another substance
bleaching agents - chemicals that act as a bleach (making things white)

vitamin C - an vitamin vitamin found in fresh fruits (oranges, grapefruit) and vegetables, prevents scurvy, "the body needs to fight infection, heal wounds and keep tissues healthy, including the blood vessels, cartilage, ligaments, tendons, bones, muscle, skin, teeth and gums. It is an antioxidant that helps prevent tissue damage caused by free radicals" (See Wikipedia and Google Definitions)

plant extracts - liquids with chemicals taken from trees
Mulberry -
a flowering plant found in Asia used in traditional medicine, also known as "Morus"  (See Wikipedia and skin whitening)
effective - does its job well, producing the result that was intended ได้ผลดี

whitening agents -
chemicals that make things white
hydro-quinone
- a chemical used for skin whitening (See Wikipedia)

Tretinoin -
the acid form of vitamin A (See Wikipedia)
Retin A - one brand name of "Tretinoin"
fade - to slowly disappear, lose importance or become weaker อ่อนลง,หายไป,ค่อย ๆ ตาย
stubborn - determined to do what you want and refusing to do anything else ดื้อรั้น
patch - an area that is different from the rest of the area that surrounds it (example: a patch of dark skin surrounded by white skin)
permanently - for all time in the future อย่างเป็นการถาวร
rebound - start increasing again, after decreasing (ค่าขนส่ง) เพิ่มขึ้นอีกครั้ง หลังจากมีการปรับลดราคาไป
rebound - start to rise again after decline การฟื้นตัวของเศรษฐกิจ
medication - a medicine, or a set of medicines or drugs used to improve a particular condition or illness

micro-dermabrasion -
"a method for facial rejuvenation that uses a mechanical medium for exfoliation along with adjustable suction to remove away the outermost layer of dead skin cells from the epidermis," also referred to as mechanical exfoliation or micro-resurfacing (See Wikipedia)
dead-cell layer of the skin - called the "epidermis"

slough - remove outer layer of skin
slough off - remove outer layer of skin
sloughing of the skin - same as "slough off"
desquamation - the shedding of the outermost membrane or layer of a tissue, such as the skin, more formal medical word for "slough off" (See Wikipedia)

peel - 1. to remove the skin from a fruit or vegetable, 2. to remove something from the surface of something else, especially by taking one end or side and pulling it up

chemical peel - "A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin" (See Wikipedia)

principle - a basic theory, or rule that has a major influence on the way in which something is done หลักการ

Intense pulsed light (IPL) -
"a technology aimed at producing light of high intensity during a very short period of time. It involves specific lamps together with capacitors whose rapid discharge provides the high energy required," used for both hair removal from the body and photorejuvenation treatment of skin  (See Wikipedia)

Yag laser - "an acronym for yttrium-aluminum-garnet, the YAG laser produces short-pulsed, high-energy light beams to cut, perforate, or fragment tissue. This laser may also be called a neodymium-YAG or ND-YAG laser" (other names: hot laser, specific pigment, Ruby laser)  (See source of definition and Wikipedia and Photorejuvenating)

therapy - a treatment which helps someone feel better, grow stronger, etc., especially after an illness การบำบัดโรค
down time - time when you cannot do anything, wasted time (here: because you are recovering from treatment)
target - point the laser at, direct the laser beam at
shot - directing the laer beam at some object (like aiming a gun and firing)
scab - a hard layer of dry blood that forms when a cut on your skin is getting better
scabs up - when a bleeding cut on the skin closes and forms a scab

Fraxel (fractional) laser - a non-surgical technique for facial rejuvenation (See Wikipedia and other links: #1, #2)

rejuvenate (verb) - to make a person look and feel younger and have more energy
rejuvenation (noun)  
facial rejuvenation - "any cosmetic or medical procedure used to increase or restore the appearance of a younger age to human face. The specific term, however, refers to a set of surgical procedures which try to restore facial geometry and skin appearance which are typical of youth, by using a combination of brow lift, elimination of eye bags, eyelids lift, elimination of senile spots, skin aging, facial sagging and wrinkles by face lift and rhytidectomy and physical or chemical peeling, chin lift (reduction of double chin), restoration of facial hairline, etc. These procedures are usually successful and in some cases achieve striking results." (See Wikipedia)

reiterate - to repeat something in order to emphasise it พูดซ้ำ ย้ำ
vulnerable - easily damaged or harmed ซึ่งถูกทำลายได้ง่าย, ที่เปราะบาง ที่ล่อแหลมต่อการเกิดภัยภิบัติ
exposed - not protected from something ได้รับ ได้สัมผัส (แดด หรือสารพิษ เป็นต้น)
exposed - openly affected by and not protected from ได้รับ ในที่นี้หมายถึง สูดควันบุหรี่
sensitive (adjective) - a strong physical reaction or response to something, easily affected by something (here: sun hurts easily)
sensitivity (noun) - skin sensitivity (here: how strongly the skin reacts to sun)
certified - inspected officially and verified that the company follows the rules ผ่านการรับรองคุณภาพ

dermatologist - a doctor who specializes in dermatology and the treatment of skin diseases and conditions
dermatology - the medical subject or specialty of the treatment of skin diseases (See Wikipedia)
American Board-certified dermatologist - has passed the examinations necessary to practice medicine and be a doctor in the US

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